Social Problem Solving as a Mediator of Stress-Related Depression and Anxiety in Middle-Aged and Elderly Community Residents

This study examined the relations between everyday problems, social problem solving, and depression and anxiety in middle-aged and elderly community residents, using a multidimensional measure of social problem-solving ability that assesses positive problem orientation, negative problem orientation, rational problem solving, impulsivity/carelessness style, and avoidance style. While problem-solving deficits were found to be significantly related to depression and anxiety in both age samples, no support was found for a moderator hypothesis which assumes that problem-solving ability interacts with everyday problems to reduce depression and anxiety. On the other hand, support was found in both samples for a mediational model which assumes that problem solving is an intervening variable that accounts to a significant degree for the causal relations between everyday problems and depression and anxiety. Although all five problem-solving dimensions were significantly related to depression and anxiety, negative problem orientation was found to contribute most to the significant mediating effect.     

Perceived Social Problem Solving,Perfectionism, and Mindful Awareness in Clinical Depression: An Exploratory Study

Perfectionism, problem solving, and mindfulness have all been variously implicated in the experience and treatment outcomes for depression. Maladaptive perfectionism represents a cognitive set that is believed to exacerbate the symptoms of depression, whereas social problem solving is believed to play a role in potentially buffering the effects of perfectionism on depressive symptomatology. Little is currently known about the role of mindfulness during a current depressive episode, however a number of studies have shown that mindfulness-based interventions significantly reduce relapse rates in depression. The current study examined the role of social problem solving, adaptive and maladaptive perfectionism, and mindful awareness during a current depressive episode. Participants were 141 inpatients experiencing a clinical depressive episode. No support was found for social problem solving buffering the effects of maladaptive perfectionism on depression severity. Results suggest that mindful awareness mediates the negative association between social problem solving and depression severity and the positive association between maladaptive perfectionism and depression severity. Mindful awareness contributed the greatest amount of variance to depression symptom severity.     

Interpersonal Sensitivity and Social Problem-Solving: Relations with Academic and Social Self-Esteem, Depressive Symptoms, and Academic Performance

This study investigated the relation betweeninterpersonal sensitivity and social problem-solving aspredictors of three outcomes in a college population (N= 207): self-esteem, depressive symptoms, and academic performance. Consistent with predictions,interpersonal sensitivity was related to problem-solving-- in particular, negative problem orientation. Bothinterpersonal sensitivity and social problem-solving were significant predictors of self-esteem anddepressive symptoms, each accounting for uniquevariance. Interpersonal sensitivity was a significantpredictor of academic performance, for both males and females. However, in females, social problemsolving was not related to academic performance. Inmales, negative problem orientation and dysfunctionalproblem-solving styles were important aspects of problem solving related to academic performance. Theresults are discussed in terms of the identification ofat risk college students.     

Self-esteem,control beliefs,and cognitive problem-solving skill as risk factors in the development of subsequent dysphoria

Low self-esteem, external control beliefs, and low social problem-solving skill have all been found to correlate with concurrent depressive symptoms, suggesting that they may function as risk factors for the development of future depression. But there have been very few investigations of whether these variables actually place persons at risk for future depression. This research was a 21/2-month prospective investigation of whether measures of these constructs could predict the development of dysphoria and to what extent these factors operated by moderating stressful life events. After initial symptom levels were controlled, personal control beliefs predicted subsequent dysphoria by moderating the effects of subsequent negative life events such that internal subjects were unaffected by life stress. Self-esteem, however, did not predict follow-up dysphoria. Persons with low cognitive problem-solving scores were more likely to experience subsequent symptoms regardless of stress level. In addition, coping styles involving high levels of advice seeking were also associated with increased subsequent dysphoria.     

