One size does not fit all: Links between shift-and-persist and asthma in youth are moderated by perceived social status and experience of unfair treatment

Shift-and-Persist Strategies and Psychological Well-Being: Where Adolescents Stand on Social Ladder Matters

OBJECTIVES

Shift-and-persist coping strategies have been demonstrated to be beneficial for physical health of individuals in low socioeconomic status (SES); however, their impacts on psychological well-being remain less clear. This study aimed to examine: (1) whether the protective effects of shift-and-persist with respect to psychological well-being (i.e., depressive symptoms and subjective well-being) only exist among adolescents with lower (vs. higher) subjective SES, and (2) what drives the potential benefits, shifting strategy or persisting strategy, or both of them?

METHODS

This study recruited 686 middle school students (54.5% male; Mage = 12.57 years, SD = 0.65) from Guangdong Province, China, in January 2019, and they completed measures of subjective SES (i.e., perceived family social status), shift-and-persist strategies, depressive symptoms, subjective well-being, and demographic information.

RESULTS

Adolescents who engaged in more shift-and-persist strategies reported fewer depressive symptoms and higher levels of subjective well-being, with stronger effects among those lower (vs. higher) in subjective SES. When further exploring what drove these effects, results showed that persisting strategy was associated with fewer depressive symptoms and higher levels of subjective well-being, with more pronounced effects for adolescents with lower (vs. higher) subjective SES. The shifting strategy was associated with fewer depressive symptoms only among those with lower subjective SES, while associated with higher levels of subjective well-being regardless of subjective SES levels.

CONCLUSIONS

Findings support the applicability of the shift-and-persist model to both positive and negative indicators of psychological well-being and enrich the theory by providing preliminary evidence for the domain-specific roles of shifting strategy in buffering the negative psychological effects of low-SES contexts.

Reflections on resilience

Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.

Coping with ethnic-racial discrimination: Protective-reactive effects of shift-and-persist coping on internalizing symptoms among Black American adolescents

Ethnic-racial discrimination has pervasive negative effects on Black youth's mental health; therefore, it is crucial to identify factors that provide resilience against discrimination. Two promising factors to help youth cope are ethnic-racial identity (how one feels about their ethnicity/race) and shift-and-persist coping (reappraising and accepting an uncontrollable stressor while remaining optimistic about the future). While there is existing scholarship on ethnic-racial identity among Black youth, this work has not yet assessed the impacts of shift-and-persist in this population. Using a sample of 155 Black youth (ages 13-17), the current study examined the interplay between discrimination, ethnic-racial identity, shift-and-persist coping, and internalizing symptoms. Symptoms of depression and anxiety were positively associated with discrimination and negatively associated with shift-and-persist. Significant interactions between discrimination and shift-and-persist predicting both depressive and anxiety symptoms revealed significant negative associations between shift-and-persist and internalizing symptoms at low and average, but not high discrimination levels. Effects are, thus, protective-reactive; the protective effects of shift-and-persist are not significant for youth facing high levels of discrimination. Ethnic-racial identity, surprisingly, was not significantly associated with either depressive or anxiety symptoms, nor did it interact with shift-and-persist as it has in studies of Latinx youth. By understanding the protective benefits of shift-and-persist and ethnic-racial identity in Black youth, during a pivotal period for mental health, we can provide this growing population with tools to lessen the maladaptive outcomes associated with discrimination.

Fostering resilience in adolescence and young adulthood: Considerations for evidence-based, patient-centered oncology care

Adolescence and young adulthood are times of growth and change. For adolescents and young adults (AYAs) who are diagnosed with cancer, the demands of illness may compound normal developmental challenges and adversely affect physical, emotional, and social health. Nevertheless, AYAs have a tremendous capacity for psychosocial adaptation and resilience. Informed by the Transactional Model of Stress and Coping, observational studies in AYA oncology suggest consistent individual, social, and existential resources that may promote resilience. To date, few interventions have been designed to examine whether resilience can be taught and whether doing so affects patient-centered outcomes. Findings point to the potential value of multicomponent programs that include various skills-building strategies, such as stress management, mindfulness, gratitude, and positive reappraisal coping, among others. New research directions include the need to evaluate delivery strategies to enhance participant adherence and retention (e.g., eHealth modalities, optimization studies) and to examine program effectiveness in community-based oncology practices (e.g., less resource-rich settings in which most AYAs receive care). Ultimately, this scholarship may inform, refine, and strengthen intervention science in resilience more broadly.

Resilience in adolescent and young adult oncology: Problems and prospects

Although resilience research in adolescent and young adult oncology is promising for improving patient‐centered outcomes, it does not adequately incorporate diverse perspectives of marginalized individuals. Including the unique aspects of minoritized adolescents and young adults and incorporating cultural, community, and system‐level considerations is essential to understanding and promoting resilience in an equitable fashion.

