Coping self-efficacy buffers psychological and physiological disturbances in HIV-infected men following a natural disaster

Resilience processes among Ukrainian youth preparing to build resilience with peers during the Ukraine-Russia war

The war in Ukraine significantly impacts the mental health and well-being of its youth. Like other communities affected by war, Ukraine's youth are at risk of developing psychopathological symptoms, and there is a shortage of mental health and psychosocial support services to address this. Resilience-building initiatives present an alternative approach to supporting the well-being of young people by promoting protective processes to enhance the likelihood of positive development in the context of adversity. Emerging research findings suggest that young people themselves can serve as powerful facilitators of such initiatives with one another. Yet, evidence about culturally and contextually relevant protective processes is needed to guide such interventions, especially among young people experiencing the war and working to boost resilience within their communities. In this study, we identified key protective processes Ukrainian youth depend on as they adapt to the conflict while also preparing to implement a resilience-building intervention as a facilitator. Through thematic analysis of transcripts of three training sessions with Ukrainian youth (n = 15, 100% female; aged 18-22), we identified the following themes: positive thinking, sense of control, emotion awareness and regulation, close personal relationships, and community support. Findings also highlighted the cultural and contextual nuance of these protective processes, as well as individual differences in the ways they co-occurred and manifested within each youth. Results have implications for developing tailored yet flexible resilience-building interventions that can be delivered by lay people, including youth with their peers, in Ukraine and other cultures and contexts.

Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19

Purpose

Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID‐19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses.

Methods

A quantitative, cross‐sectional, descriptive and comparative design was used. Data were collected using a Web‐based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire.

Results

The majority of nurses (64%) are experiencing ASD due to the COVID‐19 pandemic and thus are at risk for PTSD predisposition. More than one‐third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self‐efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self‐efficacy was a protective factor.

Conclusion

Given that individuals who suffer from ASD are predisposed to PTSD, follow‐up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self‐efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms.

Implications for Nursing Management

Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID‐19 crisis. They need to implement stress‐reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well‐being, as well as providing referrals to appropriate psychological services.

The Power of Faith: The Influence of Athletes' Coping Self-Efficacy on the Cognitive Processing of Psychological Stress

Coping self-efficacy (CSE) has a positive mental health effect on athletes’ ability to cope with stress. To understand the mechanism underlying the potential impact of CSE, event-related potentials (ERPs) were used to explore the neural activity of the cerebral cortex under acute psychological stress in athletes with different CSE levels. Among 106 high-level athletes, 21 high-CSE athletes and 20 low-CSE athletes were selected to participate in the experiment. A mental arithmetic task was used to induce acute psychological stress. The results showed that high-CSE athletes responded more quickly than low-CSE athletes. In the stress response stage, the N1 peak latency of low-CSE athletes was longer than that of high-CSE athletes, and the N1 amplitude was significantly larger than that of high-CSE athletes. In the feedback stage, the FRN amplitude with error feedback of high-CSE athletes was larger than that of low-CSE athletes, and the P300 amplitude with correct feedback was larger than that with error feedback. The results indicate that high-CSE athletes can better cope with stressful events, adjust their behaviors in a timely manner according to the results of their coping, and focus more on processing positive information.

Anxiety effects on disaster precautionary behaviors: A multi-path cognitive model

Previous studies have revealed a negative relationship between anxiety and health-promoting behavior. This study identified three cognitive pathways through which anxiety operates on preparedness behaviors for terrorist attacks. Preparedness was regressed on trait anxiety, perceived threat, and self-efficacy based on data from 306 adults. Mediating paths through perceived threat (positive) and self-efficacy (negative) and an independent negative path were identified. Results suggest that the anxiety/precautionary behavior relationship is more complex than previously thought, involving multiple pathways of competing directionality. Interventions to improve disaster preparedness and thus reduce disaster-related morbidity/mortality would benefit by capitalizing on this multidimensionality.

