Families of adolescents and adults with autism spectrum disorders in Taiwan: The role of social support and coping in family adaptation and maternal well-being

In this study we examined differences in social support and coping between mothers of adolescents and adults with an autism spectrum disorder (ASD) in Taiwan and the United States and to investigate the effects of social support and coping strategies on family adaptation and maternal well-being. Participants were 76 Taiwanese mothers who had at least one son or daughter with an ASD (10 years old and older), and a comparison group of 325 mothers in the United States matched on the age range of the child with an ASD. Mothers completed self-administered, written questionnaires and participated in an interview. Taiwanese mothers reported significantly greater use of problem-focused and emotion-focused coping strategies than did mothers in the United States. For Taiwanese families, greater use of problem-focused coping strategies was associated with lower levels of depressive symptoms and anxiety. Emotion-focused coping mediated the relationships between ethnicity/culture and several outcome measures: family adaptability, family cohesion, and maternal depressive symptoms. The higher levels of emotion-focused coping in Taiwanese mothers appeared to account for their lower levels of family adaptability and cohesion and higher levels of maternal depressive symptoms. The results from this cross-cultural study helped determine the role of social support and coping strategies in family adaptation and maternal well-being in families of individuals with an ASD in each culture. Implications for service delivery are discussed.     

Coping strategies,caregiving burden,and depressive symptoms of Taiwanese mothers of adolescents with autism spectrum disorder

Little research focuses on the caregiving experiences of Taiwanese mothers of adolescents with autism spectrum disorder (ASD). The effects of the caregiving burden and coping strategies on the depressive symptoms of 60 of these mothers were examined. The adolescents they cared for ranged from 10 to 19 years old (mean age: 14.7 years). Mothers completed self-report written questionnaires. Findings indicated that greater use of problem-focused rather than emotion-focused coping was generally associated with lower levels of caregiver burden and fewer depressive symptoms. Problem-focused coping acted as a buffer when caregiving burdens were high. Specifically, actively confronting, planning, and suppressing competing activities as coping strategies moderated the effect of the caregiving burden on the depressive symptoms of these mothers. This significant buffering effect reflected adaptation to the caregiving burden. Awareness of the effects of coping strategies on maternal well-being could serve as a valuable guide for practitioners.     

Differences in coping effectiveness and well-being among aging mothers and fathers of adults with mental retardation

In this longitudinal study, we examined stress and coping processes among 133 married mothers (age 59 to 83) and fathers (age 56 to 84) of adults with mental retardation (age 19 to 53). There were no differences between mothers and fathers with respect to their frequency of use of emotion-focused coping, but mothers used significantly more problem-focused coping strategies than did their husbands. For mothers, greater use of problem-focused coping strategies and lower use of emotion-focused coping buffered the impacts of caregiving stress on their psychological well-being. However, for fathers, no buffering effects of coping were detected. The implications of gender differences in coping effects were examined in the context of the impact of lifelong caregiving.     

Appraised control, coping, and stress in a community sample: A test of the goodness-of-fit hypothesis

Lazarus and Folkman proposed one of the most comprehensive theories of stress and coping in the psychology literature, but many of their postulates have received little empirical attention, and some of the existing research has yielded contradictory findings. This longitudinal study sought to clarify the associations among control appraisal, coping, and stress within this theoretical framework. The theory postulates that coping strategies used tend to match the level of appraised controllability of the stressor (matching hypothesis). It further states that the effects of problem-focused versus emotion-focused coping are moderated by the appraised controllability of the stressor (goodness-of-fit hypothesis). An alternative to the latter is the main-effects hypothesis, which states that problem-focused coping is generally more effective in reducing distress regardless of appraisal. These hypotheses were tested on 72 adults who completed questionnaires on coping and control appraisal. Stress was assessed using self-report (Symptom Checklist-90-Revised) and a behavioral measure (proofreading task) at two times approximately 2 months apart. Appraised control significantly predicted type of coping such that greater control was associated with more problem-focused and less emotion-focused coping. Although the main-effects hypothesis was not supported, the goodness-of-fit hypothesis was partly confirmed by a significant control by emotion-focused coping interaction predicting both self-report and behavioral measures of stress. We acknowledge Laura Redwine, Ph.D. for her contributions to the research project; Michele Hayward, M.S. and Janel Alberts, M.S. for their help with data processing; and Kimberly Laubmeier, M.S. for her comments on an earlier version of the article.     