Shift-and-persist coping and health among rural African American adolescents

This study examines whether shift-and-persist coping, a coping strategy defined by accepting challenges and remaining hopeful for the future, is associated with psychosocial and physical health and/or moderates the effects of contextual stress (i.e., racial discrimination, financial strain) on health among African American adolescents living in the rural Southeastern United States. Participants (N = 299, 56% boys, Mage  = 12.91) completed measures of shift-and-persist coping, contextual stress, and psychosocial and physical health. Shift-and-persist coping was generally associated with better health but did not buffer the effects of contextual stress. Results suggest that shift-and-persist coping may serve as a source of resilience among African American adolescents living in a context where many experience heightened contextual stress.

Resilience in children with chronic illness: Tests of the shift-and-persist and skin-deep resilience theories

This study investigated, and discusses the integration of, the shift-and-persist (SAP) and skin-deep resilience (SDR) theories. The SAP theory states that the combination of shifting (adjusting oneself to stressful situations through strategies like emotion regulation) and persisting (enduring adversity with strength by finding meaning and maintaining optimism) will be beneficial to physical health in children experiencing adversity. The SDR theory states that high striving/self-control will be beneficial to mental health but detrimental to physical health among those confronting adversity. This study investigated 308 children ages 8-17 experiencing the adversity of a chronic illness (asthma). SAP and SDR (striving/self-control) were assessed via questionnaires, and physical health (asthma symptoms, inflammatory profiles), mental health (anxiety/depression, emotional functioning), and behavioral (medication adherence, activity limitations, collaborative relationships with providers) outcomes were measured cross-sectionally. SAP was associated with better physical health, whereas SDR was associated with worse physical health. Both were associated with better mental health. Only SDR was associated with better behavioral outcomes. Implications of findings and discussion of how to integrate these theories are provided. We suggest that future interventions might seek to cultivate both SAP and SDR to promote overall better health and well-being across multiple domains in children experiencing adversity.

Properties of the Shift and Persist Questionnaire in adolescent and young adult cancer patients and survivors: Validity, consistency, and interpretability

PURPOSE

The Shift and Persist model provides an informative framework to understand how adolescent and young adult (AYA) cancer patients and survivors (ages 15-39) may withstand stress and thrive despite adversity. The goal of the present study was to examine the psychometric properties of the Shift and Persist Questionnaire (SPQ) in this population and provide guidelines for interpretation.

METHODS

AYA cancer patients and survivors were recruited via an online research panel. Participants reported demographics and health history and completed the SPQ and Patient-Reported Outcome Measurement Information System 29-item profile (PROMIS®-29). We evaluated the structural validity, internal consistency, and construct validity of the SPQ. Minimally important differences (MIDs) were estimated to inform SPQ score interpretation.

RESULTS

572 eligible individuals completed the survey. On average, participants were aged 24 (SD = 7) at evaluation. Of the participants, 43.5% were female, 77.1% were white, and 17.5% were Hispanic (across races). The two-factor structure of the SPQ demonstrated very good structural validity (CFI > 0.95, SRMR < 0.08), and construct validity with PROMIS-29® domains (convergent Rs = 0.17 to 0.43, divergent Rs = - 0.11 to - 0.51). Internal consistency was adequate (ω = 0.76-0.83). Recommended MIDs were 1 point for the Shift subscale, 1-2 point(s) for the Persist subscale, and 2-3 points for the total SPQ score.

CONCLUSION

The SPQ is a psychometrically sound measure of skills that contribute to resilience in AYA cancer patients and survivors. MID recommendations enhance the interpretability of the SPQ in this population. Future studies examining shifting and persisting in this population may benefit from administering the SPQ.

Shift and Persist in Mexican American Youth: A Longitudinal Test of Depressive Symptoms

This paper tested whether shift-&-persist coping, or coping involving the combination of cognitive reappraisal, acceptance, and optimism (Chen & Miller, Perspectives on Psychological Science, 2012, 7, 135), attenuates the risks presented by economic hardship and ethnic discrimination for change in depressive symptoms from 9th to 12th grade, in a sample of 674 Mexican American youth (Mage W1 = 10.86; 50% female; 72% US born) and whether this effect depends on ethnic pride. Structural equation modeling indicated that, when accounting for economic hardship, shift-&-persist was associated with fewer concurrent depression symptoms. Youth with lower ethnic pride who endorsed high levels of shift-&-persist were protected against the negative impacts of peer ethnic discrimination on depressive symptoms. Future research on ethnic discrimination should examine patterns of coping and identity that can mitigate risk.