Online support groups for head and neck cancer and health-related quality of life

Purpose

To investigate the association between using online support groups (OSGs) and health-related quality of life (HRQoL), and the psychosocial factors that may influence this association among individuals with head and neck (H&N) cancer.

Method

A sample of 199 persons with H&N cancer using four OSGs completed an online questionnaire using six pre-validated measures for social network, self-efficacy, anxiety and depression, adjustment, empowerment and quality of life. In addition, socio-demographic as well as illness-related and OSGs-related information was collected.

Results

Participants who had better HRQoL had been using OSGs for a longer time than those who had worse HRQoL (B = 0.07, p < 0.05). Depression and adjustment were the only direct mediators in this association, whereas self-efficacy, anxiety and empowerment appeared as indirect mediators.

Conclusion

Participation in OSGs was found to be associated to better HRQoL either directly or indirectly through decreasing depression, anxiety and the negative adjustment behaviours and increasing self-efficacy and empowerment of the users. The study presented a potential model of pathways linking OSG use and HRQoL for those with H&N cancer. However, the model needs to be tested in future longitudinal studies and the associations proposed need to be explored in greater detail.

Costs and benefits of self-efficacy: Differences of the stress response and clinical implications

Encounters with stressors induce diverse idiosyncratic neuroendocrine, behavioral and psychological reactions across people. Perceived self-efficacy can alter autonomic responses and their effects on mental health. The beneficial effects of self-efficacy in buffering physiological arousal, enhancing performance, and diminishing psychopathological symptoms have been observed in diverse contexts. We show that the role of self-efficacy is not uniformly beneficial, and that higher levels of self-efficacy can sometimes lead to increases in neuroendocrine and psychological stress responses and decreases in performance, a phenomenon that has been widely neglected. We discuss specific conditions under which self-efficacy effects do not uniformly ameliorate or prevent the consequences of stress. These conditions suggest that therapeutic interventions need not always promote self-efficacy in principal. Simultaneously, they to do suggest that keeping self-efficacy high might be disadvantageous or detrimental.

Group Intervention to Reduce HIV Transmission Risk Behavior Among Persons Living With HIV/AIDS

Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the intervention development and intervention content of the social cognitive risk reduction intervention for HIV-positive persons. The effective five group session intervention focused on enhancing motivation through self-reflection and developing coping efficacy skills for HIV disclosure decision making, active listening, assertiveness, and problem solving for disclosure and transmission risk reduction behaviors. Intervention components were tailored for gender and sexual orientation and integrated skills practice sessions used role-plays couched within scenes from popular films. This intervention was demonstrated to be effective in a community-service delivery setting and can be adapted for implementation in HIV-related services delivered within support groups.

Psychoneuroimmunology: Then and Now

Psychoneuroimmunology (PNI) emerged in the neurosciences in the late 1970s to early 1980s and has extended to influence the fields of psychology, psychiatry, endocrinology, physiology, and the biomedical research community. This review documents the journey of PNI from the early 1980s to the present. Today, we recognize that the highly complex immune system interacts with an equally complex nervous system in a bidirectional manner. Evolutionarily old signals continue to play a role in these communications, as do mechanisms for protection of the host. The disparity between physical and psychological stressors is only an illusion. Host defense mechanisms respond in adaptive and meaningful ways to both. The present review will describe a new way of thinking about evolutionarily old molecules, heat shock proteins, adding to a body of evidence suggesting that activation of the acute stress response is a double-edged sword that can both benefit and derail optimal immunity.

Self-resilience as a protective factor against development of post-traumatic stress disorder symptoms in police officers

BACKGROUND

This study was conducted to check whether self-resilience, one of the characteristics known to affect the occurrence of post-traumatic stress disorder (PTSD) symptoms after experiencing traumatic events, could serve as a protective factor for police officers whose occupational factors are corrected.