A Comparative Analysis of Well-Being and Coping among Mothers of Toddlers and Mothers of Adolescents with ASD

The present study examined the impact of autism symptoms and coping strategies on the well-being of mothers of children with autism spectrum disorder (ASD). The sample consisted of 153 mothers of toddlers and 201 mothers of adolescents drawn from two ongoing, longitudinal studies of families of individuals with ASD. For mothers of toddlers, lower levels of emotion-focused coping and higher levels of problem-focused coping were generally associated with better maternal well-being, regardless of the level of child symptomatology. For mothers of adolescents, coping often acted as a buffer when autism symptoms were high. Although there was evidence of maternal distress in both groups, the presence of significant buffering effects reflects adaptation in the face of stress, particularly for mothers of adolescents.     

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.     

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.     

Psychological factors in recurrent genital herpes infection: stress, coping style, social support, emotional dysfunction, and symptom recurrence

The relationship among stress, coping style, emotional dysfunction, social support, and severity of symptoms (frequency of recurrence, and pain, duration, and bother of recurrences) was investigated in 35 females and 32 males suffering from severe cases of genital herpes infection. Level of emotional dysfunction as measured by the SCL-90 approached two standard deviations above the mean as compared with non-patient normals, and frequency, pain, and bother of recurrences were associated with level of emotional dysfunction. Negative life stress (as measured by the Life Experiences Survey) was unrelated to psychopathology, and was associated only with duration among the symptom measures. Regression analyses indicated that higher frequencies of recurrence and greater discomfort associated with symptoms were associated with an external locus of control orientation and with a tendency to use emotion-focused wishful thinking and to avoid using cognitive strategies to cope with the stress associated with herpes. It was suggested that stress management procedures involving teaching of problem-focused coping strategies and provision of social support would be most effective for this population.     

The process of a group intervention for caregivers of demented persons living at home: conceptual framework,components, and characteristics

Most earlier group interventions for caregivers of demented persons lacked a theoretical basis to guide the intervention process and focused on providing information and practical advice and encouraging the expression of feelings. This article presents the process of a group intervention with emphasis on its conceptual framework, components and characteristics. As caregivers are exposed to numerous daily stressful demands, the intervention's conceptual framework was derived from Lazarus and Folkman's transactional theory of stress and coping and Folkman's Coping Effectiveness Training Program. The central aim of the intervention was to improve the ability of caregivers to cope with the stressful demands at the core of caring for a demented person, rather than to focus on information and the task-oriented aspects of caring. The two components of the intervention deal with the cognitive appraisal of stressors and coping strategies, with a view to determining which strategies are most appropriate on the basis of the changeability of stressors. Three coping strategies were proposed: problem solving (problem-focused coping to deal with changeable stressors), reframing (emotion-focused coping to manage the emotional response to unchangeable stressors), and seeking social support (problem- or emotion-focused coping). The most salient characteristics of this group intervention were its intensity (15 meetings) and its focus on the caregivers' daily reality, which provided concrete reference points for the discussion of conceptual notions.     

Burden of relatives and predictors of burden. Baseline results from the Munich 5–year–follow–up study on relatives of first hospitalized patients with schizophrenia or depression

In the present study, part of the Munich 5-year follow-up study on key relatives of first-hospitalized schizophrenic and depressive patients, baseline results with respect to relatives' burden and predictors of burden are presented. Basing on a transactional stress model the following hypothesis was tested: the impact of the patients' illness on their relatives' stress outcome is moderated by the psychosocial resources of the relatives. Stress outcome was measured in terms of objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. Potential moderating variables included age and gender, generalized stress response and illness-related coping strategies, beliefs of control,perceived social support,personality factors, expressed emotion and life stressors. A total of 83 relatives, whose ill family members had been hospitalized in the Department of Psychiatry of the Ludwig-Maximilians-University of Munich for the first time, participated in the study. Findings did not entirely support the hypothesis. On the one hand, relatives' stress outcome was independent of the objective stressors (severity of the illness, kind of symptoms, level of psychosocial functioning at admission). On the other hand, burden was significantly associated with several psychosocial resources and dispositions of the relatives. Multivariate linear regression analyses indicated that expressed emotion, emotion-focused coping strategies and generalized negative stress response are the most relevant predictors of burden. It is argued that a multidimensional approach in burden assessment is necessary and has relevant implications for improving family intervention strategies.     

