Adverse Life Experience and Psychological Distress in Adolescence: Moderating and Mediating Effects of Emotion Regulation and Rumination

The current study tested whether emotion regulation and rumination moderated and/or mediated the relationship between accumulated adverse life experience and psychological distress in adolescence. In class, Australian high school students (n = 2637, 12–18 years, 68% female) from 41 schools completed well‐validated measures of adverse life experience, emotion regulation, rumination and psychological distress, and were followed up 1 year later (n = 1973, 75% retention rate). Adjusting for age, gender and baseline psychological distress, adverse life experience predicted psychological distress 1 year later. Expressive suppression and rumination were positively associated with psychological distress. Cognitive reappraisal was negatively associated with psychological distress and moderated the relationship between adverse life experience and psychological distress. This relationship was also partially mediated by cognitive reappraisal, expressive suppression and rumination. Promoting cognitive reappraisal and minimizing expressive suppression and rumination may be useful strategies to improve mental health for adolescents who have experienced adverse life events. Future research should examine whether adolescents who have experienced adverse life events can be trained in effective emotion regulation strategies and whether this training can prevent development of psychological maladjustment. Copyright © 2015 John Wiley & Sons, Ltd.     

Coping Behaviours and Post‐traumatic Stress in War‐affected Eastern Congolese Adolescents

This study explores coping strategies used by war‐affected eastern Congolese adolescents across age and sex, and the association between post‐traumatic stress symptoms and engagement and disengagement coping. Cross‐sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13–21 years (M = 15.83, standard deviation = 1.81) participated in self‐report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post‐traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war‐affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.     

A holistic understanding of the effect of stress on adolescent well‐being: A conditional process analysis

Although traditional assumptions tend to conceptualize stress as inherently dysfunctional, psychological theory suggests that it is not intrinsically maladaptive. Contemporary models emphasize that the stress response can be differentiated into both negative and positive aspects, known as distress and eustress. Research examining the differential effect of positive and negative stress on adolescent well‐being is limited and has been hindered by a lack of appropriate measurement tools. The aim of the present study was to utilize the recently developed Adolescent Distress‐Eustress Scale to provide a balanced understanding of the impact of stress on positive mental health, holistically considering the effect of both distress and eustress on adolescent well‐being. One thousand eighty‐one Australian adolescents (M_age = 15.14, 54.03% female) completed an online survey composed of the Adolescent Distress‐Eustress Scale alongside measures of well‐being, self‐efficacy, psychological ill‐being, physical activity, and daytime sleepiness. Conditional process analysis suggested that distress exerted no direct influence on well‐being, with the observed negative relationship fully mediated by psychological and behavioural variables. Contrastingly, eustress was both directly related to increased well‐being and exerted an indirect effect through relationships with mediating variables. These results demonstrate that stress can have profoundly positive consequences. Theoretical contributions, implications for practice, and perspectives for future research are discussed.     

The relationship between bicultural identity,acculturative stress,and psychological well‐being in multicultural adolescents: Verification using multivariate latent growth modelling

This study aimed to examine causal relationships between bicultural identity, acculturative stress, and subjective well‐being among multicultural adolescents. Secondary longitudinal data that were obtained from 1,635 multicultural adolescents were analysed. The results showed that bicultural identity had a positive effect on psychological well‐being and a negative impact on acculturative stress; in addition, greater acculturative stress was associated with lower psychological well‐being. Finally, bicultural identity indirectly affected psychological well‐being by mediating the effects of acculturative stress. These findings underscore the need to facilitate the adaptation of multicultural adolescents by reducing acculturative stress and promoting bicultural acceptance in educational institutions.     