METHODS

We conducted a cross-sectional study in which 112 male police officers in Gangwon Province participated. They visited the Wonju Severance Christian Hospital Occupational Environment Center for medical check-ups from June to December 2015. Their general characteristics were identified using structured questionnaires, and they were asked to fill in the Korean Occupational Stress Scale-Short Form (KOSS-SF). Further, the Center for Epidemiologic Studies-Depression Scale (CES-D), Connor-Davidson Resilience Scale-Korean (CD-RI-K), and Impact of Event Scale-Revised-Korean version (IES-R-K) were used to evaluate their job stress, depression, self-resilience, and PTSD symptoms. Logistic regression analysis was conducted to correct their personal, occupational, and psychological factors to analyze the relationship between self-resilience and PTSD symptoms.

RESULTS

Among 112 respondents who experienced a traumatic event, those with low self-resilience had significantly higher rate of PTSD symptoms than those with high self-resilience even after correcting for the covariate of general, occupational, and psychological characteristics (odds ratio [OR] 3.51; 95 % CI: 1.06-19.23).

CONCLUSIONS

Despite several limitations, these results suggest that a high degree of self-resilience may protect police officers from critical incident-related PTSD symptoms.

Daily cortisol activity, loneliness, and coping efficacy in late adolescence: A longitudinal study of the transition to college

Many late adolescents who transition to the college environment perceive changes in psychosocial stress. One such stressor, loneliness, has been associated with numerous health problems among adolescents and adults. The hypothalamic-pituitary-adrenal axis is one mechanism through which loneliness may affect health. Guided by a risk and resilience framework, the present study investigated the association between longitudinal changes in loneliness from high school to college and diurnal cortisol activity (waking levels, cortisol awakening response, diurnal slope) by sampling saliva intensively 5 times a day for 3 weekdays in a US sample of late adolescents in their first semester of college (N = 70; M_age = 18.49, SD = 0.38). The present study also explored how the link between loneliness and cortisol might depend on coping efficacy-one's belief in successfully coping with future stressors or novel situations. Results from hierarchical linear growth curve models demonstrated that an increase in loneliness across this contextual transition was associated with steeper cortisol slopes in college. Coping efficacy at baseline (in high school) significantly moderated the relation between changes in loneliness and diurnal slopes, such that late adolescents with low levels of coping efficacy who reported increased loneliness across the transition exhibited significantly flatter diurnal slopes in college. Higher levels of coping efficacy at baseline also significantly predicted lower waking cortisol levels during the first semester of college. These results suggest that coping efficacy may serve as a protective factor by contributing to regulation of daily physiological stress activity for late adolescents as they struggle with loneliness across the transition to college.

Post-traumatic stress disorder symptomatology and alcohol use among HIV-seropositive adults in Haiti

Psychological trauma resulting from natural disasters can negatively affect the health of persons living with HIV/AIDS (PLWH). This study examined relationships of alcohol use and exposure to the 2010 Haiti earthquake on symptoms of posttraumatic stress disorder (PTSD) among HIV-positive adults enrolled in an intervention study. Baseline data were collected from male and female PLWH, 19-56 years old on: alcohol consumption and related harms; anxiety; and coping strategies used to deal with HIV. Two to three months postearthquake, data were collected from 104 of the study participants on PTSD and earthquake-related impacts. Most participants had less than a secondary education (66%) and very low income (92% ≤ H$10,000 or ≤ US$1250/year). Over two-thirds of participants felt at some point that they should cut down on drinking. Fifty-two (50.5%) met criteria for PTSD. More than 83% lost their belongings and 64% had someone close to them hurt or killed during the earthquake. Bivariate analysis showed that women, younger participants, those who lost all belongings, and those with greater overall alcohol impact were more likely to report PTSD symptoms. In the multivariate model, participants more likely to meet PTSD criteria (p<0.05) were those who reported feeling a need to cut down on drinking (OR = 3.14, [CI = 1.16, 8.49]) and participants who used behavioral disengagement as a coping mechanism (OR = 1.49, [CI = 1.15, 1.92]). Following a natural disaster, it is important to address trauma-related mental health needs of PLWH - particularly women and individuals who abuse alcohol.