Shifting and Persisting in the Face of Life Stressors: Consequences for Adolescent Health

The current study assessed whether greater use of shift-and persist strategies, which entail the reappraisal of stressors (shifting) and endurance through optimism and meaning-making, buffered the associations between life stressors and adolescents' psychological health (i.e., depressive symptoms, anxiety) and physical health and health behaviors (i.e., self-rated health, sleep quality). Survey data were drawn from a racially/ethnically and socioeconomically diverse sample of 750 9th grade adolescents (53% female). Path analysis revealed racial discrimination, neighborhood risk, and deportation exposure were linked to poorer psychological and physical health, while socioeconomic disadvantage was related to greater anxiety and poorer physical health. Some evidence suggested that shift-and-persist may be protective-reactive, wherein shift-and-persist typically promoted well-being across health domains but more so when the life stressors were at low versus high levels. Shift-and-persist strategies promote both mental and physical health, but the promotive effects appear to be maximized when adolescents' exposure to life stressors is minimal.

Interaction between Health and Financial Status on Coping Behaviors during the COVID-19 Pandemic

BACKGROUND

The year 2022 started with protests against COVID-19 restrictions throughout North America. These events manifest the fact that some segments of the population are not compliant with the preventive measures of COVID-19, and the reasons of the disobedience against public health regulation remain unclear. The current paper examined the joint effect of financial and health status on people's likelihood of pursuing active coping efforts (i.e., following preventive measures) and giving up coping with the COVID-19 pandemic.

METHOD

We conducted a large-scale survey study in China (N = 3834) in May 2020.

RESULTS

Our results showed that people with low financial status were less likely to manifest active coping behavior and more likely to give up coping with the pandemic. People's self-confidence in coping with the pandemic mediated this effect. We showed that one's health status could interact with their financial status in a way that healthy people with low financial status would have less confidence in their coping abilities and thus become less likely to pursue active coping efforts and more likely to give up coping with the pandemic.

CONCLUSIONS

Our results call for policymakers to find more effective solutions for noncompliant groups so that they can abide by the general guidelines in the COVID-19 context and other social crises that may emerge in the future. We suggest that governments should concentrate their support efforts on healthy populations of low financial segments to prevent COVID-19 and other infectious diseases in the future from spreading further.

Shift-&-Persist and discrimination predicting depression across the life course: An accelerated longitudinal design using MIDUSI-III

Life course theorists posit that sensitive periods exist during life span development where risk and protective factors may be particularly predictive of psychological outcomes relative to other periods in life. While there have been between-cohort studies trying to examine differences in discrimination and depressive symptoms, these studies have not been designed to identify these sensitive periods, which are best modeled by examining intra-individual change across time. To identify sensitive periods where discrimination and shift-&-persist (S&P) - a coping strategy that may protect against the negative impact of discrimination - are most strongly predictive of depressive symptoms, we employed latent growth curve modeling using an accelerated longitudinal design to track intra-individual change in depressive symptoms from ages 20-69. Participants were 3,685 adults measured at three time points ~10 years apart from the Midlife in the United States study (Mage = 37.93, SD = 6.948 at Wave I). Results identified two sensitive periods in development where high levels of S&P interacted with discrimination to protect against depressive symptoms; during the 30s and a lagged effect where 40's S&P protected against depressive symptoms when participants were in their 50s. Implications for the life course study of discrimination, coping, and depression are discussed.

Examining the promotive versus the protective impact of culturally informed shift-&-persist coping in the context of discrimination, anxiety, and health behaviors

This study aims to better understand how racially/ethnically minoritized youth exhibit adaptive psychological functioning (less anxiety) and health behaviors (better sleep and less binge drinking) in the context of discrimination, ethnic-racial identity and coping. Among 364 minoritized emerging adults (Mage  = 18.79, 85.2% female), we utilized higher-order factor analysis to examine how culturally informed shift-&-persist (S&P), a higher-order construct explaining associations between coping factors (shift, persist, spiritually based coping, civic engagement), and ethnic-racial identity were related to anxiety, binge drinking, and sleep in the context of discrimination. Culturally informed S&P promoted better sleep and less anxiety controlling for discrimination. No significant effects were observed for binge drinking and no moderated effects were observed across outcomes. The harmful effect of discrimination on sleep was intensified for those with stronger ethnic-racial identities. The promotive and potentially protective effects of culturally informed S&P coping differs across mental health and health behavior outcomes.

