Psychological characteristics related to cocaine use during pregnancy: a postpartum assessment.

This study assessed four psychological factors that have been suggested by previous research to be highly correlated with drug use. Twenty-one postpartum urban African-American women served as the research participants. At parturition, 10 infants tested positive for cocaine and 11 did not. Measures of depression (Beck Depression Index), anxiety (Spielberger Trait Anxiety Inventory), anger/self-control (Self-Analysis Questionnaire), and sociopathy (California Personality Inventory subscale) were obtained from the mothers within 6 weeks of delivery. Women who gave birth to cocaine-positive infants were significantly more depressed and had significantly higher sociopathy scores than their cocaine-negative counterparts. No differences with respect to anxiety and anger were obtained. The implications of these findings, as well as the potential adverse effects of cocaine use during pregnancy, are discussed.     

Development of a Russian state–trait anger expression inventory

We examined the possible universality of Spielberger's (1988) model of anger by validating a Russian State–Trait Anger Expression Inventory (STAXI). In Eckhardt, Kassinove, Tsytsarev, and Sukhodolsky (1995), support was found for all STAXI factors except anger-in, using students from St. Petersburg State University. In the present study, 346 students from Russian high schools and the Pavlov Medical School served as subjects. Using new items, we found strong support for the factor structure hypothesized by Spielberger. All scales showed good to excellent alphas, and there was substantial similarity of the current means with results from the earlier study. The Russian samples, however, showed a lower level of state anger. The data support the possibility that state anger consists of two subscales, a simple experience and an experience combined with an action tendency. Trait anger occurs as a general temperament or as a reaction to specific triggers. It is positively related to anger-out and negatively related to anger control. Future studies can use this instrument to evaluate the stability of anger in Russian speaking populations, and to assess anger experiences and expression in response to specific triggers. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53 : 543–557, 1997     

Can stress management at the workplace prevent depression? A randomized controlled trial

BACKGROUND: Stress, mental health and depression at the workplace have emerged as common and significant problems. The effectiveness of a stress-management program at the workplace was investigated. METHODS: The effectiveness of a stress-management program was examined in workers at a highly stressful workplace using a randomized controlled trial. The 58 workers in the office were randomly assigned into a stress-management group (n = 28) and a control group (n = 30). The stress-management program included lectures on the perception of stress, measures to cope with it, stress-management recording sheets, and e-mail counseling. This program was based on the cognitive behavioral approach. The stress-management program was carried out for 3 months, and perceived work-related stress and psychological symptoms were evaluated using: General Health Questionnaire (GHQ)-30, Center for Epidemiologic Study for Depression (CES-D), the Questionnaire of Work-Related Stress and the Effort-Reward Imbalance Questionnaire. Twenty-one out of the 28 in the stress-management group and all in the control group were successfully followed up. RESULTS: In the stress-management group, a significant improvement in the depressive symptoms was observed, compared with the control group in CES-D (p = 0.003 by two-tailed paired t-test, and p = 0.042 by repeated measure analysis of variance). In the multiple regression analysis, the effect of stress management on depressive symptoms at follow-up was significant (p = 0.041), controlling for potential confounding factors. However, the alleviation of perceived occupational stress was limited. CONCLUSIONS: A stress-management program based on the cognitive behavioral approach at the workplace may have potential for the prevention of depression.     

Sexually and physically abused adolescents: An empirical search for PTSD

Recently, clinical manifestations of post-traumatic stress disorder (PTSD) in children and adolescents have been investigated, yet little is known about its assessment or diagnosis. Few empirically based studies appear in the PTSD literature on non-adult populations. Data were collected from 19 physically and sexually abused adolescents (aged 13–18 years) who were living in a group home setting. Subjects were administered the MMPI, Beck Depression Inventory (BDI), and Spielberger State Trait Anxiety Inventory (STAI). Results suggest that the subjects were moderately depressed and anxious, but that these adolescents did not manifest significant symptomatology of PTSD similar to that seen in adult, civilian PTSD populations using comparable MMPl measures. Implications of these findings for assessment purposes are discussed.     