Unique Correlates of Problem Solving Effectiveness in Individuals with Generalized Anxiety Disorder

Over the last decade, research on the problem-solving characteristics of individuals high in chronic worry has waned. It is proposed that there remains a lot to be learned about the way in which excessive and uncontrollable worrying affects the way in which people approach problems. The present study examined the relations of negative problem orientation, problem solving styles, intolerance of uncertainty, and worry to in vivo problem-solving performance in people with generalized anxiety disorder (GAD; N?=?43). Problem-solving performance was assessed by rating participants’ ability to develop effective problem solutions. Impulsive/careless problem-solving style was uniquely predictive of lower effectiveness of problem solutions; whereas negative problem orientation, habitual avoidant problem solving style, intolerance of uncertainty and chronic worrying were not. After controlling for state anxiety, none of the variables were unique correlates of problem-solving effectiveness. The study represents an initial examination of the potential impact of negative problem orientation, dysfunctional problem-solving style, intolerance of uncertainty, and worry on problem-solving quality. The findings are discussed in relation to theoretical models and therapeutic approaches for GAD.     

Social Problem Solving, Mood, and Suicidality Among Inpatient Adolescents

Relationships between social problem solving, mood, and suicidality were examined in a sample of 105 adolescent psychiatric inpatients (ages 12–18). Youth were administered the Social Problem-Solving Inventory—Revised (T. D'Zurilla & A. Maydeu-Olivares, 1995) as well as standardized self-report and interview measures of dysphoria, hopelessness, anxiety, and suicidality. Results indicated that a negative problem orientation as well as an avoidant or impulsive problem-solving style were associated with less favorable scores on all of the latter measures, including greater reported suicidality. By contrast, associations were not observed between utilization of rational problem-solving skills and measures of either mood or suicidality. Structural equation modeling analyses revealed that the relationships found between the former measures of social problem solving and suicidality were mediated by more direct associations of less-effective social problem solving with both dysphoria/state-depression and hopelessness.     

Which Social Problem-Solving Components Buffer Depression in Adolescent Girls?

Life stress is associated with depression, although it accounts for only about 10% of the variance. Social problem solving has been found to be a moderator of the stress–depression relationship in adults and children. This study extends research in this area by testing whether social problem solving moderates the relationship between stress and depression among adolescent girls and whether the moderating role of social problem solving is specific to certain domains of social problem solving. The hypothesized role of specific social problem-solving deficits in the association between stress and depressive symptomatology was supported.     

The Relations of Internalizing Symptoms to Conflict and Interpersonal Problem Solving in Close Relationships

This study examined the relations between interpersonal conflict, interpersonal problem solving, and internalizing symptoms (viz., depression and anxiety symptoms) in a sample of 123 college students. Conflict was assessed in five different close relationships (viz., best friend, second best friend, romantic partner, mother, father). In addition, five dimensions of problem-solving ability were examined (viz., positive and negative problem orientation, rational problem solving, impulsivity/carelessness style, avoidance style). Regression analyses showed negative problem orientation to predict depression above and beyond what was accounted for by mother conflict and romantic conflict. Avoidance style was also found to predict depression beyond what was accounted for by mother conflict alone. Negative problem orientation was also found to be a highly significant moderator of the relationship between romantic partner conflicts and anxiety symptoms. Specifically, the relationship between conflicts and anxiety symptoms was stronger when negative problem orientation was high rather than low. Implications for theory, clinical practice, and future research are discussed.     

The Influence of Social Problem-Solving Ability on the Relationship Between Daily Stress and Adjustment

This study examined the role of social problem solving as a moderator and a mediator of the relationship between daily stressful events and adjustment in a sample of 259 college students. Problem solving was assessed by the Social Problem-Solving Inventory-Revised, which provides scores for global problem-solving ability as well as five specific problem-solving dimensions, namely, positive problem orientation, negative problem orientation, rational problem solving (i.e., effective problem-solving skills), impulsivity/carelessness style, and avoidance style. Adjustment was assessed by using the scores for internalizing symptoms and externalizing symptoms from the Adult Self-Report. Because of significant gender differences on the major study variables, results were analyzed separately for men and women. The most consistent finding was for the importance of negative problem orientation as a moderator or a mediator of the relationship between daily stress and adjustment. In women, negative problem orientation, impulsivity/carelessness style, and avoidance style were all found to mediate internalizing and externalizing symptoms. In addition, positive problem orientation mediated internalizing symptoms. In men, negative problem orientation was found to be a moderator for externalizing symptoms and a mediator for internalizing symptoms. The gender differences and implications for clinical practice were discussed.     