Resilience as a predictor of treatment response in patients with posttraumatic stress disorder treated with venlafaxine extended release or placebo

This post-hoc analysis evaluated resilience as a predictor of treatment response in patients with posttraumatic stress disorder (PTSD). Data were pooled from two randomized, double-blind studies conducted with adult outpatients treated with flexible doses of venlafaxine extended release (ER) 37.5 to 300 mg/day or placebo. The 17-item Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS-SX(17)) was the primary outcome measure. Baseline Connor-Davidson Resilience Scale (CD-RISC) scores for the 25-, 10-, and 2-item versions were used to predict changes in PTSD symptom severity at week 12 and symptomatic remission (CAPS-SX(17) ≤ 20). Analyses were conducted for the overall population and separately for the individual treatment groups. In total, pretreatment resilience predicted a positive treatment response. For the overall population, all versions of the CD-RISC predicted CAPS-SX(17) change scores and remission after controlling for variables such as treatment group and baseline symptom severity. For venlafaxine ER-treated patients, all versions of the CD-RISC were predictive of remission, but only the 10-item version was predictive of CAPS-SX(17) change score. Our results suggest that higher pretreatment resilience is generally associated with a positive treatment response. Future research may be warranted to explore the relationship between response to active treatment and the spectrum of resiliency.

Ethnic identity and perceived stress in HIV+ minority women: the role of coping self-efficacy and social support

BACKGROUND

Ethnic minority women living with HIV (WLWH) face multiple stigmas that can contribute to overwhelming levels of stress, which could hamper their ability to manage their chronic disease. Little is known about whether having a greater sense of ethnic identity might insulate WLWH from stress. It is also possible that certain cognitive and interpersonal factors (i.e., coping self-efficacy and perceived social support) may act as mediators of this relationship. We hypothesized that WLWH with a greater sense of ethnic identity would report less stress because they access these cognitive and interpersonal resources to better manage stressors.

PURPOSE

The present study (1) related ethnic identity to perceived stress and (2) examined coping self-efficacy and social support as co-mediators of this relationship in a sample of low-income minority WLWH.

METHOD

Ninety-two minority women (89% African American) completed self-report psychosocial measures including the Multigroup Ethnic Identity Measure (MEIM), Perceived Stress Scale (PSS), Cognitive Coping Self-efficacy Scale (CCSE), and Social Provision Scale (SPS).

RESULTS

Greater ethnic identity was associated with less perceived stress, and this relationship was mediated by greater levels of both coping self-efficacy and social support.

CONCLUSIONS

WLWH who identify more with their ethnic group may experience less stress via their access to more cognitive and interpersonal resources.

If at first you don't succeed: the neuroendocrine impact of using a range of strategies during social conflict

Using a variety of cognitive or behavioral strategies to manage stressful situations may be more adaptive than relying on a narrow selection. Although research has explored the psychological benefits of a range of coping responses, the physiological impact within and across stressful situations has not been examined. Moreover, research has primarily relied upon self-reports of what people believe they generally do across stressful situations, which may be subject to recall bias. This study observed and coded the range of behavioral response strategies that young adults (n=74, mean age 18.1) used to manage a laboratory-based, interpersonal conflict task and collected self-reports of the cognitive strategies used to manage similar stressors. Analyses examined the impact of response range on cortisol activity during the task. Greater range of observed response strategies predicted lower cortisol reactivity (t(133)=2.65; p=.009), whereas the range of self-reported strategies was unrelated to cortisol reactivity (t(133)=.53; p=.60). Results support observational assessment as an important supplement to self-reports of responses to stress and suggest that the range of strategies used to manage the momentary demands of a stressful situation may help explain individual differences in the impact of stress on physiological systems.