Assessment of the type D personality construct in the Korean population: a validation study of the Korean DS14

This study aimed to develop a Korean version of the Type D Personality Scale-14 (DS14) and evaluate the psychiatric symptomatology of Korean cardiac patients with Type D personality. Healthy control (n = 954), patients with a coronary heart disease (n = 111) and patients with hypertension and no heart disease (n = 292) were recruited. All three groups completed DS14, the Eysenck Personality Questionnaire (EPQ), the state subscale of Spielberger State and Trait Anxiety Inventory (STAI-S), the Center for Epidemiologic Studies Short Depression Scale (CESD), and the General Health Questionnaire (GHQ). The Korean DS14 was internally consistent and stable over time. 27% of the subjects were classified as Type D. Type D individuals had significantly higher mean scores on the STAI-S, CESD, and GHQ compared to non-Type D subjects in each group. The Korean DS14 was a valid and reliable tool for identifying Type D personality. The general population and cardiovascular patients with Type D personality showed higher rate of depression, anxiety and psychological distress regarding their health. Therefore, identifying Type D personality is important in clinical research and practice in chronic medical disorders, especially cardiovascular disease, in Korea.     

Possible connections among job stress, depressive symptoms, lipid modulation and antioxidants

BACKGROUND: Oxidative/antioxidative status may be related to psychological stress or pathogenesis of depression. SUBJECTS AND METHODS: Participants were selected from 381 female nurses working in a university hospital, and the Brief Job Stress Questionnaire was utilized to assess them. Nurses with high job stress (JS) (n = 18) and with low JS (n = 15) consented to participate in this study. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D). Cholesterols, lipid peroxidation (malondialdehyde, MDA) and antioxidants in the plasma were measured. RESULTS: High JS participants exhibited significantly higher CES-D scores (t = 3.34, p < 0.005), and significantly lower concentrations of total cholesterol (TC), low density+very low density lipoprotein cholesterols (LDL+VLDL), alpha-tocopherol, and beta-carotene compared with low JS participants (t = 2.69, p < 0.05; t = 3.46, p < 0.005; t = 2.96, p < 0.05; t = 2.98, p < 0.05, respectively). However, the reductions in plasma indicators were substantially weakened after controlling for lifestyle factors with the exception of LDL+VLDL and alpha-tocopherol. In addition, the significance of alpha-tocopherol concentrations appeared to depend on cholesterol levels. CES-D scores correlated positively with plasma MDA levels, the MDA/TC ratio and the MDA/LDL+VLDL ratio among the low JS group (r = 0.69, p < 0.001; r = 0.79, p < 0.001; r = 0.75, p < 0.005, respectively), whereas there were no correlations among the high JS group. After controlling for lifestyle covariates, the relationship between CES-D scores and the MDA/LDL+VLDL ratio remained significant (beta = 0.95, p < 0.05) using a multiple linear regression model (F = 3.61, p < 0.05). LIMITATIONS: Sample numbers in each JS group were relatively small. CONCLUSIONS: Psychological stress may reduce the plasma levels of LDL+VLDL accompanying an alpha-tocopherol decrease. There appeared to be a correlation between elevated MDA and depressive symptoms in low JS participants.     

Psychosocial predictors of long-term mortality among women with suspected myocardial ischemia: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

This paper evaluated long-term associations between psychosocial factors and premature mortality among women with suspected coronary artery disease (CAD). We tracked total mortality events over a median 9.3 years in a cohort of 517 women [baseline mean age = 58.3 (11.4) years]. Baseline evaluations included coronary angiography, psychosocial testing, and CAD risk factors. Measures included the Spielberger Trait Anxiety Scale, Beck Depression Inventory, self-rated health, and Social Network Index. Cox regression analysis was used to assess relationships. Covariates included age, CAD risk factors, and CAD severity. BDI scores (HR 1.09, 95 % CI 1.02–1.15), STAI scores (HR .86, 95 % CI .78–.93), and very good self-rated health (relative to the poor self-rated health group; HR .33, 95 % CI .12–.96) each independently predicted time to mortality outcomes in the combined model. SNI scores (HR .91, 95 % CI .81–1.06) and other self-rated health categories (i.e., fair, good, and excellent categories) were not significant mortality predictors after adjusting for other psychosocial factors. These results reinforce and extend prior psychosocial research in CAD populations.     