Do Coping Strategies Mediate the Relationship Between Parental Attachment and Self-Harm in Young People?

Insecure attachment is associated with self-harm in young people, but little research has explored the pathways through which this relationship develops. We investigated whether attachment impacts on self-harm via its effect on coping strategies and appraisal of problem-solving abilities. A total of 314 students aged 18–20 years completed an online survey with measures of parental attachment, emotion-focused and problem-focused coping strategies, and psychological distress and self-harm. A mediational model was not supported as there were no direct effects between parental attachment and self-harm. However, analysis of specific indirect pathways revealed that perceived parental attachment impacts on self-harm through problem-focused coping. Higher quality of attachment was associated with greater reliance on problem-focused (adaptive) coping, which in turn was associated with a decreased risk of having self-harmed. Furthermore, poorer paternal attachment was associated with lower appraisal of problem-solving skills, which in turn was associated with an increased risk of having self-harmed. Individuals with insecure attachment may be more vulnerable to self-harm because they lack other more constructive coping strategies for relieving stress.     

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.     

Variations of lymphocyte subsets associated with stress in depressive populations

Major depression and dysthymia have been associated with increased perception of day-to-day stressors, greater reliance on emotion-focused coping efforts, and reduced perception of uplifting events. Moreover, it has been observed that levels of circulating natural killer (NK) cells were elevated in depressed patients. Given that mild stressors may increase circulating NK cells, it is conceivable that the elevated NK cells in depression may be secondary to the increased stress perception associated with the illness. In the present investigation a laboratory stressor, comprising a mathematical challenge, increased circulating NK cells; however, the extent of the increase was comparable in depressive, dysthymic and control subjects. Moreover, the increased NK cells induced by the stressor procedure appeared to be independent of variations of plasma cortisol, ACTH or norepinephrine. Interestingly, although the NK changes were not differentially influenced by stressors in the subject populations, in the major depressive patients correspondence existed between NK cell levels and emotion-focused coping styles. Likewise, the response to a laboratory stressor was directly related to the severity of depression and to the use of coping styles involving cognitive restructuring or problem solving.     

Emotional distress, coping and adjustment in family members of neuroscience intensive care unit patients

Objective

We evaluated emotional distress, coping strategy use, caregiver adjustment, and the relationship among these variables in family members (FMs) of patients hospitalized in a neuroscience intensive care unit (NSICU).

Methods

Fifty-one primary relatives of NSICU patients were administered the Brief Symptom Inventory (BSI) and an abbreviated version of the COPE within 2 days of admission to the NSICU, just prior to patient discharge from the unit, and approximately 30 days after patient discharge (follow-up). FMs' adjustment to the role of caregiver was also evaluated at follow-up with the Caregiver Appraisal Scale (CAS).

Results

BSI emotional distress levels were higher than those of the nonpatient normative sample at patient admission, but, except for anxiety, were within a standard deviation of the mean of the said group; with the exception of anxiety they declined to below nonpatient normative levels at follow-up. Females' distress levels were higher than those of males'. FMs' use of both problem-focused and emotion-focused coping strategies increased from admission through follow-up. Emotional distress was unrelated to problem-focused coping but was associated with emotion-focused coping at admission and discharge, with use of denial as a coping strategy primarily accounting for this relationship. Extent of use of both problem-focused and emotion-focused coping at admission was associated with better caregiver adjustment at follow-up, but over time only increases in problem-focused coping were associated with better subsequent caregiver adjustment.

Conclusions

Findings suggest that interventions fostering increased use of problem-focused coping and sense of control will be effective in lowering FM distress level and enhancing subsequent adjustment in the role of caregiver.     

