Coping with stress by children and adolescents with cancer

Children and adolescents with cancer not only have to cope with everyday stressors and developmental tasks, as do their healthy peers, but also with illness-related stressors. Thus, it can be assumed, that children and adolescents with cancer differ from healthy peers in coping. Stress reactions and adjustment have been investigated in recent studies. In contrast, coping styles have not often been in the focus of research. In this study, the coping of children and adolescents with cancer (n = 60, 8-13 years of age) was compared to the norm, measured by the German Coping Questionnaire for Children and Adolescents (SVF-KJ; Hampel et al. 2001). The results indicated that the subjects with cancer used more positive and less negative coping strategies when confronted with school-related or social stressors. The results are discussed with respect to the experience with disease-related stress and the possibility of repressive coping.     

不同负性情绪与应对方式对超重／肥胖青少年情绪性进食的影响

目的：了解超重／肥胖青少年情绪性进食的现状,探索不同负性情绪及应对方式对情绪性进食的影响。方法采用进食行为问卷、抑郁－焦虑－压力量表、中学生应对方式量表对181名超重／肥胖青少年进行集体施测。结果（1）男生与女生在情绪性进食上差异无统计学意义（t ＝0．532,P ＞0．05）,高中阶段的青少年比初中阶段的青少年表现出更多的情绪性进食（t ＝3．353,P ＜0．01）。（2）情绪性进食与负性情绪各维度（r ＝0．522～0．581,P ＜0．01）及情绪指向的应对方式（r ＝0．571,P ＜0.01）均呈正相关,而与 BMI 值和问题指向的应对方式无相关性（P ＞0．05）。（3）焦虑和情绪指向的应对方式可对情绪性进食正向预测（R2＝0．45,P ＜0．01）。结论负性情绪及情绪指向的应对方式与情绪性进食存在相关性,并且焦虑和情绪指向的应对方式可以增加情绪性进食。     

Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes

OBJECTIVES: To evaluate coping styles and quality of life in youth with Type 1 diabetes with and without eating disorders and to identify relationships between these variables in each group. METHODS: Adolescents were evaluated for eating disorders with a two-stage diagnostic procedure. Adolescents with and without eating disorders then provided data on coping styles and on subjective well-being. RESULTS: Adolescents with Type 1 diabetes and disordered eating behavior reported more often blaming themselves and resorting to wishful thinking and poorer physical and psychosocial quality of life than do adolescents with Type 1 diabetes without disordered eating behavior. Specific coping strategies were also positively linked with quality of life and metabolic control. CONCLUSIONS: Eating disorders and disordered eating behavior in adolescents with Type 1 diabetes seem to be associated with certain negative and avoidant coping strategies and with impeded physical and bio-psychosocial well-being.     

Individual differences in adolescent health symptoms: the effects of gender and coping

Previous studies have suggested that adult men and women experience different types and severities of physical and psychological health symptoms. This study examined whether in the case of adolescents these reported gender differences in physical and psychological health symptoms could actually be the result of differences in coping styles. Five hundred and forty-six adolescents were questioned on their coping styles and symptoms. We found gender differences in physical and psychological health symptoms (e.g. anger, depression, tension, negative moods), as well as in coping styles. We also found that the relation between health symptoms and coping varied significantly by gender. The results of this study suggest that doctors, school counselors and family therapists may want to take gender differences in coping styles into account when seeing adolescent patients for physical or psychological health symptoms, and find ways to help the adolescents cope more effectively with their stressors.     

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.     