Trait and state anxiety in Israeli student athletes

Examined trait anxiety in three groups of Israeli physical education students (N = 251): competitors in individual sports, in team sports, and noncompetitors. The measure was the Spielberger, Gorsuch, and Lushene Trait Anxiety Scale (1970). Both groups of competitive athletes were lower in trait anxiety than noncompetitors. In addition, the two groups of competitive athletes were compared on State Anxiety as measured by the Spielberger scale and a physiological measure of heart rate. There were no differences in state anxiety among competitive athletes. Women competitive athletes were higher in trait, but not in state, anxiety. A high correlation was found between the psychometric and physiological measures of state anxiety.     

医务人员压力反应与社会支持、生活事件、应对方式的相关研究

目的：研究生活事件、应对方式、社会支持等应激有关因素对医务人员应激反应的影响。探讨在应激系统中各应激有关因素的作用途径。方法：使用领悟社会支持量表、生活事件量表、特质应对方式问卷和自编压力反应问卷对556名医务人员进行调查。结果：单因素相关分析显示：压力反应与生活事件、应对方式、社会支持之间相关均有显著性意义。多因素回归分析和路径分析表明生活事件、应对方式、社会支持对压力反应均有预测性。其中消极应对方式是影响医务人员压力反应的最主要因素；积极应对方式通过影响消极应对方式间接影响压力反应；生活事件可以直接导致压力反应，也可通过应对方式间接影响压力反应；社会支持对压力反应没有直接影响，而是通过生活事件和应对方式来影响压力反应。结论：心理压力是多因素相互作用的系统。     

The effect of a naturalistic stressor on frontal EEG asymmetry, stress, and health

The aim of the current study was to investigate the effect of a naturalistic stressor, examination stress, on frontal EEG asymmetry, psychological stress, hormonal stress, and negative health. Forty-nine subjects were tested during periods of low and high examination stress. During the high examination stress period, subjects reported higher levels of stress on the Spielberger State Anxiety Inventory and Cohen's Perceived Stress Scale. However, no change in cortisol was detected across the two sessions. Furthermore, a shift from relatively greater left frontal activity during the low examination session to relatively greater right frontal activity during the high examination session was also found. Moreover, the increasing right frontal activity asymmetry associated with the high exam session compared to the low exam session correlated with increasing reports of negative health. No evidence was found for the prediction that cortisol mediated either the relationship between examination stressor and right frontal asymmetry or between right frontal asymmetry and negative health. In conclusion, while the findings from this study are compelling, the mechanism mediating increases in psychological stress, relatively greater right frontal activity, and increases in negative health from naturally occurring stressors is in need of further investigation.     

Anger expression and ambulatory blood pressure: a comparison of state and trait measures.

OBJECTIVES: The goals of this study were (1) to compare trait and state measures of anger expression, (2) to examine associations between situational variables and anger expression, and (3) to examine relationships between trait and state anger expression and ambulatory blood pressure. METHODS: One hundred college students completed state and trait versions,of the Spielberger (1) anger expression scale. State measures were completed in response to specific anger-provoking situations as they occurred over a 7-day period. Ambulatory blood pressure was recorded on one of these days. RESULTS: Moderate correlations were observed between trait and state anger expression. Significant associations were found between a number of situational variables and state anger expression scales. Neither trait nor state anger expressions scales were related to blood pressure levels. CONCLUSIONS: These results indicate that trait and state measures of anger expression are not equivalent and that situational factors play an important role in anger expression. Situational variability may be an important factor in determining the health consequences of anger expression.     