Developing a model for online support group use, empowering processes and psychosocial outcomes for individuals living with HIV/AIDS

This study examined the mechanism through which online support group (OSG) participation may promote patient empowerment among 340 individuals living with HIV/AIDS. Results from structural equation modelling revealed that greater use of OSGs was associated with more frequent occurrence of the empowering processes as measured by receiving useful information, receiving social support, finding positive meaning and helping others. Receiving useful information and finding positive meaning were related to higher levels of adaptive coping and lower levels of maladaptive coping, while receiving social support and helping others were related to higher levels of self-care self-efficacy, which in turn was related to higher levels of adaptive coping, and lower levels of maladaptive coping. Finally, higher levels of maladaptive coping were related to poorer quality of life, while higher levels of adaptive coping were related to better quality of life. Results suggest that OSG participation may offer some benefits for those living with HIV/AIDS.

The firefighter coping self-efficacy scale: measure development and validation

The authors evaluated the psychometric properties of the Firefighter Coping Self-Efficacy (FFCSE) Scale, a new measure developed to assess firefighters' perceived competence in managing stressful and traumatic experiences encountered on the job. Two samples of firefighters completed the FFCSE Scale at two different time points. Exploratory factor analysis yielded a unidimensional structure, which was further supported with confirmatory factor analysis using a second sample. Internal consistency of the measure was excellent. Analysis of cross-sectional data indicated FFCSE was positively associated with measures of psychological well-being and social support, and negatively associated with work-related stress and psychological distress. FFCSE also uniquely contributed to the variance in psychological distress, over and above variables previously shown to be associated with distress among this population. Implications and suggestions for future research are discussed.

The psychological impact from hurricane Katrina: effects of displacement and trauma exposure on university students

The following study examined the reactions of university students to Hurricane Katrina. A group of 68 New Orleans area students who were displaced from their home universities as a result of the hurricane were matched on race, gender, and age to a sample of 68 students who had been enrolled at Louisiana State University (LSU) prior to the hurricane. All students were enrolled at LSU at the time they participated in an online survey, conducted 3 months following the hurricane. The survey included symptom measures of depression, anxiety, stress, posttraumatic stress disorder (PTSD), and other variables. Results indicated displaced students experienced more trauma exposure and greater subsequent distress, more symptoms of PTSD, and more symptoms of depression. Moreover, traumatic exposure and distress from the traumatic exposure were found to fully mediate depressive symptoms and posttraumatic symptoms in the displaced students.

Self-Efficacy and Health-Related Outcomes of Collective Trauma

The objective of our study was to systematically review research evidence for relationships between self-efficacy beliefs and psychological as well as somatic outcomes of collective traumatic events. Twenty-seven studies enrolling adult and adolescent survivors of acute, escalating, and chronic collective trauma with a total of N = 8011 participants were reviewed. Cross-sectional studies suggest medium to large effects of self-efficacy on general distress, severity and frequency of PTSD (posttraumatic stress disorder) symptoms (weighted r values range from –.36 to –.77), whereas longitudinal studies indicate large effects on general distress and PTSD symptom severity (weighted r values range: –.55 to –.62). Self-efficacy was also related to better somatic health (self-reported symptoms, i.e., less pain, fatigue, or disability). Studies addressing the relationship between self-efficacy and substance abuse after collective trauma revealed a more complex picture. Some types of pretreatment self-efficacy (e.g., self-efficacy for coping with urges) or changes in efficacy beliefs may predict less substance use or relapses. Studies testing the mediating role of cognitive or social variables in the relationship among efficacy beliefs and health outcomes indicated rather direct, unmediated effects of beliefs about ability to deal with adversities on posttraumatic adaptation. Men may benefit more from stronger efficacy beliefs. In terms of reciprocity between self-efficacy and health, evidence from longitudinal studies suggested that self-efficacy determines health-related outcomes, but changes in diagnosis do not predict changes in self-efficacy. Although a lack of experimental studies limits the conclusions, the results indicated that self-efficacy is a powerful predictor of posttraumatic recovery among collective trauma survivors.

Internet interventions for traumatic stress: a review and theoretically based example

Trauma recovery Web sites are proliferating with limited supportive evidence for effectiveness. In this article, the authors review the current very early studies on trauma recovery Web sites highlighting the different approaches, the empirical support provided, and the critical development issues facing this exciting frontier. An example site based on social cognitive theory is also reviewed.