Psychological Resources as a Buffer Between Racial/Ethnic and SES-based Discrimination and Adolescents' Academic Well-being

While the detrimental consequences of racial/ethnic discrimination for adolescent well-being are well-established, less is known about the impact of SES-based discrimination and the potential protective benefits of adolescents' intraindividual assets. The current study addressed these gaps by investigating the longitudinal associations between racial/ethnic and SES-based educator-perpetrated discrimination and adolescents' academic well-being and assessed whether psychological resources moderated these pathways. To do so, the study used longitudinal data from a diverse sample of 750 9th grade students (54% female; 41% White, 34% Latina/o/x, 8% Asian American, 6% African American, 11% biracial/other race/ethnicity; 43% had parents with an associate's degree or less) in the Southwestern U.S. who were subsequently surveyed one year later. Educator-perpetrated racial/ethnic discrimination was negatively associated with students' school engagement, and both psychological resilience and self-efficacy emerged as protective for students' educational expectations in the face of racial/ethnic and SES-based discrimination, respectively. The results of the current study highlight the role of discriminatory treatment in educational disparities and provide insights on effective coping strategies to combat the negative impacts of discrimination in academics.

Culturally informed shift-&-persist: A higher-order factor model and prospective associations with discrimination and depressive symptoms

OBJECTIVES

Based on the conceptual overlap between shift-&-persist (S&P) and culturally based strategies (critical civic engagement [CCE] and spiritually based coping), this study tests whether associations between these three previously disparate strategies are attributable to the existence of a higher-order coping construct: culturally informed S&P.

METHODS

Among 364 diverse minoritized youth (Mage = 18.79, 85.2% female), we tested for the existence of this higher-order factor through confirmatory factor analysis.

RESULTS

We found theoretical and empirical support for the existence of a higher-order factor structure and for our higher-order factor-culturally informed S&P. Culturally informed S&P promotes fewer depressive symptoms as a main effect in addition to completely protecting against the negative impact of discrimination on depressive symptoms when culturally informed S&P is high.

CONCLUSIONS

The current study illustrates relations between three previously distinct coping strategies through their association with culturally informed S&P. Results highlight culturally informed S&P's promotive and protective effects in the face of ethnic-racial discrimination. Implications for subsequent study of culturally based coping are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Chronic stress and asthma in adolescents

OBJECTIVE

First, to review and critically discuss published evidence on psychosocial stressors, stress, and asthma in adolescents and, then, discuss potential future directions in this field.

DATA SOURCES

The data source is the National Library of Medicine (PubMed database).

STUDY SELECTIONS

A literature search was conducted for human studies on stressors or stress and asthma between 2000 and 2020. Studies that were published in English, contained a full text, and included adolescents were considered for inclusion in this review.

RESULTS

Compared with the available body of evidence in children and adults, relatively few studies have been published in adolescents. Current evidence suggests that exposure to stressors (at the individual, family, and community levels) or stress (acute and chronic) is associated with asthma and worse asthma outcomes, but such evidence must be cautiously interpreted owing to limitations in the design or the analytical approach of the published studies.

CONCLUSION

Future large studies with a prospective design should determine whether and how stressors or stress causes or worsens asthma in adolescents. At present, clinicians should assess exposure to stressors (eg, violence or abuse) and screen for anxiety and depressive disorders when caring for adolescents with asthma in addition to providing referrals to social workers or mental health professionals when appropriate. Public health policies are needed to reduce psychosocial stressors, such as gun violence and racism, in adolescents.

Coping and Culture: The Protective Effects of Shift-&-Persist and Ethnic-Racial Identity on Depressive Symptoms in Latinx Youth

Shift-&-persist is a coping strategy that has been shown to lead to positive health outcomes in low-SES youth but has not yet been examined with respect to psychological health. This study tests whether the shift-&-persist coping strategy works in tandem with ethnic-racial identity to protect against depressive symptoms in the face of two uncontrollable stressors: economic hardship and peer discrimination. In a sample of 175 Latinx youth (51.4% female; M_age = 12.9), shift-&-persist buffered the positive relation between economic hardship and depressive symptoms. In terms of peer discrimination, among youth who reported little use of shift and persist, discrimination was related to higher depressive symptoms, whereas youth who reported higher amounts of shift and persist (at and above the mean) were protected and did not evidence this association. However, among youth with high ethnic-racial identity, shift-&-persist failed to protect against the deleterious association between peer discrimination and depressive symptoms. These findings suggest that shift-&-persist is protective for Latinx youth, although the context in which it is protective changes based on the racialized/non-racialized nature of the stressor.

Cultural development and psychopathology

Culture plays a pivotal role in adaptive and maladaptive development. However, culture remains disconnected from theory, research, training, assessment, and interventions in developmental psychopathology, limiting our understanding of the genesis and epigenesis of mental health. Cultural development and psychopathology research can help overcome this limitation by focusing on the elucidation of cultural risk, protective, and promotive factors, at the individual and social levels, that initiate, derail, or maintain trajectories of normal and abnormal behavior. The goal of this Special Issue is to showcase research on the association between culture, development, and psychopathology that investigates equifinality and multifinality in cultural development, the interplay between culture and biology, cultural assessment and interventions, and cultural differences and similarities.