Passage meditation reduces perceived stress in health professionals: a randomized, controlled trial

The authors evaluated an 8-week, 2-hr per week training for physicians, nurses, chaplains, and other health professionals using nonsectarian, spiritually based self-management tools based on passage meditation (E. Easwaran, 1978/1991). Participants were randomized to intervention (n = 27) or waiting list (n = 31). Pretest, posttest, and 8- and 19-week follow-up data were gathered on 8 measures, including perceived stress, burnout, mental health, and psychological well-being. Aggregated across examinations, beneficial treatment effects were observed on stress (p = .0013) and mental health (p = .03). Treatment effects on stress were mediated by adherence to practices (p = .05). Stress reductions remained large at 19 weeks (84% of the pretest standard deviation, p = .006). Evidence suggests this program reduces stress and may enhance mental health.     

The effects of physical activity in the acute treatment of bipolar disorder: a pilot study

BACKGROUND: Physical activity has demonstrated efficacy in depression and anxiety, but its potential in the management of bipolar disorder is yet unexplored. This study is a pilot investigation into the effectiveness of an adjunctive walking program in the acute treatment of bipolar disorder. METHODS: This is a retrospective cohort study of all patients admitted over a 24-month period to a private psychiatric unit with a primary diagnosis of bipolar disorder (ICD-10). All patients were invited to participate voluntarily in a walking group during their admissions. Those who reliably attended the walking group (participants) were compared against those who did not attend (non-participants), using the clinician-rated Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I) scales and the self-reported 21-item Depression Anxiety Stress Scales (DASS) as primary outcome measures. RESULTS: There were 24 admissions for participants and 74 admissions for non-participants. The two groups did not differ significantly in patient demographics or admission CGI and DASS measures, except for a lower DASS Stress subscore for participants (p=0.049). At discharge, the inter-group differences in CGI measures remained non-significant, but participants had significantly lower scores than non-participants for DASS (p=0.005) and all its subscales (Depression p=0.048, Anxiety p=0.002, Stress p=0.01). LIMITATIONS: Methodological limitations include a retrospective design, small sample size, lack of randomisation or control, and indirect measure of manic symptoms. CONCLUSIONS: The results of this trial provide preliminary support for a therapeutic role of physical activity in bipolar disorder, and warrant further investigation with randomised controlled trials.     

Anger expression and natural killer cell activity in family caregivers participating in a physical activity trial

Associations between psychological functioning and natural killer cell activity (NKA) were examined in 23 older (62.2 ± 7.5 years) family caregivers randomized to a moderate intensity four-month exercise program or to a wait-list control condition. At baseline, although NKA was related to anger-control (r = -.42; trend p < .06) and anger-out (r = .50; p < .03), it was not related to depression, anxiety, perceived stress, or caregiver burden. After controlling for baseline NKA, changes in anger-control explained 14 percent of the variance in NKA four months later. Decreases in anger-control predicted increases in NKA. Group assignment (exercise vs control) was unrelated to changes in NKA over the four-month period; however, the study was not powered to detect this effect. These results are consistent with reported relationships of anger expression with other physiological measures, and extend the importance of anger expression to immune functioning in older family caregivers.     

应激相关因素与护士生活质量的关系

目的：研究应激相关因素对护士生活质量的影响，为改善护士生活质量提供参考．方法：采用整群抽样法，用生活质量综合评定问卷、压力反应问卷、生活事件量表、特质应对方式问卷、领悟社会支持量表、艾森克人格问卷对405名护士进行调查。结果：应激相关的5个因素与综合生活质量及其中的躯体、心理和社会功能3个维度均显著相天；多元回归分析表明：应激相关因素对综合生活质量以及躯体功能、心理功能、社会功能、物质功能4个维度的预测力分别为53.4％、32．6％、57．6％、46％、6.6％．结论：应激相关因素对护士生活质量有显著影响。     