Preschool Israeli Children Exposed to Rocket Attacks: Assessment,Risk, and Resilience

Preschool children are among the most vulnerable populations to adversity. This study described the effects of 4 weeks of daily exposure to rocket attacks on children living on Israel's southern border. Participants enrolled in this study were 122 preschool children (50% boys) between the ages 3 and 6 years from 10 kindergartens. We assessed mothers' report of children's symptoms according to the DSM‐IV and alternative criteria resembling the DSM‐5 criteria for posttraumatic stress disorder (PTSD), general adaptation, traumatic exposure, and stressful life events 3 months after the war. The prevalence of PTSD was lower when the diagnosis was derived from the DSM‐IV (4%) than from the DSM‐5 criteria (14%). Mothers of children with 4 or more stressful life events reported more functional impairment in social, occupational, and other important areas of functioning compared to children with 0 or 1 stressful life event. Children with more severe exposure showed more severe symptoms and mothers had more concerns about the child's functioning (η_p² = .09–.25). Stressful life events and exposure to traumatic experiences accounted for 32% of the variance in PTSD and 19% of the variance in the adaptation scale. Results were explored in terms of risk and resilience factors.     

Psychological and Environmental Correlates of HPA Axis Functioning in Parentally Bereaved Children: Preliminary Findings

This study examined bereaved children's HPA‐axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self‐report instruments and in‐person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = ?.45), depression (r = ?.40), posttraumatic stress (r = ?.45), and maladaptive grief (r = ?.43), as well as higher levels of avoidant coping (r = ?.53). Higher levels of parental maladaptive grief were also associated (r = ?.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.     

Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review

Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one’s life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.     

Psychological distress of adolescents exposed to Hurricane Hugo

To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.     

Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction

Socioeconomic status (SES) remains an important population health risk factor and impacts a patient's experience of care during breast cancer. This study explored the relationship between SES and quality of life and satisfaction in survivorship following breast cancer and reconstruction. All patients underwent breast reconstruction at a single academic center from 2013 to 2017. Patients completed the five quality of life and satisfaction domains of the BREAST‐Q, a validated patient‐reported outcome measure. Estimated home value using a web‐based real estate website was used to approximate a patient's socioeconomic status. Correlations were evaluated using Pearson's correlation methods, where appropriate, as well as analysis of covariance. Data were stratified for comparison utilizing t tests and linear regression models. Significance was defined as P ≤ .05. Four hundred patients underwent 711 breast reconstructions during the study time period. Satisfaction with the breast (P = .038) and psychosocial well‐being (P = .012) had significant positive correlations with increasing socioeconomic status. When stratifying patients’ socioeconomic status into thirds, the upper third had significantly higher psychosocial well‐being (P = .001), satisfaction with breasts (P = .010), and physical well‐being of the chest (P = .001) than the lower third. Significance persisted even after controlling for cancer stage, treatment, complications, and baseline comorbidities. Higher socioeconomic status is associated with greater satisfaction with breast reconstruction and psychosocial well‐being following breast cancer treatment. Providing added social, psychological, and emotional support networks may be beneficial long after the initial cancer treatment and reconstruction are complete. Patients of lower socioeconomic status may benefit from additional resources.     

Posttraumatic Stress Disorder Among Low‐Income Adolescents Experiencing Family–Neighborhood Income Disparities

Certain neighborhood factors may increase the risk of exposure to trauma, therefore increasing the risk of posttraumatic stress disorder (PTSD). Other aspects of neighborhoods can be protective, such as neighborhood‐based social relationships, which provide social support that buffers the risk of developing PTSD. The strength of these social relationships may not be as dependent on neighborhood conditions as much as they are contingent on socioeconomic similarities between neighborhood residents. Using a nationally representative sample of hospital emergency department admissions in the United States (N = 13,669,251), this study hypothesized that an interaction between family‐level income and neighborhood‐level income would be associated with adolescent PTSD. The results show that female adolescents who resided in the highest income areas were 1.39 times more likely, 95% CI [1.09, 1.77], to be diagnosed with PTSD than those who lived in the lowest income areas. This association was not statistically significant for male adolescents. Additionally, low‐income female youth were nearly one‐third more likely than their non–low‐income counterparts to be diagnosed, odds ratio (OR) = 1.29, 95% CI [1.12, 1.48], whereas low‐income male youth were nearly twice as likely than their non–low‐income counterparts to be diagnosed, OR = 1.95, 95% CI [1.62, 2.34]. Furthermore, there was an interaction among both male and female adolescents such that lower‐income adolescents living in higher‐income areas had higher odds of a PTSD diagnosis compared to their higher‐income peers in areas that were in the same median household income quartile.     