Coping and quality of life among children and adolescents with attention deficit/hyperactivity disorder

First studies suggest an impaired emotion regulation especially with negative emotions among children and adolescents with attention deficit/hyperactivity disorder (ADHD), which particularly emerged in the subgroup with comorbid conduct disorder. Moreover, first results have shown that quality of life of children and adolescents with ADHD are negatively affected compared to healthy controls. The present study examined differences in age and subgroup on coping and quality of life among boys with ADHD. Furthermore, coping and quality of life were compared to healthy norms. In total, N=48 boys with ADHD with and without conduct disorder (ages 8 to 12 years) were asked to complete self-report questionnaires on coping and quality of life. Fifth and sixth graders with ADHD reported less distraction than third and fourth graders. The subgroup with ADHD and conduct disorder showed more passive avoidance and resignation compared to the subgroup with ADHD alone. Compared to normative data, especially third and fourth graders with ADHD showed an increased maladaptive coping. Additionally, the subgroup with conduct disorder scored higher on all maladaptive coping strategies than the normative sample. Finally, all domains of quality of life were impaired among children and adolescents with ADHD compared to normative data. These findings support the consideration of emotion regulation and quality of life in the research of ADHD in childhood and adolescence to develop effective programs for prevention and intervention.     

温州留守中学生自我意识、应对方式与家庭环境状况调查

目的了解温州地区留守中学生的心理特点。方法对温州地区二所中学共196例初中学生的心理状况进行评定，其中留守中学生91例，非留守中学生105例。评定工具采用儿童自我意识量表（CSCS）、应付方式问卷（CPQ）和家庭环境量表（FES-CV）。结果留守中学生与非留守中学生相比，CSCS焦虑因子分较高（P〈0．01）、躯体外貌因子分较低（P〈0．01）。CPQ留守中学生的成熟应付方式因子分如解决问题、求助高于非留守中学生（P〈o．01），不成熟应付方式因子如退避也显著高于非留守中学生（P〈0．01），幻想因子分也较高（P〈0．05）。留守组中学生在FES-CV独立性因子评分显著低于非留守中学生（P〈0．01），控制性因子评分留守儿童组也较低（P〈0．05）。结论留守中学生更倾向焦虑、自信心不足，应付方式矛盾，家庭中可能会表现依赖与任性。     

Examining stress and coping as a mediator for internalizing symptomatology: A comparison between sexual minority and majority first-year college students

Sexual and gender minority (SGM) adolescents experience unique stressors and elevated internalizing symptoms. This study examines differences in coping styles between SGM and heterosexual adolescents and the potential mediating roles of stress and coping styles. Analyses indicated that SGM (N = 75) adolescents reported higher levels of internalizing symptoms (depression, anxiety, and distress), higher use of maladaptive coping styles (denial and blame), lesser use of adaptive coping styles (reframing and religion), and greater experiences of stress, compared to their heterosexual counterparts (N = 1702). Bootstrapping analyses revealed the relationship between sexual identity and internalizing symptoms measured approximately 3 months later was not mediated by stress and coping, adjusting for gender, age, and baseline symptomatology. Findings suggest that earlier adolescent differences in internalizing symptoms presage increasing symptomatology across the transition to college, and other mediators during the college transition explain the continued increases in internalizing symptoms.     

Early detection of bipolar disorder: a pilot familial high-risk study of parents with bipolar disorder and their adolescent children

OBJECTIVES: Disturbances in cognition, affect, sleep and activity have been identified in bipolar disorder (BD) but little is known about the possible role of these factors in the development of the condition. We studied these variables in a familial high-risk sample. METHODS: Twenty-five children (13-19 years) of bipolar parents were compared with 22 similar aged children of age- and sex-matched healthy controls. Participants were assessed using Schedule for Affective Disorders and Schizophrenia-Lifetime version (SADS-L) and completed self-report measures of dysfunctional attitudes, behavioural inhibition/activation, social rhythms, coping styles and subjective experience of sleep. Children completed a 7-day recording of actigraphy (sleep and activity) and a 7-day diary measuring self-esteem, positive and negative affect and reactions to positive and negative events. RESULTS: Fifty-six per cent of children of bipolar parents (CBP) reported mood symptoms compared to 9% of children of control parents (CC). The CBP group had coping styles and instability of self-esteem consistent with abnormal strategies for regulating affect. Both groups also differed on sleep measures. The majority of differences observed were between CBP with a current or past mood diagnosis and CC. BD parents reported dysfunctional coping styles and (to a lesser extent) disrupted activity patterns. CONCLUSIONS: A familial high-risk strategy for studying the role of psychological factors in BD is feasible and informative. This pilot study indicates that abnormal coping styles, instability of self-esteem and dysregulation of sleep may be early markers of bipolar illness. However, current findings need to be explored further in longitudinal studies to clarify which potential markers are truly predictive of BD.     

