Insight, distress and coping styles in schizophrenia

BACKGROUND: The stigma and negative societal views attached to schizophrenia can make the diagnosis distressing. There is evidence that poor insight into symptoms of the disorder and need for treatment may reflect the use of denial as a coping style. However, the relationships between insight and other coping styles have seldom been investigated. METHOD: We examined the associations between insight, distress and a number of coping styles in 65 outpatients with schizophrenia (final n=57) in a cross-sectional study. RESULTS: We found that (i) awareness of symptoms and problems correlated with greater distress, (ii) 'preference for positive reinterpretation and growth' coping style correlated with lower distress and with lower symptom awareness (re-labelling), (iii) 'preference for mental disengagement' coping style correlated with greater distress and lower awareness of problems, and (iv) 'social support-seeking' coping style correlated with greater awareness of illness, but not distress. No relationship occurred between the use of 'denial' as a coping style and insight or distress. CONCLUSIONS: Our findings demonstrate that awareness of illness and related problems is associated with greater distress in schizophrenia. However, this investigation has not supported a simple psychological denial explanation for this relationship, as complex relationships emerged between different dimensions of insight and coping styles. The negative association between 'positive reinterpretation and growth' and distress suggests that adopting this style may lead to re-labelling symptoms in a less distressing way. Avoidant and isolating styles of coping both appear unhelpful. Psychological interventions should aim to promote more active coping such as discussing a mental health problem with others.     

Caregiver distress, coping and parenting styles in cases of childhood encephalitis

This study presents an exploration of the impact of childhood encephalitis on parental mood, coping and disciplinary strategies. Thirty six parents of children aged between 10 and 17 years were recruited. They were split into groups of recent and remote cases (within or beyond 7 years). Group comparison revealed that neurobehavioural consequences of childhood encephalitis appear to persist over time. Higher levels of behavioural symptoms consistent with dysexecutive disorder were associated with greater parental distress. Parents remain distressed despite reporting proactive profiles of coping. There was an indication that severity of dysexecutive disorder was asscociated with less use of proactive parental management strategies. Support for parents, in particular focused on effective management of dysexecutive problems, is recommended.     

大学生特质应对方式与抑郁、焦虑的关系

目的探讨大学生特质应对方式与抑郁、焦虑的关系。方法用特质应对方式问卷（TCSQ）、状态-特质焦虑问卷（STAI）、贝克抑郁测验（BDI）对120名大学生施测。结果消极应对与状态焦虑（r=0.296,P〈0.01）、特质焦虑（r=0.447,P〈0.001）及抑郁（r=0.227,P〈0.05）存在显著的正相关;积极应对与特质焦虑（r=-0.360,P〈0.001）及抑郁（r=0.227,P〈0.05）存在显著的负相关;抑郁与状态焦虑（r=0.447,P〈0.001）及特质焦虑（r=0.574,P〈0.001）之间也存在显著的正相关。特质焦虑能预测抑郁（P〈0.001）;抑郁、消极应对、状态焦虑和积极应对能预测特质焦虑（P〈0.001）;特质焦虑和积极应对能预测状态焦虑（P〈0.001）。结论特质应对方式对状态-特质焦虑和抑郁有影响。     

Relationships between psychological distress, coping styles, and HPA axis reactivity in healthy adults

Psychological distress and coping styles have been suggested to relate to altered function in the hypothalamic-pituitary-adrenal (HPA) axis, although there remains much to be understood about their relationships. High and low cortisol levels (or reactivity) both represent HPA axis dysfunction, with accumulated evidence suggesting that they are linked to different types of psychopathology. The dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test has been extensively used to identify HPA axis abnormalities in various psychiatric conditions including mood disorders; however, the possible associations of psychological distress and coping styles with HPA axis function have not been well documented using this test. Here, we examined the relationships of HPA axis reactivity as measured by the DEX/CRH test with subjectively perceived psychological distress and coping styles, both of which were assessed with self-report questionnaires, in 121 healthy volunteers. Subjects were divided into three groups by the cortisol suppression pattern, namely the incomplete-suppressors (DST-Cortisol ≥ 5 μg/dL or DEX/CRH-Cortisol ≥ 5 μg/dL), moderate-suppressors (DST-Cortisol < 5 μg/dL and 1 μg/dL ≤ DEX/CRH -Cortisol < 5 μg/dL), and enhanced-suppressors (DST-Cortisol < 5 μg/dL and DEX/CRH-Cortisol < 1 μg/dL). The enhanced-suppressors showed significantly higher scores in obsessive-compulsive, interpersonal sensitivity and anxiety symptoms and significantly more frequent use of avoidant coping strategy, compared to the other two groups. These results point to the important role of enhanced suppression of cortisol, or blunted cortisol reactivity, in non-clinical psychopathology such as avoidant coping strategy and greater psychological distress.     

Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress

AIMS: This study investigated the consequences caregivers of outpatients with bipolar disorder are confronted with, the distress they experience and their coping styles. METHODS: Caregivers (n = 115) were asked to complete the Involvement Evaluation Questionnaire (IEQ) to measure caregivers' consequences, the Utrecht Coping List (UCL) to measure caregivers' coping styles, and the 12-item General Health Questionnaire (GHQ-12) to measure caregiver distress. Scale (sub)scores were calculated and relationships between the results were explored. RESULTS: Caregiver consequences were found to be limited, although approximately 30% reported distress. Male caregivers used a more avoiding coping style and undertook activities to provide diversion. Female caregivers used a less active approach and sought less social support. Correlations were found between the IEQ overall score and its subscales 'tension' and 'worrying' and the UCL subscales 'palliative reaction pattern' and 'passive reaction pattern'. Distress appears to occur more often in caregivers who report more consequences, tend to use a more avoiding coping style, and have a more passive reaction pattern. CONCLUSIONS: Clinicians should assess symptoms of caregiver distress. When caregiver distress is noticed, efforts should be undertaken to support the caregiver and teach them skills to cope effectively with the consequences they experience in order to stay well.     

Child and parent reports of childhood anxiety: Differences in coping styles

This study compares children anxious only on parent report (PR) with those anxious on self-report (SR) and self- and parent report (SPR) to examine the reasons for the reporting differences. Sixty-five children aged 7–12 years who met criteria for one or more Axis I anxiety disorders (25% with comorbid nonanxiety diagnoses) completed standardized measures of anxiety, depression, and coping style. Parents completed measures of child psychopathology and adult coping style. Assessing clinicians completed the Global Assessment of Functioning. All parents endorsed anxiety in their children. Based on their responses on standardized self-report measures of anxiety, children were classified as endorsing anxiety (SPR group) or not endorsing anxiety (PR group). Multivariate analysis of variance revealed that children in the SPR group endorsed more depression and employed a greater variety of coping strategies than children in the PR group. The two groups did not differ on parent or clinician measures. These findings suggest that reporting differences may be related to differences in coping styles in anxious children. SPR children may overreport anxiety symptoms due to feelings of decreased self-worth associated with depressive thinking, whereas PR children may be able to distract themselves from their anxieties. The lack of difference in functioning between the two groups suggests that self-report anxiety questionnaire scores are not necessarily indicative of severity. Depression and Anxiety 6:62–69, 1997. © 1997 Wiley-Liss, Inc.     

Fluctuations in mood and psychological distress during the menstrual cycle

This paper examines fluctuations in mood and symptoms associated with psychological distress during the phases of the menstrual cycle in two samples of university women. The first (Study I) sample of women (N = 162) was randomly selected from the University population. The second sample (Study II) was women (N = 138) who attended a psychiatric clinic. The subjects completed a questionnaire which included measures of depression, anxiety and general psychological distress. Information about the menstrual cycle and contraceptive pills was elicited from the subjects who were unaware that affect during the menstrual cycle was being studied. In study I there were no significant differences in depression, anxiety or psychological distress between phases of the cycle. The results of study II indicated that even in a group of women with emotional problems, it was not possible to demonstrate an increase in the average severity of mood disturbance or psychological distress during any phase of the menstrual cycle. It was concluded that in general, university women between the ages of 18-30 who are mostly single, nulliparous, with or without significant psychopathology, seeking or not seeking psychiatric help do not experience significant or disruptive fluctuations in mood and symptoms of psychological distress during the phases of the menstrual cycle. Women who are afflicted with distressing and incapacitating cyclical fluctuations are best studied as a vulnerable subgroup.     

