Psychosocial stressors and behavioral interventions in gay men with HIV infection

Homosexual men who are diagnosed as HIV-1 seropositive may face major psychosocial changes including multiple, chronic, uncontrollable stressors, and losses in familiar sources of social support. This combination of events may overwhelm previously learned coping strategies resulting in a loss of perceived self-efficacy, feelings of hopelessness and depression, and increases in maladaptive behaviors such as unprotected sexual activities and substance use. These sequelae may, in turn, compromise future mental and physical health status. This population may benefit substantially from behavioral interventions that increase self-efficacy, encourage emotional expression, and increase social support resources in a supportive group environment. It is plausible that such increases in self-efficacy, adaptive coping and social support may reduce the likelihood of distress and depression, sexual risk behaviors and substance use with potential benefits as well for immunologic status and clinical health. Recent work, though preliminary, supports the utility of such behavioral interventions and it appears that further larger-scale investigations are warranted.     

Gender and developmental effects on perceived stress, coping, somatic symptoms and psychological disorders among children and adolescents

The aim of this one-year longitudinal study was to investigate gender and developmental effects on perceived stress related to interpersonal stressors, coping strategies, somatic symptoms and psychological disorders. Additionally, associations of perceived stress and coping styles at the first assessment with psychological problems at the second measurement were examined. In total, N = 169 Austrian children and adolescents (ages 10 to 13 years) participated in this self-report study. Compared to male children and adolescents, female counterparts scored higher on perceived stress related to interpersonal stressors and on social support but evaluated a lower amount of distraction. Moreover, girls reported higher levels of somatic symptoms and anxiety/depression. Boys showed a developmental increase in anger control problems and both genders showed developmental increases in antisocial behavior. Low levels of the emotion-focused coping strategies distraction and minimization were related longitudinally to emotional and behavioral disorders. The results support gender-adjusted stress management programs applied in the primary and secondary prevention.     

Predictors of Depression in a Sample of African-American Homeless Men: Identifying Effective Coping Strategies Given Varying Levels of Daily Stressors

In a sample of African-American, homeless or insecurely sheltered men, the occurrence of discrete stressors in the prior week contributed to the experience of depressive symptoms among this generally stressed population. Reliance on active, problem-focused coping strategies as opposed to emotion-coping strategies was associated with lower levels of depressive symptoms contradicting the hypothesis that active coping is counter-productive for African-American men. However, depressive symptoms increased, with added uncontrollable stress, even for active copers, contradicting a stress-buffering hypothesis. Under conditions of high uncontrollable stress, problem-focused coping was associated with lower levels of depressive symptoms than emotion-focused coping, however, additional discrete stressors exerted less impact on the level of depressive symptoms among the emotion-focused copers than the active, problem-focused copers.     

An examination of stress and coping among adults diagnosed with severe mental illness

The present study explored the types of major life and chronic stressors that people with severe mental illness experience, and the coping strategies that are used in response to them. Twenty-eight adults with severe mental illness completed qualitative interviews focused on stress and coping in the prior six months. Participants reported experiencing disruptive major life events including the sudden death of a loved one, loss of housing, and criminal victimization, as well as chronic stressors such as psychiatric symptoms and substance abuse issues, substandard living conditions, legal problems, and health concerns. Results suggested that persons with severe mental illness frequently use problem-centered coping strategies in response to most types of stressors, including major life events, although this occurred after the initial application of avoidant coping strategies. Future research should explore whether or not the identified stressors and the coping strategies used in response to them are unique to this population.     

Workplace stressors and coping strategies among Chinese psychiatric nurses

PURPOSE. This study was conducted with Chinese psychiatric nurses to identify their workplace stressors and coping strategies, as well as the relationships between their demographics, workplace stressors, and coping strategies. DESIGN AND METHODS. This survey was conducted, with the use of three questionnaires, on 188 psychiatric nurses recruited via convenient sampling in central China. FINDINGS. The findings indicated that (a) workload and dealing with death/dying were the greatest workplace stressors; (b) positive coping strategies were the most often used coping strategies; and (c) a series of correlation results occurred. PRACTICE APPLICATION. Understanding the relationship between workplace stressors, effective and ineffective coping, and demographics can contribute to designing less stressful environments and more constructive coping strategies.     