Friendship in War: Camaraderie and Prevention of Posttraumatic Stress Disorder Prevention

Aspects of social support during combat deployment, such as unit cohesion, have been shown to affect later posttraumatic stress disorder (PTSD) development among veterans. We utilized a longitudinal database to assess how relationship quality with fellow soldiers in World War II (WWII) might be linked with postwar PTSD symptoms. Data were available on 101 men who experienced combat exposure in WWII, documented through postwar assessment. Upon study entry (1939 to 1942), data were collected on the quality of participants’ early childhood relationships and their emotional adjustment during college. Data on WWII experiences were collected in 1946. Relationship quality with fellow soldiers in WWII was examined as a moderator of the link between combat exposure and postwar PTSD symptoms. Prewar emotional adjustment was examined as a mediator between quality of childhood relationships and subsequent quality of relationships quality with fellow soldiers during war. Better quality relationships with fellow soldiers attenuated (i.e., moderated) the link between combat exposure severity and PTSD symptom count, explaining a significant percent of the variance, R ² = .19, p < .001. There was also a significant indirect mediation effect of childhood relationship quality on relationships with soldiers through prewar emotional adjustment, ab = 0.02, 95% BCa CI [0.01, 0.05]. Results suggest that better peer relationship quality during deployment may reduce the likelihood of subsequent PTSD symptom development, and that the quality of early relationships may set the stage for better relationships during stressful contexts such as war. These findings have implications for PTSD risk factor screening prior to deployment, and underscore the importance of interpersonal support among soldiers during deployment.     

Stress management and sexual health of young adults: a pilot randomised controlled trial

Young people often experience excessive stress that definitely undermines their sexual life and leads them to adopt risky sexual behaviours. As such, the design and application of a stress management programme in this particular age group is, undoubtedly, a crucial matter. In this parallel randomised controlled trial, 60 psychology students of the Panteion University of Athens, aged 18–20, were randomly assigned to undergo either an 8‐week stress management programme (n = 30; diaphragmatic breathing–progressive muscle relaxation and guided imagery, twice a day) or not (n = 30). Self‐reported validated measures were used to evaluate stress, stressful life events, health locus of control, general health status, sexual behaviours, sexual desire, satisfaction from sexual life and interpersonal relationships. Between‐group analyses revealed statistically significant differences in internal health locus of control and general health evaluation. Within the intervention group analyses showed reductions in BMI, stress, the ‘chance’ subscale of multidimensional health locus of control (MHLC) and greater satisfaction from sexual life. No other significant change was reported. We deem that our results should encourage relevant future studies.     

Stressful life events and posttraumatic growth among police officers: A cross‐sectional study

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police officers working in the New Orleans area following Hurricane Katrina. Hierarchical regression was used to evaluate if gratitude, social support, and satisfaction with life moderated the relationship between stressful life events (as measured by the total life stress score) and PTG, after adjustment for age, sex, race, level of involvement in Hurricane Katrina, and alcohol intake. Results indicate that stressful life events are independently associated with PTG. Gratitude, satisfaction with life, and social support were seen to moderate this relationship; as stressful life events increased so too did PTG—particularly among officers with higher levels of gratitude (B = 0.002, p ≤ .05), satisfaction with life (B = 0.002, p ≤ .05), and social support (B = 0.001, p ≤ .05). These findings suggest that promoting satisfaction with life, interpersonal support, and gratitude may be beneficial to those who are regularly at risk of trauma exposure.     