Levels of anxiety sensitivity in relation to repressive and self-deceptive coping styles

Levels of anxiety sensitivity (AS) were investigated in relation to self-deception and repression in 296 university students. It was hypothesized that a low level of AS, rather than constituting "normal" functioning, would be associated with more general response biases. Scores on the Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1987, 1992) were negatively and significantly correlated with measures of self-deception and denial. Individuals with low AS were significantly more likely to meet an operational definition of repression (i.e., low anxiety and high defensiveness), compared to mid AS and high AS groups. When confronted with a hypothetical health problem, individuals with low AS were less likely to choose a task-oriented response and more likely to choose denial and self-deceptive responses, compared to the other groups. These findings support the observations of Shostak and Peterson (1990) that low AS represents an extreme group that may not be indicative of normal functioning.     

Stress, depression and immunity: the role of defense and coping styles

It is by now widely recognized that acute and chronic stress have an impact on the immune system. Acute stress may have a stimulating effect on the immune system, while in the case of chronic stress--and in particular in depression--the immune system may be down-regulated. However, there is considerable individual variability in the immune response to stress. This seems to a large extent to be determined by the subject's way of dealing with stress. The perception and evaluation of a stressor and the specific ways of stress coping may in different ways be related to various aspects of the stress response: sympathetic nervous system (SNS) activation and activation of the hypothalamic-pituitary-adrenal (HPA) axis, both systems affecting the immune system. Prolonged exposure to stressors or to severe life stresses may outweigh the person's coping resources leading to feelings of depression. The affective changes with the accompanying changes in the HPA axis are one of the hypothesized mechanisms underlying the immune changes in depression. It should be noted that the relationship between depression and immunity is affected by several other factors, such as gender and age and other personal resources. Increasing the subject's abilities to cope with stress and to reduce the negative affect by psychological interventions may on the other hand have a beneficial effect on the immune system.     

新兵的应付方式、自尊水平与心理健康的关系

目的分析新兵的应付方式、自尊与心理健康的关系,为促进其心理健康提供理论依据。方法抽取陆军某部队2013夏秋入伍2~3周的421名新兵为研究对象,采用应付方式问卷(CSQ)、自尊量表(SES)、症状自评量表(SCL-90)对其心理应付方式、自尊水平和心理健康状况进行团体施测。结果 1独生子女新兵SES、解决问题因子评分低于非独生子女(t=-2.497,-2.445,P0.05),SCL-90总评分、自责与退避因子评分高于非独生子女(t=3.353,2.603,2.229,P0.05);城市新兵SCL-90总评分高于农村新兵(t=2.291,P0.05)。2新兵心理健康水平与解决问题、求助、自尊呈正相关(P0.05),与自责、幻想、退避、合理化呈负相关(P0.05);对心理健康水平影响大小依次是自责、自尊、幻想、解决问题、合理化因子。3解决问题、合理化、自责、幻想对心理健康产生直接影响(路径系数=-0.14,0.11,0.24,0.21),解决问题、合理化、自责通过自尊中介对心理健康产生间接影响(路径系数=0.35,0.17,0.36)。结论非独生子女与农村新兵心理健康水平较高,应付方式对新兵心理健康产生直接预测作用,自尊是应付方式与心理健康的中间变量。     

抑郁症患者家属心理健康水平、应对方式及社会支持的现状

目的:探讨抑郁症患者家属的心理健康水平、应对方式及社会支持水平。方法:对与抑郁症患者同住的150名家属进行症状自评量表(SCL-90)、简易应对方式问卷(SCSQ)和社会支持评定量表(SSRS)评估,并与全国常模的数据比较。结果:抑郁症患者家属SCL-90总分及躯体化、抑郁、焦虑、精神病性因子分明显高于全国常模(P均0.05);SCSQ中积极的应对方式得分明显低于全国常模,而消极方式得分明显高于全国常模(P均0.05);SSRS中男性家属客观支持、主观支持、支持利用评分及女性家属客观支持评分明显低于全国常模(P均0.05)。结论:抑郁症患者家属心理健康水平较差,社会支持少,多采取消极的应对方式;他们需要心理干预。     

临床医学研究生抑郁与焦虑状况与应对方式的关系

目的 探讨我校临床医学研究生抑郁、焦虑状况与应对方式的关系.方法 采用随机整群抽样的方式抽取我校549名临床医学研究生进行问卷调查,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)和应付方式问卷(CSQ)进行调查.结果 共发放问卷549份,收回有效问卷510份,有效率为92.9％.本次调查结果显示临床医学研究生抑郁、...     

