Predictors of parent stress in a sample of children with ASD: Pain,problem behavior,and parental coping

Studies have shown that children with ASD have increased severity and incidence of pain symptoms compared to typically developing children and children with other disorders. Pain has also been shown to act as a setting event for problem behavior. Further, problem behavior is one of the biggest impediments to quality of life for families and highly relates to parent stress. This study examined pain and problem behavior as predictors of parent stress and also examined how parenting style interacted with pain and problem behavior to influence parent stress. Results showed that problem behavior was a moderating factor between pain and parent stress and there was a significant interaction between pain and problem behavior predicting stress. An overprotective parenting style also moderated the relationship between pain and parent stress and there was an interaction between the two factors predicting stress. Implications are discussed in terms of treatments that focus on children's behavior and parenting behavior in order to improve quality of life in families of children with ASD.     

Dexamethasone suppression test and coping behavior in psychosocial stress

The dexamethasone suppression test (DST) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 144 healthy inductees on day 2 of military service. One hundred and four of them completed a 120-item questionnaire describing their coping responses to this particular challenge. Thirty-six subjects (25%) failed to suppress plasma cortisol adequately. Their mean scores on the MMPI clinical standard scales were within the normal range. High postdexamethasone cortisol levels were associated with denial and passivity, and with low demand for social support. These results suggest that the DST might be more related to coping with a stressor than to a specific diagnosis. The authors speculate that high hypothalamic-pituitary-adrenal activity may have a primary role in psychological defense promoting inattention to the aversive aspects of stressful situations.     

The epidemiology of major depression: implications of occurrence, recurrence, and stress in a Canadian community sample.

OBJECTIVE: To study the effects of stress process variables on the prevalence of major depressive disorder (MDD) and to explore the factors related to its onset and recurrence, using measures of stress and disorder that are more comprehensive than those in previous studies of depression. METHOD: Data were collected from a randomly selected community sample of 1393 adult respondents in Toronto, Ontario. Depression was measured using the Composite International Diagnostic Interview (CIDI). RESULTS: Bivariate and multivariate analyses examine demographic and stress process correlates of MDD to assess their impact on both occurrence and recurrence. The effects of childhood experiences on lifetime MDD are examined as risk factors for the initial onset of depression. With respect to occurrence, the multivariate analyses tended to show agreement with established findings. Results using a subsample of people with lifetime depression to predict recurrence tended to mirror results using the full sample, except with respect to gender, birthplace, and, to a certain degree, stress differences. Finally, traumas experienced in childhood, as well as early childhood experiences involving parental substance abuse and mental health problems, were significant predictors of the onset of major depressive disorder. CONCLUSION: This research currently represents the only Canadian community study to examine the relationship between stress, social support, coping, and depression using outcome measures that approximate Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. In addition, it is among the few that use a comprehensive measure of life stress encompassing childhood experiences and current operant stress (both events and chronic problems).     

Physiological stress reactivity and empathy following social exclusion: A test of the defensive emotional analgesia hypothesis

Experiences of social exclusion elicit social pain responses. The current study examined the ability of social exclusion to activate physiological stress responses and adaptively modulate affect and empathy consistent with “defensive emotional analgesia.” Measures of affect and empathy, and saliva samples for cortisol and alpha-amylase (sAA) analysis, were collected before and after subjects participated in a computer game (“Cyberball”) designed to manipulate feelings of social exclusion. Contrary to our hypotheses, social exclusion was associated with a reduction in cortisol, and social inclusion with an increase in cortisol. Both Cyberball groups showed increases in sAA and decreases in both positive and negative affect, with the greatest drop in affect occurring after social exclusion. Empathy did not differ between the social exclusion and inclusion groups and was not correlated with cortisol or sAA levels. These results support the presence of a defensive response to social exclusion in which central stress pathways controlling cortisol release are inhibited. Cortisol and sAA were shown to have distinct patterns of responses to psychological stress, with sAA responding more rapidly. Related methodological concerns for the use of these physiological stress markers and of Cyberball in social neuroscience research are discussed.     

Traumatic stress and ways of coping of community residents exposed to a train disaster

OBJECTIVES: The aims of this study were to examine the degree of traumatic stress and the coping strategies employed by community residents who lived on both sides of a rail track where a train collision occurred in 1996 in Stafford, UK. The hypothesis was that there would be a high level of traumatic stress and that emotion-focused coping would be the predictor to distress. METHOD: This was a cross-sectional survey with a retrospective design in which 66 community residents, who lived between 30 and 100 feet away from the crash site, were interviewed. The study began approximately 7 months after the disaster. The Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC) were administered to the residents. RESULTS: On the whole, the results did not entirely support the hypothesis. The residents were found to have experienced some intrusive thoughts and avoidance behaviour but their mean scores were significantly lower than those of standardized samples. Thirty-five per cent scored at 4 or above on the GHQ-28. Traumatic stress was predicted by both emotion-focused and problem-focused coping strategies. CONCLUSION: Although community residents were not on the train or related to the dead or injured in any way, they could, after being exposed to a train disaster, manifest traumatic stress symptoms which had long-lasting effects. Such traumatic stress was found to be associated with coping strategies of community residents characterized by their efforts to manage or alter the source of stress, and by their efforts to regulate stressful emotions.     

Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents

A study of 384 18-year-old adolescents living in the community demonstrated a frequent co-occurrence of substance use disorders and post-traumatic stress disorder. Multiple pathways appeared to lead to this comorbidity, which was associated with widespread psychological impairment that might have serious developmental consequences. Implications for research and practice are discussed.     

Salivary cortisol and posttraumatic stress disorder in a low-income community sample of women.

BACKGROUND: Studies of male combat veterans with posttraumatic stress disorder have demonstrated a profile of low cortisol. Studies with women with posttraumatic stress disorder (PTSD) have focused on childhood sexual abuse and holocaust survivors, both of whom experienced trauma during development, which could be different than adult trauma exposure. METHODS: Using an epidemiologic sample of low-income women from an urban area in Michigan, we conducted structured psychiatric interviews and saliva cortisol collection on a subsample of women with exposure to trauma but never PTSD (n = 72), recent PTSD (n = 29), and past PTSD (n = 70). Saliva cortisol was collected at awakening, 30 minutes later, at bedtime, and during a clinic visit. RESULTS: Recent trauma exposure but not past trauma exposure led to an increase in saliva cortisol. Neither recent PTSD nor past PTSD resulted in any saliva cortisol changes compared with the trauma exposed, never PTSD group. Recent major depression (past 12 months) demonstrated a weak effect (p =.08) on bedtime saliva cortisol. CONCLUSIONS: While recent trauma exposure can increase saliva cortisol, neither recent nor past PTSD affected saliva cortisol in our community sample of women. Our data do not support saliva cortisol changes associated with PTSD.     

Symptoms of posttraumatic stress disorder in a community sample of low-income pregnant women

OBJECTIVE: The purpose of this study was to examine symptoms of posttraumatic stress disorder (PTSD) in a community sample of low-income pregnant women who met the DSM-IV diagnostic criteria for the disorder. METHOD: Pregnant women (N=948) were screened for trauma, PTSD, depression, and co-occurring illicit substance use. PTSD symptoms were compared in traumatized pregnant women and a sample of nonpregnant traumatized women from the National Comorbidity Survey. RESULTS: Suicidal thoughts and a high degree of psychiatric comorbidity were common in pregnant women with PTSD. Pregnant women were selectively and significantly less likely to endorse reexperiencing symptoms of PTSD (29.5%, N=82), compared to nonpregnant women (79.4%, N=464). CONCLUSIONS: PTSD in pregnancy was associated with comorbidity, poor health behaviors, and lower recall of memory-related PTSD symptoms. Further prospective study is needed.     

Cumulative adversity and posttraumatic stress disorder: evidence from a diverse community sample of young adults

The authors hypothesized that a history of adversities, whether they were objectively traumatic or not, predicts risk for 1st onset of PTSD. Survival analysis in a community sample of 1,803 young adults revealed that risk is associated with retrospectively reported adverse experiences that occurred in years prior to the focal traumatic event. Analyses control for clustering of events proximal to onset. Implications for etiology and preventive intervention are noted.     

Schizophrenia: lifetime co-morbidity in a community sample

Twenty persons with schizophrenia were identified in a community sample of 2144 adult household residents interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The hierarchy-free lifetime prevalence for a variety of psychiatric disorders is compared in those with and without schizophrenia. Those with schizophrenia were found to have increased chances of having other disorders, all except one having had at least one other disorder. Major depressive episodes, obsessive compulsive disorder, phobia, alcohol abuse/dependence and drug abuse/dependence, each occurred in over half of the schizophrenics, and panic disorder, antisocial personality, and mania were each found in one sixth to one quarter of the schizophrenics. Although current diagnostic systems generally lack an empirical basis for hierarchies, the practical significance of co-morbidity must be determined from outcome studies, familial morbid risk data and possible differential effects of treatments.     

A taxometric investigation of agoraphobia in a clinical and a community sample

The nosological status of agoraphobia is controversial. Agoraphobia may be a distinct diagnostic entity or a marker of avoidance severity. The current study examines the latent structure of agoraphobia through the use of taxometric analysis. The latent structure of agoraphobia was examined in two independent samples, one comprising outpatients presenting for treatment for panic disorder (PD) with or without agoraphobia (n = 365), and the other comprising community volunteers to a national mental health survey who experienced fear or avoidance of at least one prototypic agoraphobic situation (n = 640). Two taxometric procedures were carried out – maximum eigenvalue (MAXEIG) and mean above minus below a cut (MAMBAC) – using indicators derived from questionnaire measures of, and structured diagnostic interviews for, agoraphobia. Results show consistent evidence of dimensional latent structure in both samples. It is concluded that scores on measures of agoraphobia best represent an agoraphobic severity dimension.     