The Role of Anxiety on the Experience of Peer Victimization and Eating Disorder Risk

This study examined the mediating effect of anxiety and its subtypes on the relation between peer victimization and eating disorder risk and how this mechanism may be contingent on gender. Data were analyzed from 1391 male and female children between the ages of 10 and 14. Measures used include: the Eating Disorder Inventory-3, the School Climate and Bullying Scale, and the Multidimensional Anxiety Scale for Children. It appears that the increase in anxiety associated with being bullied partly explains why peer victimization is related to eating disorder symptoms for the anxiety symptom clusters of physical symptoms, social anxiety symptoms, and separation anxiety symptoms but not for harm avoidance symptoms. This present study further explored the development of eating disorders across genders using moderated mediation analysis, which found gender differences for physical symptoms of anxiety, social anxiety symptoms, and overall anxiety symptoms when such anxiety symptoms were studied as a mediating variable using an exploratory model of moderating mediation (i.e., first- and second-stage moderated mediation). Here, both the effect of peer victimization on these symptoms of anxiety and the effect of these anxiety types on eating disorder symptoms were greater for girls than for boys, while no gender differences were found with harm avoidance and separation anxiety symptoms in this model. This study was the first to identify a significant mediating effect of different types of anxiety symptoms on peer victimization and eating disorder risk as well as ways in which boys and girls appear to be similar with regard to these mechanisms as well as different. Findings highlight the importance of considering interpersonal vulnerabilities of the victim in selecting intervention efforts. In addition to intrapersonal strategies aimed at reducing bystander behavior and increasing assertiveness, school-based interventions for victims of bullying should also assess victims for anxiety and support the development of healthy coping skills.     

Temperament types are associated with weak self-construct, elevated distress and emotion-oriented coping in schizophrenia: evidence for a complex vulnerability marker?

Knowledge concerning temperament factors involved in vulnerability to schizophrenia is limited. We hypothesized that temperament and self-variables (emotional distress, coping styles, self-efficacy and self-esteem) might present a complex trait marker for underlying vulnerability to schizophrenia. We sought to (1) assess temperament dimensions and types in schizophrenia patients and healthy controls using the Tridimensional Personality Questionnaire (TPQ), and (2) explore their association with symptom dimensions, emotional distress, coping styles, self-constructs, demographic and background variables. We evaluated 90 consecutively recruited DSM-IV schizophrenia patients and 136 healthy controls matched for gender and age. We found that the harm avoidance (HA) factor was higher, while reward dependence (RD) was lower in schizophrenia patients than in healthy controls. Relationships of negative symptoms to novelty seeking (NS) and general psychopathology with both NS and HA show a confounding relation to self-variables. TPQ temperament types were defined by dichotomization into high and low according to medians of the three TPQ temperament dimensions. The odds ratios for the HA and HA/NS temperament types were significantly higher, while the NS/RD type was lower in schizophrenia patients than in healthy controls. HA/NS, HA/RD and high-HA/NS/RD types revealed higher scores for emotional distress, emotion-oriented coping and lower scores on self-constructs. No links were found between temperament types and schizophrenia symptom dimensions, task and avoidance oriented coping, or demographic and background variables. Thus, our findings strengthen the hypothesis that temperament types, when associated with elevated emotional distress, emotion-oriented coping and weak self-constructs, might represent a complex trait marker for underlying vulnerability to schizophrenia.     