Self‐selection for stressful experiences

Studies of self‐selection for stressful experiences have employed different models advocating variables specific to those models. These investigations typically utilize personal resource or psychological distress measures to predict occurrences of life events and daily hassles. The purpose of this investigation was to combine both types of measures to estimate the occurrence of life events and daily hassles prospectively. Using hierarchical multiple regression, occurrences of stressful experiences were regressed on personal resource variables (mastery, self‐esteem, conscientiousness and neuroticism), perceived social support, avoidance coping, gender and psychological distress assessed 10 weeks prior. Results indicated that depressive symptoms and avoidance coping were consistent estimators for both types of stressor. The influence of mastery, self‐esteem, neuroticism, social support and gender varied across stressor categories. Copyright © 2010 John Wiley & Sons, Ltd.     

Anorectal malformations: what happens in adulthood?

Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To comprehensively evaluate the outcomes in adults who were born with anorectal malformations (ARMs), to assess the relationships between the major types of ARM and outcomes, and to examine the relationships between bowel and urinary function and sexual well‐being, as advances in surgical treatment for ARMs have led to more patients surviving into adult life, and adult data on urinary and bowel function are scant, with even less known about the effect of diagnosis and treatment on sexual and reproductive function.

PATIENTS AND METHODS

In all, 74 adult patients with a diagnosis of ARM confirmed by review of paediatric medical records completed a series of validated questionnaires on urinary and bowel function, body esteem, sexual well being, fertility and overall quality of life.

RESULTS

There were high levels of urinary and bowel incontinence for both men and women. A high ARM was associated with a greater degree of incontinence. Both men and women scored more poorly than controls on the body esteem, sexual well‐being and quality‐of‐life assessments. Urinary and bowel incontinence was associated with poorer sexual well‐being.

CONCLUSIONS

Bowel and urinary outcomes in adults appear to be worse than suggested in paediatric reports, with high levels of both urinary and fecal incontinence. Poorer outcomes appeared to affect sexual well‐being adversely. To date, attention to issues during transition from childhood to adulthood, particularly concerns about sexual function and well‐being, has been conspicuous by its absence. Patient‐focused multidisciplinary care during this transition must address these issues, which are central to an acceptable quality of life.     

Optimizing the Perceived Benefits and Health Outcomes of Writing about Traumatic Life Events

Expressive writing, which involves disclosing one's deepest thoughts and feelings about a stressful life event by using a first‐person perspective, has been linked to gains in health and well‐being, though effect sizes range widely. Assuming a third‐person perspective is a natural and effective way of coping with highly distressing events. Therefore, the current study examined whether a distanced, third‐person approach to expressive writing might be more beneficial than a traditional, first‐person intervention for high baseline levels of event‐linked intrusive thinking. Randomly assigned participants wrote expressively about traumatic life events by using a first‐person or third‐person‐singular perspective. Linguistic analyses showed that assuming a first‐person perspective is linked to higher levels of in‐text cognitive engagement, whereas a third‐person perspective is linked to lower cognitive engagement. However, in a context of higher levels of intrusive thinking, third‐person expressive writing, relative to a traditional first‐person approach, yielded (1) greater perceived benefits and positive, long‐lasting effects as well as (2) fewer days of activity restriction due to illness. Although more research is needed, these results suggest that third‐person expressive writing may be an especially fitting technique for recovering from traumatic or highly stressful life events. Copyright © 2012 John Wiley & Sons, Ltd.     

Borderline hypertension,daily stress and psychological variables

Borderline hypertensive patients (N = 33) were studied in order to ascertain if they showed a specific psychological profile and a greater emotional and cardiovascular reactivity than normotensive controls (N = 21). Borderline hypertensive patients scored significantly higher in type A behaviour (JAS), total hostility (BDI), anxiety, physical symptoms and general psychopathology (GHQ), but did not differ from controls in the frequency and intensity of stressful daily events, the quality and magnitude of emotional response (daily evaluated through visual analogue scales) and the degree of blood pressure variability. Taken in general, results did not confirm the psychological and psychophysiological profile repeatedly proposed for hypertensive patients.     

