Mediators of disability and hope for people with spinal cord injury

Purpose: To test potential strength-based mediators of functional disability and hope in adults with spinal cord injury. Method: Two hundred and forty-two participants with spinal cord injury were recruited for this study. The mean age of participants was 44.6 years (standard deviation?=?13.2), and 66.1% were men. Participants completed a survey containing a demographic questionnaire, as well as measures of functional disability, hope, self-esteem, proactive coping, perceived social support and disability acceptance. Mediation analysis was conducted using a bootstrap test for multiple mediators. Results: Proactive coping, self-esteem and perceived social support significantly mediated the relationship between functional disability and hope, while disability acceptance did not. The combination of mediators resulted in functional disability no longer being a significant predictor of hope. Conclusions: The strength-based constructs of proactive coping, self-esteem and social support appear effective in predicting hope regardless of severity of spinal cord injury. Functional disability was no longer predictive of hope after controlling for these strength-based constructs. Disability acceptance did not significantly add to the mediation model. These results provide further evidence for strength-based interventions in rehabilitation.

• Implications for Rehabilitation

• Strength-based constructs of proactive coping, self-esteem and social support are important factors for addressing hope following spinal cord injury, regardless of level of severity.

• Rehabilitation services providers should focus efforts on supporting clients in the accurate appraisal of predictable stressors and then generate means for addressing them as a form of proactive coping.

• Rehabilitation services providers must be cautious when addressing self-esteem to focus on perceived competence and learning processes rather than self-esteem directly or through the accomplishment of goals that may not be achieved.

• Knowing that social supports are related to hope post-spinal cord injury, it is important for rehabilitation services providers to recognize potential social supports early in the rehabilitation process and involve those social supports in the rehabilitation process when possible.

     

Maladaptive Coping Strategies in Relation to Quality of Life Among HIV+ Adults

This study examined relationships between coping strategies and psychological quality of life (QOL) among people living with HIV/AIDS (N = 141). Participants completed baseline assessments, which included a demographic survey, the Brief COPE, the MOS-HIV, and a medical history questionnaire. Additionally, we obtained CD4 count information from medical charts. After controlling for demographic and AIDS-related factors, hierarchical multiple regression analyses indicated that maladaptive coping strategies used to deal with the stress of living with HIV/AIDS significantly lowers psychological quality of life as defined by cognitive functioning, mental health, and health distress. Developing adaptive coping skills to increase adaptive coping behaviors for dealing with living with HIV/AIDS may be a particularly effective intervention strategy to improve QOL. Future research must use methodological designs that can evaluate the influence of coping on QOL over time.     

Association between coping strategies,social support,and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS

Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p?p?=?.01) coping were associated with more depressive symptoms while greater family support (EF: p?=?.002; PF: p?=?.003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p?p?=?.02) and higher community support (EF&;PF: p?=?.01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.     

硕士新生的自我效能感对应对方式和抑郁的中介效应

目的:探讨硕士新生的自我效能感在应对方式和抑郁之间的中介效应。方法:采用一般自我效能感量表(GSES)、流调用抑郁自评量表(CES-D)、特质应对方式问卷(TCSQ)对硕士新生进行调查,用SPSS的层次回归分析得出三者之间的关系。结果:自我效能感与抑郁呈显著负相关、与积极应对呈显著正相关、与消极应对呈显著负相关,积极应对方式与抑郁和消极应对方式呈显著负相关,消极应对方式与抑郁呈显著正相关。应对方式对抑郁具有显著地预测效果(P0.001);自我效能感在应对方式与抑郁关系间起部分中介作用。结论:硕士新生的抑郁可能与其应对方式有关,而自我效能感起到部分中介作用。     

Reflections on living with HIV over time: exploring the perspective of HIV-infected women over 50

Objectives: Approximately 32.7% of people living with HIV/AIDS (PLWHA) in the USA are now over the age of 50. Women comprise a significant percentage of the US HIV epidemic and the percentage of women diagnosed with HIV continues to grow; however, little is known about women's experiences living and coping with HIV over time. The goal of this study was to explore the experiences of US women over 50 living with HIV to better understand how they make sense of their diagnosis and cope with their illness over time and during the aging process.

Method: Nineteen women (mean age = 56.79, SD = 4.63) referred from Boston-area organizations and hospitals completed one-time, in-depth individual interviews, out of which 47% of the participants were identified as Black/African Americans, and 37% as White. The average time since diagnosis was 16.32 years (SD = 5.70). Inclusion criteria included: (1) female sex, (2) aged 50 or older, (3) HIV diagnosis, and (4) English speaking. Transcribed interviews were analyzed using a grounded theory approach and NVivo 9 software.

Results: Findings are described across the following themes: (1) experiences at diagnosis, (2) uncertainty of disease course, (3) acceptance, and (4) living ‘well’ with HIV. Participants appeared to be well adjusted to their HIV diagnosis and described a progression to acceptance and survivorship; they identified strategies to ‘live well’ in the context of HIV. For some, health-related uncertainty about the future remained. These findings were organized into a model of coping with HIV.

Conclusion: Themes and issues identified by this study may help guide interventions across the lifespan for women with HIV.     

Quality of in-home care,long-term care placement,and the survival of persons with dementia

Purpose of the study: Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.

Design and methods: We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.

Results: Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.

Implications: It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.     

Quality of Life and Emotional Distress Early After Left Ventricular Assist Device Implant: A Mixed‐Method Study

Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end‐stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed‐method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty‐six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in‐depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P < 0.001 and 0.764, P < 0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient–doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.     

Medical Students' Use of Different Coping Strategies and Relationship With Academic Performance in Preclinical and Clinical Years

Phenomenon: Medical students' coping abilities are important for academic success and emotional health. The authors explored differences in students' use of active, problem-solving strategies and emotional, inwardly directed approaches; the change in coping strategies used during medical school; and coping strategy impact on performance. Approach: One hundred eighty-three students completed the Ways of Coping Scale at matriculation and end of the 2nd and 3rd years. Frequency of each of 8 ways of coping, changes in coping strategy use over time, and relationship of coping method with preclinical and clinical scores were calculated. Findings: Students varied widely in use of coping mechanisms. Over time, students shifted to using emotional strategies more frequently while decreasing their use of active strategies. Coping strategies were unrelated to preclinical academic performance (R² = .09, adjusted R² = .04, ns) but were related to clinical performance (R² = .23, adjusted R² = .18, p < .0001), with active coping associated with higher performance and emotional methods associated with lower performance. Insights: Students decreased use of active coping strategies and increased use of emotional coping strategies over time, but emotional strategies were associated with poorer clinical academic performance. These shifts in coping methods may be detrimental to student performance and learning. Improving students' ability to cope should be an educational priority.