Cross-situational coping with peer and family stressors in adolescent offspring of depressed parents

Offspring of depressed parents are faced with significant interpersonal stress both within their families and in peer relationships. The present study examined parent and self-reports of adolescents' coping in response to family and peer stressors in 73 adolescent children of parents with a history of depression. Correlational analyses indicated that adolescents were moderately consistent in the coping strategies used with peer stress and family stress. Mean levels of coping were similar across situations, as adolescents reported greater use of secondary control coping (i.e., acceptance, distraction) than primary control coping (i.e., problem solving, emotional expression) or disengagement coping (i.e., avoidance) with both types of stress. Regression analyses indicated that fewer symptoms of self-reported anxiety/depression and aggression were related to using secondary control coping strategies in response to family stress and primary control coping in response to peer stress. Implications for understanding the characteristics of effective coping with stress related to living with a depressed parent are highlighted.     

Patterns of children's coping with life stress: implications for clinicians

In a study of children's patterns of coping with daily stressors, boys and girls 9-17 years old were asked to complete a coping checklist in response to one of four types of stressors--school, parents/family, siblings, or peer/interpersonal. Patterns of coping-strategy use were found to be similar across the various stressors, with wishful thinking, problem-solving, and emotional regulation being among those most frequently used. Older adolescents, compared to younger children, tended to use a broader range of coping strategies, regardless of stressor. Implications for clinical practice are discussed.     

Marital adjustment in families of young children with disabilities: associations with daily hassles and problem-focused coping

A family systems framework was used to examine associations between stressors/hassles, problem-focused coping, and marital adjustment in 67 families of young children with disabilities. Most of the couples were experiencing average to above average marital adjustment. When daily stressors/hassles were higher, husbands and wives viewed their marriages more negatively. After variance contributed by stressors/hassles was statistically controlled, fathers who employed more problem-focused coping strategies were more positive about their marriages. For wives (but not husbands), a cross-spousal partner effect was found; women reported higher marital adjustment when their husbands employed more problem-focused coping strategies. We reaffirmed the systemic nature of family processes and highlighted the role of parent gender in understanding the relationships among stressors, coping, and marital well-being.     

Coping strategies and social support in old age psychosis

BACKGROUND: According to vulnerability-stress models of psychosis, cognitive and behavioural coping strategies can help mediate the potentially negative effects of daily stressors. The nature, frequency and effectiveness of coping have been studied in people with psychosis under 65 years of age. However, these findings may not generalise to older people with the diagnosis, as the nature of stressors and coping strategies may change with increasing age. This study therefore aimed to explore coping in older patients with psychosis. METHODS: A total of 48 older patients with psychosis (F20-29, ICD-10) and 25 non-clinical elderly controls were compared using self-report measures of stressors, perceived control over stressors, coping strategies, perceived coping efficacy and social support. A regression analysis was used to explore predictors of dysfunctional coping in the patient group. RESULTS: Patients used a significantly higher proportion of problem-focused coping strategies, but they were more dysfunctional copers and rated their coping as less effective compared to controls. They also had fewer friends and less emotional support. Severity of symptoms was a significant predictor of dysfunctional coping when depression, cognitive impairment and functional disability were controlled. CONCLUSIONS: Patients with psychosis coped less well with daily stressors than controls and patients with more severe symptoms were more dysfunctional copers. The findings highlight the potential benefit of psychosocial interventions in old age psychosis.     

Treatment of Selective Serotonin Reuptake Inhibitor—Resistant Depression in Adolescents: Predictors and Moderators of Treatment Response

ObjectiveTo advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in adolescents, we conducted a randomized controlled trial evaluating alternative treatment strategies. In primary analyses, cognitive-behavioral therapy (CBT) combined with medication change was associated with higher rates of positive response to short-term (12-week) treatment than medication alone. This study examines predictors and moderators of treatment response, with the goal of informing efforts to match youths to optimal treatment strategies.MethodYouths who had not improved during an adequate SSRI trial (N = 334) were randomized to an alternative SSRI, an alternative SSRI plus CBT, venlafaxine, or venlafaxine plus CBT. Analyses examined predictors and moderators of treatment response.ResultsLess severe depression, less family conflict, and absence of nonsuicidal self-injurious behavior predicted better treatment response status. Significant moderators of response to CBT + medication (combined) treatment were number of comorbid disorders and abuse history; hopelessness was marginally significant. The CBT/combined treatment superiority over medication alone was more evident among youths who had more comorbid disorders (particularly attention-deficit/hyperactivity disorder and anxiety disorders), no abuse history, and lower hopelessness. Further analyses revealed a stronger effect of combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer prestudy pharmacotherapy.ConclusionsCombined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is comorbid with other disorders. Given the additional costs of adding CBT to medication, consideration of moderators in clinical decision making can contribute to a more personalized and effective approach to treatment.     

The moderating effects of coping strategies on major depression in the general population.