Invited Manuscript Poster on Renal-Related Education American Society of Nephrology,Nov. 16–21, 2010 Adolescents with Chronic Kidney Disease and Their Need for Online Peer Mentoring: A Qualitative Investigation of Social Support and Healthcare Transition

Abstract

Adolescents with chronic kidney disease (CKD) tend to be isolated from peers who also have CKD, develop non-adherent behavior with treatment recommendations, and consequently are at higher risk for poor health outcomes such as transplant rejection. At the same time, patients in this age group tend to be technologically savvy and well-versed in using Internet-based communication tools to connect with other people. In this study, we conducted semi-structured interviews among adolescents with CKD to assess their information needs and their interest in using a CKD-oriented peer-mentoring website that we are developing, kTalk.org. We interviewed 17 adolescents with CKD, ages 14–18 years old, to learn about (1) any concerns regarding transition from pediatric to adult care teams; and (2) their interest in using the Internet as a source for disease-related information and as a social networking tool for finding and interacting with their peers. The interviews were digitally recorded, transcribed, and qualitatively analyzed. Results showed that (1) the adolescent participants are commonly concerned about transitioning to an adult clinic; (2) they are isolated from peers with the same medical condition who are of similar age; (3) they are frequent Facebook users and are highly interested in exploring the possibility of using an online community website, such as kTalk.org, to discover and communicate with peers and peer mentors; and (4) there exist divergent opinions regarding if an online community of adolescent CKD patients should be open to the public.     

Quality of recipient–caregiver relationship and psychological distress are correlates of self‐care agency after lung transplantation

Self‐care behaviors are crucial for following the complex regimen after lung transplantation, yet little is known about recipients' levels of self‐care agency (the capability and willingness to engage in self‐care behaviors) and its correlates. We examined levels of self‐care agency and recipient characteristics (socio‐demographics, psychological distress, quality of relationship with primary lay caregiver, and health locus of control) in 111 recipients. Based on Perceived Self‐Care Agency scores, recipients were assigned to either the low‐ or high‐self‐care agency comparison group. Characteristics were compared between groups to identify characteristics likely to be associated with lower‐self‐care agency. Mean (SD) score for self‐care agency (scale range, 53–265) was 223.02 (22.46). Recipients with lowest‐self‐care agency scores reported significantly poorer quality of caregiver relationships (p < 0.001) and greater psychological distress (p < 0.001). After controlling for psychological distress, the quality of the recipient–caregiver relationship remained significantly associated with self‐care agency. Every one‐point decrease in the quality of caregiver relationship increased the risk of low‐self‐care agency by 12%. Recipients with poorer caregiver relationships and greater psychological distress may need additional support to perform the self‐care behaviors expected after lung transplantation.     

Lymphaticovenular anastomosis improves quality of life and limb volume in patients with secondary lymphedema after breast cancer treatment

Secondary lymphedema is a common side effect of breast cancer treatment, with significant impact on patients' physical and psychological well‐being. Conservative therapies are the gold standard treatment, however surgical options are becoming more popular. Lymphaticovenular anastomosis (LVA) is a supermicrosurgical procedure that aims to restore lymphatic flow by anastomosing damaged lymphatics to subcutaneous venules. We aimed to assess the effects of LVA on patients' limb volume and quality of life. Pre‐ and postoperative limb volumes and LYMQOL scores were collected for patients undergoing LVA for lymphedema secondary to breast cancer. Thirty‐seven patients underwent LVA. A significant reduction was seen in median excess limb volume postoperatively (13.3%‐6.6%, P < 0.005), with volumetric improvement seen in 78% of patients. Thirteen patients were able to discontinue compression garment use. Eighty‐six percent of patients reported improved quality of life postoperatively with median LYMQOL score increasing from 90 to 104 points (P < 0.005). LVA is a minimally invasive surgical option for patients with early stage lymphedema. It can lead to significant volumetric improvements and in select patients, freedom from compression therapy. LVA can also lead to significant improvements in quality of life, in particular patients' mood and perception of their appearance.