Psychometric properties of the Hurricane Coping Self-Efficacy measure following Hurricane Katrina

The Hurricane Coping Self-Efficacy (HCSE) measure is a validated tool for assessing self-efficacy appraisals after hurricanes. Data were collected 6 months after Hurricane Katrina from 1542 employed residents of New Orleans, and 181 participants randomly selected to complete a repeat survey to confirm the psychometric properties of the HCSE measure. Overall, coping self-efficacy was greater among men, the most educated and those with the highest income. Confirmatory factor analyses indicated a relatively good fit of the HCSE items into a single construct, with Bentler's comparative fit and McDonald's centrality index scores of 0.92 and 0.87, respectively. The repeatability of scores was high (Pearson's correlation = 0.70). Additionally, HCSE scores were highly correlated with validated scales of perceived stress and posttraumatic stress symptoms, and significantly lower scores were observed among participants who sought counseling after the storm. The HCSE measure exhibited excellent internal consistency, external validity and repeatability after Hurricane Katrina.

Coping self-efficacy mediates the effects of negative cognitions on posttraumatic distress

Although cognitive distortions have predicted posttraumatic distress after various types of traumatic events, the mechanisms through which cognitive distortions influence posttraumatic distress remain unclear. We hypothesized that coping self-efficacy, the belief in one's own ability to manage posttraumatic recovery demands, would operate as a mediator between negative cognitions (about self, about the world, and self-blame beliefs) and posttraumatic distress. In the cross-sectional Study 1, data collected among 66 adult female victims of child sexual abuse indicated that coping self-efficacy mediated the effects of negative cognitions about self and about the world on posttraumatic distress. The same pattern of results was found in a longitudinal Study 2, conducted among 70 survivors of motor vehicle accidents. Coping self-efficacy measured at 1 month after the trauma mediated the effects of 7-day negative cognitions about self and about the world on 3-month posttraumatic distress. In both studies self-blame was not related to posttraumatic distress and the effect of self-blame on posttraumatic distress was not mediated by coping self-efficacy. The results provide insight into a mechanism through which negative cognitions may affect posttraumatic distress and highlight the potential importance of interventions aimed at enhancing coping self-efficacy beliefs.

Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy

OBJECTIVE

The study investigated whether received social support, self-efficacy, and finding benefits in disease are related to physical functioning and adherence to antiretroviral medication among men and women infected with HIV.

METHODS

Data were collected among 104 patients of three HIV clinics in India. The measures included general self-efficacy scale, Berlin social support scales, questionnaire on taking antiretroviral medication, and SF-20 (physical functioning).

RESULTS

The results of path analysis and mediation analysis revealed that finding benefits and self-efficacy were directly related to both adherence and physical functioning. Additionally, finding benefits mediated the relation between patients' self-efficacy and adherence as well as physical functioning. Although received support was unrelated to adherence directly, effects of received support on adherence were mediated by self-efficacy.

CONCLUSIONS

Besides personal and social resources, benefit finding was related to better adherence to antiretroviral medication.

PRACTICE IMPLICATIONS

Identifying patients receiving low social support, with weak general self-efficacy and finding no benefits in being diagnosed with HIV may help to elicit those people who are at risk for poorer adherence and physical functioning.

The socialization of adolescent coping behaviours: Relationships with families and teachers

A motivational theory of children's coping identified aspects of relationships--involvement, structure and autonomy support--that are expected to determine whether coping will be characterized by approach (active) or avoidance. Associations between adolescents' (N=487, Age M=14) relationships with families and teachers, and coping behaviours were examined. Whether a Family Primacy Model or a Context-Specific Model best explained the findings was also determined. A Family Primacy Model received predominant support; adolescents with more positive family relationships used more active coping with problems at home and school. Positive relationships with teachers predicted more active coping behaviours, especially at school.

The psychobiology of PTSD: coping with trauma

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.