Anxiety disorders in mid-adolescence: a community sample

The authors report the 6-month period prevalence of anxiety disorders in a community sample of 150 adolescents 14 to 16 years old. Diagnoses were based on structured psychiatric interviews, DSM-III criteria, and a psychiatrist's review of the data. Additional measures of affect, self-concept, and coping were also obtained for all subjects. Seventeen percent of the adolescents met criteria for one or more anxiety diagnoses and 8.7% were identified as "cases" of anxiety disorder. A significant relationship was found between anxiety and depression. The authors discuss the distribution and expression of anxiety disorders among adolescents in the community.     

Relationship among psychopathological dimensions, coping mechanisms, and glycemic control in a Croatian sample of adolescents with diabetes mellitus type 1

Psychopathological factors associated with metabolic control in juvenile insulin-dependent diabetes mellitus (IDDM) deserve further investigation. This study assessed the relationship among specific psychopathological dimensions, coping mechanisms, and metabolic control in a Croatian clinical sample of adolescents with IDDM. One-hundred and one adolescents (aged 11–18) with IDDM filled out the youth self report (YSR) assessing psychopathological dimension and the scale of coping with stress (SCS). Glycemic control was estimated by the percentage of glycated hemoglobin (HbA1c). Subjects were divided into three groups according to HbA1C values: “optimal”, “suboptimal control”, and “at high risk”. Subjects in optimal glycemic control presented with significantly lower scores in most of YSR scales compared to subjects at high risk. Moreover, they had significantly lower scores in avoidance and emotional reactivity and significantly higher scores in cognitive restructuring and problem solving SCS subscales. Regression models revealed that both internalizing and externalizing YSR scores, as well as emotional reactivity coping scores, independently contributed to explain variability of HbA1C values. Both internalizing and externalizing psychopathological dimensions, as well as emotion-oriented coping strategies, are independently associated with poor metabolic control in both boys and girls with IDDM, thus representing potential interest targets of psychotherapeutic interventions aimed at improving glycemic control in this population.     

Atenolol in premenstrual syndrome: a test of the melatonin hypothesis

Eleven patients with prospectively documented premenstrual depression were given 100 mg atenolol or placebo daily to suppress melatonin secretion during the symptomatic premenstrual phase of the menstrual cycle. There was no significant improvement in mood following treatment with atenolol vs. placebo. These findings suggest that bright light may exert antidepressant effects in patients with premenstrual syndrome through mechanisms other than melatonin suppression and that atenolol does not appear to be a viable treatment modality for the majority of patients with premenstrual depression.     

对受洪灾群体创伤后应激反应的调查

目的 探讨洪灾中受灾程度、灾前社会支持、应付方式等变量与灾后激反应的关系。方法 于１９９８年１１月采用整群抽取的方法,对１９９８年夏季长江中下游受洪灾程度不同的两个村１８～６０岁的村民５６４人,进行创伤后应激反应的调查,并测评事件影响表Ｉ（ＩＥＳ）、社会支持量表、应付方式量表。结果 （１）受灾群体普遍存在创伤后应激反应,受试中６１．５％ＩＥＳ总分超过１９分;（２）受灾突然、损失方式与创伤后应激反应     

Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults

OBJECTIVE: Few studies have focused on the natural course of posttraumatic stress disorder (PTSD) and its determinants in samples of the general population. The authors examined determinants of remission and chronicity of PTSD and associations with other disorders in a prospective community sample. METHOD: The data were drawn from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24 years) in Munich, Germany (N=2,548). The course of PTSD from baseline to follow-up 34-50 months later was studied in 125 respondents with DSM-IV PTSD or subthreshold PTSD at baseline. RESULTS: Although 52% of the PTSD cases remitted during the follow-up period, 48% showed no significant remission of PTSD symptoms. Respondents with a chronic course were more likely to experience new traumatic event(s) during follow-up (odds ratio=5.21, 95% confidence interval [CI]=1.95-13.92), to have higher rates of avoidant symptoms at baseline (odds ratio=10.16, 95% CI=1.73-59.51), and to report more help seeking (odds ratio=5.50, 95% CI=1.04-29.05), compared to respondents with remission. Rates of incident somatoform disorder (odds ratio=4.24, 95% CI=1.60-11.19) and other anxiety disorders (odds ratio=4.07, 95% CI=1.15-14.37) were also significantly associated with a chronic course. CONCLUSIONS: PTSD is often a persistent and chronic disorder. Specific symptom clusters--especially avoidant symptoms--might be associated with the course of PTSD. In addition, the occurrence of new traumatic events differentiates PTSD cases with a chronic course from those with remission.