Alexithymia in children with cancer and their siblings

ObjectiveThe purpose of this study was to examine the levels of alexithymia in children with cancer, in siblings of children with cancer, and in healthy controls.MethodIn order to compare the groups the Alexithymia Questionnaire for Children was used. The study group consisted of 97 children with cancer, 95 siblings, and 151 healthy controls.ResultsThe highest level of alexithymia was reported by children diagnosed with cancer, followed by their siblings. Healthy controls reported the lowest level of alexithymia. No gender differences were observed. The intensity of cancer was a significant predictor of the alexithymia score, with patients with the most severe cancers reporting the highest levels of alexithymia. No differences were found between the patients with moderately severe and least severe cancers.ConclusionsNot only children with cancer, but also their siblings show significantly more alexithymia than their healthy counterparts. Professionals should aim at preventing or reducing the psychological problems in both patients and their siblings.     

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.     

青少年强迫症与应激等的关系研究

目的：了解青少年强迫症发病与生活事件、应对方式和社会支持的关系.方法：对44例青少年强迫症患者和214名正常对照者进行一般社会人口学资料表、青少年生活事件量表（ASLEC）、特质应对方式问卷（TCSQ）和领悟社会支持量表（PSSS）的测评.结果：与对照组相比,强迫症组在人际关系、学习压力、受惩罚、健康适应、应激总量的得分上均显著较高（P＜0.05）;强迫症组患者较多采用消极应对方式,较少采取积极应对方式,获得较少社会支持,与正常对照者比较差异非常显著（P＜0.01）.结论：青少年强迫症的发病与负性生活事件、不良应对方式和缺乏社会支持有关.     

Physical activity practice,body image and visual impairment: A comparison between Brazilian and Italian children and adolescents

The aim of this study was to analyze the physical activity and body image of children and adolescents with visual impairment (VI) in Brazil and Italy. For this, 41 children and adolescents with VI (19 Brazilian and 22 Italian) aged 10.22 ± 2.19 years old (18 girls and 23 boys) answered the Physical Activity Questionnaire for Children (PAQ-C), the Offer Self-Image Questionnaire (OSIQ), and an instrument with information about the disability, body weight and height. We analyzed the relationship between data from PAQ-C and OSIQ, as well as the gender, level of disability (blindness or low vision) and country using independent Mann–Whitney test. Body mass index (BMI) values were higher for Brazilian youths, with more than half of them classified as overweight and obese. Italian youths exhibited values of body image that were more positive and only 27% presented overweight or obesity. Blind children and adolescents were less active than those with low vision, but no differences were found between countries or genders. In Brazil, we detected significant correlations (p > 0.05) between physical activity, body image and BMI, which more active youths presenting lower values of BMI and a better perception of body image. Physical activity seems to have a positive influence on body image and BMI for children and adolescents with VI, thus it should be encouraged especially for those with higher disability degrees.     

Coping styles in people with chronic fatigue syndrome identified from the general population of Wichita, KS

OBJECTIVE: Studies of primary and tertiary care patients suggest that maladaptive coping styles contribute to the pathogenesis and maintenance of chronic fatigue syndrome (CFS). We assessed coping styles in persons with unexplained fatigue and nonfatigued controls in a population-based study. METHODS: We enrolled 43 subjects meeting the 1994 Research Case Definition of CFS, matching them with 61 subjects with chronic unexplained fatigue who did not meet criteria for CFS [we term them insufficient symptoms or fatigue (ISF)] and 60 non-ill (NI) controls. Coping styles and clinical features of CFS were assessed using standard rating scales. RESULTS: Subjects with CFS and ISF reported significantly more escape-avoiding behavior than NI controls. There were no differences between the CFS and ISF subjects. Among participants with CFS, escape-avoiding behavior was associated with fatigue severity, pain, and disability. CONCLUSIONS: We demonstrate significantly higher reporting of maladaptive coping in a population-based sample of people with CFS and other unexplained fatiguing illnesses defined by reproducible standardized clinical empirical means in comparison to NI controls.     