Behavioral States and Milk Immunology in Preterm Mothers

The purpose of this study was to analyze behavioral states in preterm mothers and determine the presence of relationships between these states andbiological markers potentially related to maternal stress (i.e., Cortisol and secretory Immunoglobulin A [slgA] in the mothers milk). Lactating, postpartum (Days 6 through 9) mothers (N = 41) of infants born between 29 and 36 weeks gestation were recruited to participate. Mothers were instructed to collect a pooled 24-hr sample of hindmilk and complete a demographic questionnaire, the Profile of Mood States (POMS), and the Spielberger State Anxiety Scale on Day 5 or 6 postpartum. Depression, fatigue, confusion, and tension subscale scores on the POMS were all higher than published normative sample scores, whereas anger and vigor scores were lower. Anger and vigor scores were significantly correlated to slgA concentration. Median splits of each of the mood state scores indicated that low scorers on every negative mood scale, except anger, had higher milk slgA concentrations, whereas high scorers had lower milk slgA concentrations. High scorers on both the anger and the vigor scales had higher milk slgA concentrations. These differences were not statistically significant but may represent a trend that could be further analyzed with a larger number of subjects. Consistent with the literature and our own studies, the slgA concentration was higher than that found in comparable term milk. There was a statistically significant inverse relationship between milk slgA and Cortisol, suggesting a possible influence of Cortisol on the secretion of antibody by milk B lymphocytes.     

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

OBJECTIVE: Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of life (QoL) and perceptions of self-efficacy and mastery, and (2) whether increased perceptions of mastery and self-efficacy contributed to a higher QoL after rehabilitation. METHODS: Thirty-nine consecutive COPD patients (aged 60.5 +/- 9.0) were included from a rehabilitation centre and completed self-report questionnaires assessing symptoms, QoL, and perceptions of personal control. RESULTS: COPD patients improved during rehabilitation in overall QoL and self-efficacy, although no significant changes were found in QoL domains and mastery. Changes in self-efficacy during rehabilitation contributed to the explanation of the social and psychological functioning QoL domains. CONCLUSION: Even in seriously impaired COPD patients in advanced stages of illness, positive changes in self-efficacy and overall well-being can be established during rehabilitation. Changes in self-efficacy were related to a better QoL, suggesting the importance of personal control in the adjustment to COPD. PRACTICE IMPLICATIONS: Focussing more explicitly on the enhancement of perceptions of personal control in COPD patients may be an important aim of pulmonary rehabilitation.     

Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990

BACKGROUND: There have been six randomized controlled trials of psychological therapy with generalized anxiety disorder (GAD) using DSM-III-R and DSM-IV. All have used the Trait version of the Spielberger State-Trait Anxiety Inventory (STAI-T) as one of several outcome measures. Each study, however, employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment. METHODS: Raw data on STAI-T scores at pre-, post- and follow-up were obtained for each of the six studies (total N = 404). Jacobson methodology for defining clinically significant change (criterion c, reliable change index = 8, cut-off point = 46) was used to allocate each patient to one of four outcomes: worse, unchanged, improved and recovered. The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment. RESULTS: A recovery rate of 40% was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30% or less. Two treatment approaches--individual cognitive behavioural therapy and applied relaxation--do relatively well with overall recovery rates at 6-month follow-up of 50-60%. CONCLUSIONS: Jacobson methodology, in distinguishing between improvement and recovery on a standardized measure of general vulnerability to anxiety, provides a stringent but clinically more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto. Systematic focus on either excessive worry or physiological arousal gives worthwhile results.     

Psychological and physiological predictors of lipids in black males

The association between lipids and both psychological and physiological measures were examined in this study of healthy black males. The results revealed that certain psychological measures, namely, State and Trait Curiosity and Trait Anger, explained a significant proportion of the variance in high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides. Although psychological factors accounted for a significant proportion of the variance in lipids (29% for HDL, 25% for LDL, 64% for LDL/HDL, 29% for triglyceride), the amount of explained variance was significantly increased by the inclusion of both psychological and physiological variables in the regression equation. However, neither of the psychological variables explained any of the variance for total cholesterol when physiological variables were included in the regression analysis. The overall pattern of the findings suggests that black males who are at increased risk for elevated lipid levels may be identified by their level of mental vigilance, the frequency at which their anger is experienced, and the presence of other traditional risk factors.This work was supported by NHLBI Grant RO1-HL38424 to Dr. Johnson, who completed this study at the Division of Hypertension at the University of Michigan Medical Center.