Marital functioning, chronic pain, and psychological distress

This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.     

Problem solving and diabetes self-management: investigation in a large, multiracial sample

OBJECTIVE: Problem solving is a core aspect of effective diabetes and chronic illness self-management, yet there are relatively few objective evaluations of problem-solving skills, especially in large, multiracial samples. RESEARCH DESIGN AND METHODS: A multiracial sample of 506 adults who have type 2 diabetes were assessed on a variety of patient characteristics, self-management behaviors, and biological and psychosocial measures. They also completed the Diabetes Problem-Solving Interview (DPSI). RESULTS: DPSI scores revealed significant variability across patients in problem-solving skill and were related to a number of comorbid conditions and complications but not to several other demographic factors, including race/ethnicity. Problem solving was also related to self-management behaviors (eating and exercise patterns), biological variables (A1C and lipids), and psychosocial measures (Diabetes Distress Scale) in multivariable analyses controlling for a variety of potential confounding factors. CONCLUSIONS: Diabetes problem solving, as measured by the DPSI, is an important patient skill related to several key diabetes management variables that appears applicable across racial and ethnic groups. Future research is needed to identify the generality versus specificity of diabetes problem solving and practical interventions to enhance problem-solving skills.     

Social problem solving as a moderating variable between negative life stress and depressive symptoms

The present study sought to investigate the moderating function that social problem-solving effectiveness serves in relation to negative stressful life events and depressive symptomatology. It was also hypothesized that knowledge of problem solving would improve upon the prediction of level of depressive symptoms beyond the assessment of stressful events. Results involving 462 undergraduate students provide support for both predictions. Specifically, findings from a multiple regression analysis indicated that (1) differences in reported depressive mood between subjects under high and low stress levels were minimal for individuals characterized as effective problem-solvers, relative to those persons with problem-solving scores reflective of ineffective problem solving; and (2) assessment of problem-solving scores and their interaction with stress level provided for an additional three times the amount of explained variance in predicting depression scores beyond life stress scores. Additionally, a cross-validation of the regression analysis was conducted and found to result in a minimal amount of shrinkage that could be due to samplespecific characteristics.We would like to extend our appreciation to two anonymous reviewers for their helpful comments on an earlier draft of this article. The study was supported in part by a grant funded by Fairleigh Dickinson University to the first author.     

Is Social Anxiety Associated With Both Interpersonal Avoidance and Interpersonal Dependence?

We tested the hypothesis that social anxiety is associated with both interpersonal avoidance and interpersonal dependency. Specifically, we predicted that dependence would be evident in developmentally salient close relationships upon which socially anxious people may rely. One hundred sixty-eight young people undergoing the transition to adulthood completed self-report measures of anxiety and interpersonal patterns. Results indicated that both dependent and avoidant interpersonal styles in romantic relationships, but not other relationships, were uniquely associated with social anxiety. These results remained when controlling for depressive symptoms, anxiety sensitivity, and trait anxiety. Our findings illustrate that social anxiety is not characterized solely by interpersonal avoidance as current conceptualizations suggest. Implications for models and treatment of social anxiety are discussed.     