Effects of appraisal and coping on the neuroendocrine response to extreme stress

Although many people are exposed to extreme stress, only some of them develop psychobiological disturbances that can lead to posttraumatic stress disorder (PTSD) or other posttrauma psychopathology. This paper examines the effects of different types of appraisal and coping to find clues to how individuals differ in their neuroendocrine responses to extreme stress. It proposes a conceptual model for components of the adult response to stressors. Threat appraisal and defensive coping may play crucial roles in determining the neuroendocrine response to trauma with potential mental health consequences, particularly PTSD.

The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women's Project

The purpose of the present study was to determine whether changes in self-efficacy over time would be related to changes in disease progression markers (CD4, viral load) in a sample of women with AIDS. A self-efficacy measure was developed and two sub-scales emerged via factor analysis of 391 HIV-positive women: AIDS Self-efficacy and Cognitive Behavioral Skills Self-efficacy. Subsequently, the sub-scales and an additional adherence self-efficacy item were given to 56 HIV-positive women who were measured at two time points three months apart. Half of these women were randomly assigned to a CB intervention and half to a low intensity comparison condition. Increases in AIDS Self-efficacy over the three-month period were significantly related to increases in CD4 and decreases in viral load. Similarly, increases in Cognitive Behavioral Skills Self-efficacy were significantly related to decreases in distress over time. Findings were maintained within the intervention group alone. Interestingly, increases in cognitive behavioral skills self-efficacy and increases in the self-efficacy adherence item were also significantly related to decreases in viral load. Implications of the findings and suggestions for future research are discussed.

Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy

The present article integrates findings from diverse studies on the generalized role of perceived coping self-efficacy in recovery from different types of traumatic experiences. They include natural disasters, technological catastrophes, terrorist attacks, military combat, and sexual and criminal assaults. The various studies apply multiple controls for diverse sets of potential contributors to posttraumatic recovery. In these different multivariate analyses, perceived coping self-efficacy emerges as a focal mediator of posttraumatic recovery. Verification of its independent contribution to posttraumatic recovery across a wide range of traumas lends support to the centrality of the enabling and protective function of belief in one's capability to exercise some measure of control over traumatic adversity.

Development and psychometric validation of a Domestic Violence Coping Self-efficacy Measure (DV-CSE)

Psychometric properties of a Domestic Violence Coping Self-Efficacy Measure were examined. Two-hundred eighty three women assaulted within the past 6 months were recruited. Internal reliability of the measure was very good (alpha = .97). Principle components factor analysis indicated one primary factor accounting for 56% of the variance. The measure was positively associated with optimism, adaptive coping, and healthy psychological functioning, and negatively associated with trauma-related distress, negative mood, and maladaptive coping. A small positive association with social desirability was found. This measure may have significant clinical utility in helping survivors by indicating areas where individuals feel especially vulnerable or empowered.

Evaluating patient education materials about radiation therapy

Targeted treatment education for cancer patients has the potential to promote adjustment through assisting patients to participate in treatment decision making, comply with treatment regimens and cope more effectively with treatment side effects. A quasi-experimental longitudinal pre-test post-test and follow-up design was used to assess the effect of a patient education video about radiation therapy on patients' psychological distress, knowledge about radiation therapy, self-efficacy about coping with treatment and physical symptoms. Patients with head and neck (n=26) and breast cancer (n=66) were recruited into the study and allocated into control and intervention groups. No significant differences were found between the control and intervention groups on any of the outcome variables. However, patients in the intervention group reported high levels of satisfaction with the video and all reported that they would recommend the video to other patients preparing for radiation therapy. As well, 90% of patients in the intervention group reported that some or all of the information in the video was new to them. Education materials that have excellent face validity and that are well received by patients may fail to produce significant change using standard controlled study designs. Future research in this area may need to consider alternative paradigms for evaluating the helpfulness of such materials.