Parenting styles and mental health of Palestinian-Arab adolescents in Israel

The relationship between three parenting styles (authoritarian, permissive, and authoritative) and the mental health of Arab adolescents was tested. It was hypothesized that parenting style toward boys would differ from that towards girls, psychological adjustment of girls would differ from that of boys, and that the authoritarian style applied within the authoritarian Arab society is not associated with poor psychological adjustment. The Parental Authority Questionnaire, Child Attitude Toward Parents, Lipsitt's Self-Concept Scale for Children, Rosenberg Self-Esteem Scale and the Psychological State Scale were administered to 431 Arab adolescents. Sex comparison revealed that the parenting style with regard to girls tends to be more authoritative and less authoritarian than with regard to boys. Girls scored higher than boys on identity disorder, anxiety disorder, and depression scales, whereas boys scored higher than girls on the behavior disorder scale. There was no significant relationship between the authoritarian parenting style and the mental health measures. A significant positive relationship exists between the authoritative parenting style and the mental health of children. Among boys, the permissive parenting style was associated with negative attitudes towards parents, lower self-esteem and increased identity, anxiety, phobia, depressive, and conduct disorders. It seems, therefore, that the effect of parenting style is culturally and gender dependent rather than universal.     

Predictors of mental distress in early adulthood: a five-year follow-up of 709 high-school students

Mental health risk factors in adolescence were examined as predictors of mental distress in early adulthood. A cohort of 709 Finnish adolescents was studied in 1990 (mean age 16.8) and in 1995. Trait anxiety, defence styles, life events, self-esteem and somatic symptoms were evaluated as predictors of high scores in the General Health Questionnaire in adulthood. Females (36%) were more likely to be distressed than males (23%). High trait anxiety and somatic symptom scores among adolescent females, and high immature defence style scores among males predicted mental distress. Males with low trait anxiety in adolescence had less distress. The results indicate trait anxiety as an important predictor of mental distress. Gender differences in other predictors suggest gender differences in coping.     

Binge-eating episodes are not characteristic of carriers of melanocortin-4 receptor gene mutations

Recently, Branson and coworkers reported a strong association between binge-eating disorder (BED) and variants in the melanocortin-4 receptor gene (MC4R). In the current study, we compared the eating behavior of 43 obese probands with functionally relevant MC4R mutations and of 35 polymorphism carriers (V103I or I251L) with wild-type carriers. The module for eating disorders of the Composite International Diagnostic Interview was used to identify binge-eating behavior. The Three-Factor Eating Questionnaire and the Leeds Food Frequency Questionnaire were used to assess restrained eating, disinhibition, hunger and percent total energy intake as fat. No significant differences between carriers of MC4R variants and wild-type carriers were detected. In particular, we found no evidence for an increased rate of binge-eating behavior in obese carriers of MC4R variants. Our findings do not support the strong association between BED and MC4R carrier status.     

Pakistani adolescents' coping with stress: effect of loss of a parent and gender of adolescents

The present study examined the effect of parental loss and gender of adolescents on their coping with stress. Sample included those adolescents who had either of their parents died (N = 40) and those having both living parents (N = 40). It was hypothesized that adolescents with one parent alive would differ in their ways of coping with stress compared to those who have both living parents. It was also hypothesized that there would be gender differences in adolescents' coping. Coping Strategies Questionnaire (CSQ, Kausar, 1996) was used to assess adolescents' coping. Data was analysed using t-test and multivariate analysis of variance (MANOVA). Analyses showed that avoidance-focused coping was the most frequently used and active distractive coping was the least frequently used strategy by the adolescents. Adolescents with both living parents employed more active distractive and religious-focused coping compared to those with one parent alive. Girls employed significantly more strategies to cope with stress compared to boys. Results also revealed interactive effect of parental loss and gender on coping strategies used by adolescents. The findings suggest that death of either of the parents and gender of the adolescent is important determinants of the ways adolescents deal with stress.