Measuring resilience in women experiencing infertility using the CD-RISC: Examining infertility-related stress, general distress, and coping styles

Psychological morbidity concurrent with fertility problems has been the focus of substantial scientific inquiry. However, researchers have largely overlooked psychological resilience within this population. This study explored the associations between resilience, infertility-related and general distress, and coping behaviors in forty women from nine fertility clinics throughout the United States. Participants completed the Connor-Davidson Resilience Scale (CD-RISC), Symptom Checklist-90 (SCL-90), Beck-Depression Inventory-II (BDI-II), Fertility Problem Inventory (FPI), and Ways of Coping Questionnaire (WCQ). Women with fertility problems evidenced significantly lower resilience scores than published norms. This study established evidence for the reliability and convergent validity of the CD-RISC with infertile populations. However, similar to other studies using this instrument, the factor structure reported by Connor and Davidson [Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety 2003;18:76-82] was not well supported. Resilience was negatively associated with infertility-specific and general distress. Engagement in action-focused coping skills was positively correlated with resilience. Implications for enhancing resilience with this population as are discussed.     

Self-preoccupation and general stress level as sensitizing factors in premenstrual and menstrual distress

This study considered whether general stress level and self-preoccupation sensitize women to symptoms of menstrual and premenstrual distress and whether this effect is more pronounced for premenstrual symptoms. Equal-size categories of normal college women reporting greater distress during the premenstrual period (PD), during the menstrual period (MD), or about equally in both periods were constituted. The PD women demonstrated significantly greater self-preoccupation than either the MD or equivalent groups; they also reported higher general stress than either comparison group, although statistical reliability was not attained. However, when both sensitizing factors were introduced into the same analysis, high self-preoccupation and a high level of general stress were found only in the PD group. The present evidence suggests that stress and personality not only sensitize premenstrual symptoms in PMS women but are prominent features in normal women who report more serious symptoms during the premenstrual period.     

Impact of gender and menstrual cycle phase on plasma cytokine concentrations

OBJECTIVE: The lifetime prevalence of major depression is twice as high in females as in males. Depression is known to increase at periods where there are changes in gonadal hormones. We examined pro- and anti-inflammatory cytokine levels during the normal menstrual cycle of healthy females compared to similar time points in healthy males. METHODS: Plasma concentrations of interleukin (IL)-4, IL-6, IL-8, IL-10, tumour necrosis factor-alpha (TNF-alpha) and soluble IL-6 receptor (sIL-6R) were measured with enzyme-linked immunosorbent assays in healthy females during the normal ovulatory menstrual cycle and also in males at similar time points. RESULTS: The luteal phase of the menstrual cycle is associated with increased production of sIL-6R, IL-4 and TNF-alpha compared to the early follicular phase. No change was observed in IL-6, IL-8 and IL-10 concentration throughout the menstrual cycle. We found IL-4 positively correlated with oestrogen while TNF-alpha positively correlated with progesterone. Females were found to have significantly higher concentrations of TNF-alpha and sIL-6R across all phases of the menstrual cycle, compared to males across similar time points. CONCLUSION: The normal menstrual cycle is associated with increased production of sIL-6R, IL-4 and TNF-alpha in the luteal phase compared to the early follicular phase. Females have significantly higher concentrations of sIL-6R and TNF-alpha at all time points across the menstrual cycle than males.     

汶川地震3年后某重灾区干部焦虑抑郁状况及应对方式

目的探讨汶川地震3年后某地震重灾区干部焦虑、抑郁状况及应对方式,为进一步心理干预提供实践指导。方法采用分层随机抽样方法,从四川某地震重灾区的党政机关干部(公务员)中按副科级及以上-副科级以下干部的7%等比例抽样,共1525名。采用焦虑自评量表、抑郁自评量表等对焦虑、抑郁状况进行横断面调查。结果①54.40%的干部认为自已存在心理问题,89.07%认为同事存在心理问题;②34.03%的干部SDS分≥53分、25.44%的干部SAS分≥50分,95%CI分别为31.67～36.44%、23.27～27.65%;③副科级以下、专科及以下文化的干部抑郁症状检出率分别高于副科级及以上、本科及以上文化者(36.95%vs.31.95%、38.08%vs.32.10%);④85.66%选择"自我调整"方式应对心理问题,84.32%的干部表示愿意接受专业心理疏导。结论①汶川地震3年后,重灾区干部仍存在相当的焦虑、抑郁问题,尤其以副科级以下和专科及以下文化者抑郁问题更明显,灾后心理服务应长期化;②灾后心理卫生服务工作既应关注心理问题本身,更应帮助树立正确的心理问题就医理念。