OBJECTIVES: To evaluate the moderating effects of various coping strategies on the association between stressors and the prevalence of major depression in the general population. METHODS: Subjects from the Alberta buy-in component of the 1994-1995 National Population Health Survey (NPHS) were included in the analysis (n = 1039). Each subject was asked 8 questions about coping strategies that dealt with unexpected stress from family problems and personal crises. Major depression was measured using the World Health Organization's (WHO) Composite International Diagnostic Interview-Short Form (CIDI-SF) for major depression. The impacts of coping strategies in relation to psychological stressors on the prevalence of major depression were determined by examining interactions between coping and life stress on major depression using logistic regression modelling. RESULTS: No robust impact of coping strategies in relation to various categories of stress evaluated in the NPHS was observed. There was evidence that the use of "pray and seek religious help" and "talks to others about the situations" as coping strategies by women moderated the risk of major depression in the presence of financial stress and relationship stress (with a partner). Using emotional expression as a coping strategy by women might decrease the risk of major depression in the presence of 1 or more recent life events, personal stress, relationship stress (with a partner), and environmental stress. CONCLUSION: Different coping strategies may have a differential impact on the prevalence of major depression in specific circumstances. These findings may be important both to prevent and to treat depressive disorders.     

Obsessive-compulsive and negative symptoms in schizophrenia: associations with coping preference and hope

Although agreement exists regarding the high occurrence of obsessive-compulsive (OC) symptoms in schizophrenia, it is less clear how OC symptoms are related to the traditional symptoms of schizophrenia and co-occurring deficits. One possibility is that there may be two distinct groups of persons with schizophrenia who experience OC symptoms: one group with poor and another with relatively good function. In the present study, the relationships between OC symptoms, coping, and hope were examined among 67 persons with schizophrenia spectrum disorders. First, participants with significant levels of OC symptoms were compared with participants without OC symptoms. Then, participants with significant levels of both OC symptoms and negative symptoms were compared with participants with negative symptoms, but no OC symptoms, and to participants with neither OC symptoms nor negative symptoms. Analysis of variance revealed participants with significant levels of OC symptoms were significantly more likely to experience greater levels of hopelessness and endorse a preference for avoidant focused coping strategies relative to participants without significant OC symptoms. Participants with both negative symptoms and OC symptoms also had less hope and greater preferences for ignoring stressors than participants with negative symptoms but no OC symptoms and participants with neither OC symptoms nor negative symptoms. Implications for theory, practice and research are discussed.     

Adolescent vulnerability and the distress of rejection: Associations of adjustment problems and gender with control,emotions, and coping

We examined adjustment problems as risks for patterns of emotions, appraisals, and coping with rejection, and explored whether these processes could account for sex (boy/girl) differences in coping. Young adolescents (N = 669, grades 6–8) completed questionnaires, which assessed responses to peer rejection threat with two short scenarios. Using structural equation modeling to test a multivariate process model, adolescents with heightened social anxiety had the most maladaptive responses to rejection threat, including elevated emotional reactions, more self-blame, and coping using more social isolation, rumination and opposition. Adolescents reporting more depressive symptoms felt less control and anticipated using less adaptive coping (less support seeking, distraction, and negotiation), whereas aggressive adolescents responded with more anger and coped via opposition. Moreover, as anticipated, sex differences in coping, symptoms, emotions, and appraisals were found. However, coping differences between boys and girls were mostly nonsignificant after accounting for symptoms, aggression, emotional reactions, and appraisals.     

Mindful Coping and Mental Health among Adolescents

The aim of the research described here is to provide knowledge of adolescents and their coping strategies through the construct of mindful coping. Little is known about the contributions of mindfulness to the enhancement of mental health in adolescents. Inspired by dialectical behaviour therapy (Linehan, 1993a, b), we discuss the mindful coping process and investigate how different aspects of this process are related to mental health in a non-clinical adolescent sample. The empirical approach consisted of a cross-sectional study of 652 high-school students from two high schools, covering all streams. The relations between the four proposed mindful coping aspectsawareness, distraction, preventing negative emotions and constructive self-assertionwith psychological symptoms (PS), as well as how these four aspects moderated the relationship of perceived life strains (LS) with PS, were studied. The results show that coping by preventing negative emotions and constructive self-assertion were associated with fewer PS and/or weaker association between LS and PS, whereas coping by use of distraction was related to more PS and did not moderate the association between LS and PS. Finally, coping by use of awareness was related to a stronger association of LS with PS. The results only partly supported our expectations, providing challenging and important knowledge for future research on mindful coping in adolescents.     