Urban adolescent stress and hopelessness

This study sought to explore potential mechanisms through which uncontrollable, chronic stressors may lead to hopelessness in low-income, urban adolescents. In particular, the roles of specific coping strategies as moderators and/or mediators of the association between stressors and hopelessness were examined. Results suggest that chronic, uncontrollable stressors were significantly and positively related to hopelessness in this sample. Active coping, distraction coping, and social-support-seeking coping emerged as moderators for males, such that uncontrollable stressors were more highly associated with hopelessness for those boys who reported using more active, distraction, and social-support-seeking coping strategies. An analogous moderating effect was found for ruminative coping for girls. Ruminative coping also emerged as a mediator of the relation between uncontrollable stressors and hopelessness for girls.     

The impact of coping on the relation between symptoms and quality of life in schizophrenia

The relation between severity of symptoms and level of quality of life in schizophrenia is not strong. This situation may be explained by the hypothesis that the relation is moderated by ways of coping which are known to overcome stress. The main objective of the study was to evaluate this hypothesis by assessing the relations between positive and negative symptoms, problem-focused and emotion-focused ways of coping, and various domains of quality of life in a group of psychiatric outpatients diagnosed with schizophrenia. Subjects were recruited from a community mental health center. Fifty-eight adult outpatients diagnosed with schizophrenia who gave informed consent were assessed cross-sectionally with the Positive and Negative Syndrome Scale (PANSS), the Ways of Coping Checklist, and the Wisconsin Quality of Life Index. Negative symptoms were inversely related to activities of daily living, and positive symptoms were directly related to distress. There were no other significant relations between symptoms and quality of life. Problem-focused and emotion-focused coping did not moderate the relation between symptoms and quality of life. Further study is required concerning coping in schizophrenia.     

The relationship of gender,gender identity,and coping strategies in late adolescents

The relationships among gender, gender identity, and coping in late adolescents were examined. One hundred sixty-nine late adolescents completed measures assessing their masculinity and femininity, as well as their use of coping strategies. Females endorsed greater use of emotion-focused coping strategies than males. Late adolescents who were high in masculinity endorsed higher levels of problem-focused coping strategies than those who were low in masculinity. In contrast, late adolescents who were high in femininity endorsed higher levels of emotion-focused coping strategies than those who were low in femininity. Neither the gender nor the masculinity and femininity of late adolescents were predictive of the use of avoidant coping strategies. Overall, gender identity made an important and independent contribution to the endorsement of coping strategy use. These results emphasize the importance of assessing both gender and gender identity with regard to coping in late adolescents.     

The Impact of Coping on the Relation Between Symptoms and Quality of Life in Schizophrenia

Abstract

The relation between severity of symptoms and level of quality of life in schizophrenia is not strong. This situation may be explained by the hypothesis that the relation is moderated by ways of coping which are known to overcome stress. The main objective of the study was to evaluate this hypothesis by assessing the relations between positive and negative symptoms, problem-focused and emotion-focused ways of coping, and various domains of quality of life in a group of psychiatric outpatients diagnosed with schizophrenia. Subjects were recruited from a community mental health center. Fifty-eight adult outpatients diagnosed with schizophrenia who gave informed consent were assessed cross-sectionally with the Positive and Negative Syndrome Scale (PANSS), the Ways of Coping Checklist, and the Wisconsin Quality of Life Index. Negative symptoms were inversely related to activities of daily living, and positive symptoms were directly related to distress. There were no other significant relations between symptoms and quality of life. Problem-focused and emotion-focused coping did not moderate the relation between symptoms and quality of life. Further study is required concerning coping in schizophrenia.     

Specific coping behaviors in relation to adolescent depression and suicidal ideation

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories’ associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors.     

Post-trauma symptoms following indirect exposure to the September 11th terrorist attacks: The predictive role of dispositional coping

Few data prospectively address the role of coping in the development of PTSD. In the present study, 308 undergraduates were assessed for coping prior to the 9/11 WTC attack and for PTSD symptomatology at one and three-months post-9/11. Multiple regression analyses indicated that emotion-focused coping was predictive of increased symptomatology at Month 1 and Month 3, whereas problem-focused and avoidance-focused coping were not. Specifically, analyses predicting PTSD symptom factors (Intrusions, Avoidance, Dysphoria, and Hyperarousal) indicated that greater emotion-focused coping predicted increased Dysphoria symptoms at both time points and, among females, increased levels of Hyperarousal symptoms at Month 1. The role of coping style in the development of PTSD symptomatology and its clinical implications are discussed.