Diabetic peripheral neuropathy and depressive symptoms: the association revisited

OBJECTIVE: We examined the association between severity of diabetic peripheral neuropathy and depressive symptoms and investigated the potential mediators of this association. RESEARCH DESIGN AND METHODS: The Hospital Anxiety and Depression Scale (HADS) was used to assess depressive symptoms in 494 patients (mean age 62 years; 70% male; 72% type 2 diabetic) with diabetic neuropathy diagnosed by the Neuropathy Disability Score (NDS) and the Vibration Perception Threshold (VPT). Diabetic neuropathy symptoms, activities of daily living (ADLs), and social self-perception were measured by the neuropathy and foot ulcer-specific quality-of-life instrument, NeuroQoL; perceptions of diabetic neuropathy symptom unpredictability and the lack of effective treatment were assessed by the revised Illness Perception Questionnaire. RESULTS: Both the NDS and VPT were significantly associated with the HADS after controlling for demographic and disease variables. Although diabetic neuropathy symptoms mediated this association, with unsteadiness being most strongly associated with HADS, the relationship between foot ulceration and depression was nonsignificant. The association between diabetic neuropathy symptoms and HADS was partially mediated by two sets of psychosocial variables: 1) perceptions of diabetic neuropathy symptom unpredictability and the lack of treatment control and 2) restrictions in ADLs and changes in social self-perception. CONCLUSIONS: These findings establish the association between diabetic neuropathy and depressive symptoms and identify potential targets for interventions to alleviate depressive symptoms in persons affected by diabetic peripheral neuropathy.     

Mothers' responses during the child's stem cell transplantation: pilot study

PURPOSE: Examine the relationships between the mothers' anxiety and depressive symptomatology and resources (problem-solving orientation and style, coping, and social support) during their child's stem cell transplantation (SCT). METHOD: A prospective correlation design was used. A convenience sample of 23 mothers completed State-Anxiety Inventory, Center of Epidemiologic Studies Depression Scale, Social Problem-Solving Inventory-Revised, and Stress Support Scale at the child's admission and 10 days after the stem cells infusion. FINDINGS: Significant relationships were found between mothers' negative problem-solving orientation and emotional responses, coping and depressive symptomatology, and between social support and emotional responses but in an inverse direction. CONCLUSION: Health care professionals need to increase their understanding of mothers' stress responses during the SCT. These responses may affect the mother/child interactions and the mother's ability to provide childcare. A psychosocial intervention that includes these resources may assist the mothers during their child's SCT.     

Effect of a Psychoeducational Intervention on Depression, Anxiety, and Health Resource Use in Implantable Cardioverter Defibrillator Patients

Background: Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation.
Methods: ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 ± 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group × Time effects, χ² for percentage with clinically significant anxiety and depression at each time point, and logistic regression.
Results: All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P < 0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups.
Conclusions: A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant.     

Social Problem-Solving and Depressive Symptom Vulnerability: The Importance of Real-Life Problem-Solving Performance

Previous research suggests poor social problem-solving may function as a vulnerability factor for depressive symptoms. However, the ecological validity of previous findings is questionable, with recent research using real-life performance based approaches to ascertain how solutions are implemented in the ‘real world’. The current study employed a longitudinal design to examine the role of real-life problem-solving as a predictor of future depressive symptoms. Participants completed a diary of the interpersonal problems they encountered, and their attempts to solve them. They also completed traditional measures of social problem-solving (SPSI-R and MEPS task). Real-life problem-solving performance predicted depressive symptoms 3 months after the initial testing session, beyond the variance accounted for by traditional measures of social problem-solving. This suggests that the ability to hypothetically problem-solve is distinct from the ability to generate and implement problem-solving strategies in real-life, and that it is the latter which is most important in predicting depressive symptoms.     

Life Stress, Problem Solving, Perfectionism, and Depressive Symptoms in Chinese

The present investigation sought to examine the roles of perfectionism and problem solving in the relations between stress-related depressive symptoms in a Chinese adult sample. One hundred and thirty-eighty students in an open university in Hong Kong with a mean age of 28 years participated in the study. After controlling the effectsof life stress, problem solving was shown to have significant main effects on both hopelessness and depressive features, whereas perfectionism was found to have main effects only on the latter variable. In addition, the results indicated that two constructs played a moderating role in the relations between life stress and depressive symptoms and hopelessness. The findings revealed that perfectionism and problem solving were important cognitive–behavioral variables in accounting for variances of psychological distress across cultures. Limitations of the study are discussed.