Prospective Study of the Effectiveness of Coping in Pediatric Patients

Findings about the influence of coping on psychological adjustment in children with different medical conditions are inconsistent and often based on cross-sectional data. This prospective study evaluated the effect of various coping strategies on children’s post-traumatic stress symptoms and behavioral problems 1 month and 1 year after an accidental injury or the diagnosis of a chronic disease in 161 pediatric patients 6–15 years of age. Only minor positive effects of coping on psychosocial adjustment were found: Religious coping reduced post-traumatic stress symptoms. Active coping strategies had negative effects on internalizing and externalizing behavioral problems. Support seeking strategies, distraction, and avoidance had no impact on long-term psychosocial adjustment     

Clinical and Developmental Perspectives on Adolescent Coping

Although the development of appropriate coping strategies has been understood as an essential element of healthy adjustment, few studies have demonstrated the link between coping and psychological development. Similarly, research on adolescents with behavioral problems has neglected coping as an important variable in understanding and treating these conditions. This study examines the relationships between psychological development, coping strategies and symptoms in a sample of 302 psychiatrically hospitalized adolescents, ages 12–16. Subjects completed the Adolescent Coping Orientation for Problem Strategies Questionnaire, (A-COPE), the Youth Self Report symptom checklist (YSR), and Loevinger's measure of ego development. Results showed that Avoidance and Ventilation were associated with increased behavior problems and lower levels of ego development. Problem solving and interpersonal strategies were associated with fewer symptoms and higher levels of development. Significant gender differences were found with girls using more interpersonal coping and boys using more physically active strategies. Gender differences were also found in the relationship of coping strategies to both symptomatic behavior and development. The results are discussed in the context of a developmental approach to adolescent psychopathology.     

Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue

Objectives: preliminary surveys of Persian Gulf veterans revealed a significant prevalence of self-reported symptoms consistent with chronic fatigue syndrome (CFS). The purpose of this study was to compare self-reported life stressors, combat, and chemical exposures, personality and coping between Gulf War veterans with CFS and healthy veterans.Methods: following a complete physical, psychiatric, and neuropsychological evaluation, 45 healthy veterans, 35 veterans with CFS and co-morbid psychiatric disorder, and 23 veterans with CFS and no co-morbid psychiatric disorder completed questionnaires assessing war and non-war-related life stressors, self-reports of environmental exposure (e.g. oil well fires, pesticides), personality, and coping.Results: measures of personality, self-reported combat and chemical exposures, and negative coping strategies significantly differentiated healthy veterans from those with CFS.Conclusion: a biopsychosocial model of veterans' illness was supported by the fact that personality, negative coping strategies, life stress after the war, and environmental exposures during the war were significant predictors of veterans' current physical function.     

Adolescent coping: the different ways in which boys and girls cope

In order to investigate the ways in which boys and girls cope with their concerns, 650 Year 11 and Year 12 students from seven post-primary schools in Melbourne, Australia were asked to describe how they cope with the main concerns in their lives. In addition to elicitation of spontaneous responses, a modified form of the Ways of Coping Checklist (Folkman and Lazarus, 1980; 1985b) was also administered to obtain an assessment of students coping strategies. Clear differences were found between the ways in which boys and girls cope. Girls seek more social support and generally are more likely than boys to focus on relationships. They also employ more strategies related to hoping for the best and wishful thinking. The question of how boys and girls can develop their coping repertoire so as to increase the adaptability of their responses in difficult situations is also addressed.     

Psychiatric morbidity among New Zealand Cambodians: the role of psychosocial factors

A community survey of the relationship between minor psychiatric morbidity and life events, chronic post-migration stressors, social support and coping style among adult Cambodians living in Dunedin was conducted using the 28-item version of the General Health Questionnaire (GHQ-28) as the case identification instrument. Chronic post-migration stressors, life events, poor coping style and poor social support were all associated with minor psychiatric morbidity. Social support or coping style did not moderate the relationship between life events/post-migration stressors and GHQ caseness, but had an independent relationship with the latter.     

Coping strategies in twins with chronic fatigue and chronic fatigue syndrome

Objectives: Individuals with chronic fatigue and chronic fatigue syndrome (CFS) face debilitating symptoms as well as stressful life situations that may result from their condition. The goal of this study was to examine the coping strategies used by fatigue-discordant twin pairs. Methods: We utilized a co-twin design to assess how twin pairs discordant for chronic fatigue and CFS cope with stress. All twin pairs were administered the Revised Ways of Coping Checklist. Results: Overall, the pattern of coping strategies was similar for fatigued and non-fatigued twins. However, twins with chronic fatigue or CFS utilized more avoidance strategies than their non-fatigued counterparts; those with chronic fatigue also used more avoidance relative to problem-focused coping than their co-twins. Conclusions: These results suggest that while fatigue-discordant twins generally exhibit similar behavior patterns in order to cope with stress, there may be an association between fatigue and avoidance coping. Future research should focus on the role of avoidance and its relationship to fatiguing illnesses.