Coping and psychological distress among symptomatic HIV+ men who have sex with men

This study evaluated relations among indicators of latent coping factors and psychological distress while incorporating measures of life stress and HIV illness related factors simultaneously among 211 symptomatic, HIV+ men who have sex with men (MSM). Participants were all assessed at a single time point. A structural equations model with latent factors for approach-oriented coping, avoidant-oriented coping, and psychological distress showed adequate fit. Furthermore, significant associations were identified among latent factors for approach-oriented coping, avoidance coping, and psychological distress; specifically, greater use of approach-oriented coping strategies and less use of avoidant-oriented coping were associated with lower levels of psychological distress. The model was revised to incorporate variables significantly associated with psychological distress (i.e., personal loss-total events, personal loss-controllability, and HIV-related symptoms). Relations among the coping and psychological distress latent factors remained significant. The results suggest that HIV+ MSM who do not have the coping skills or resources necessary to use adequate coping strategies to face the chronic burdens associated with HIV illness are likely to experience higher levels of psychological distress, independent of life stress and ongoing HIV-related symptoms.

The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women

The authors examined whether self-efficacy among African American abused women decreased their risk of suicide attempts through the mediating influences of perceived social support from friends, perceived social support from family, and perceived effectiveness for obtaining material resources. The sample consisted of 100 women who presented to a hospital following a suicide attempt and 100 women who presented to the same hospital for nonemergency medical problems. Results revealed that the association between self-efficacy and suicide attempt status was partially accounted for by the mediating roles of perceived social support from friends and family, and perceived effectiveness at obtaining resources. Findings suggest that interventions to increase abused women's self-efficacy should focus on increasing their capacity to obtain social and material resources.

Coping self-efficacy perceptions as a mediator between acute stress response and long-term distress following natural disasters

The mediating effect of coping self-efficacy (CSE) perceptions between acute stress responses (ASR) and 1-year distress following two disasters was tested. Between 3 and 8 weeks after the second disaster and again at 1 year, 46 residents completed questionnaires. Posttraumatic Stress Disorder (PTSD) symptoms and global distress served as outcomes. Multiple regression demonstrated that ASR and Time I CSE were significant predictors of both Time 1 outcomes. Time 1 PTSD symptoms and Time 2 CSE were significant factors for Time 2 PTSD symptoms. Gender was significant for Time 2 PTSD symptoms, but not for Time 2 global distress. Longitudinally, Time 1 CSE predicted Time 2 PTSD symptoms, but not general distress. CSE mediated between ASR and both psychological outcomes at Time 2. Coping self-efficacy perceptions provide a possible intervention target.

Social Support Mediates Loneliness and Human Herpesvirus Type 6 (HHV-6) Antibody Titers

The current study investigated the impact of a severe environmental stressor and the role that declining social integration played in mediating its effect on loneliness and immune status. Increased loneliness and decreased social support in the months following the stressor (storm) were significantly associated with increased HHV-6 antibody titers, reflecting poorer control over the virus. Poorer social integration mediated the relationship between loneliness and HHV-6, even after controlling for nonspecific polyclonal B-cell activation, disease status (CD3+CD4+ cell counts), living arrangements, acute social losses (bereavement), and potential disruptions in social-support resources. These findings suggest that specific elements of social support may explain the oft-noted negative effects of loneliness on the immune system, and generalized to a medically vulnerable population.

How injection drug users coped with testing HIV-seropositive: implications for subsequent health-related behaviors

At entry into methadone maintenance treatment, 94 HIV-positive injection drug users (IDUs) completed the Coping Reponses Inventory, which asked them to "describe your feelings and experiences when you first learned you were HIV positive." Controlling for time since HIV testing, a reliance on avoidance coping following HIV testing was correlated with high levels of recent HIV risk behavior and poor health at entry into the study. The use of any coping strategy, particularly approach strategies, was related to medication adherence. Hierarchical regression analysis showed that avoidance coping accounted for a significant proportion of the variance in recent HIV risk behavior over and above that accounted for by the other variables. Other independent predictors of continued risk behavior were poor health, lack of social support, and low levels of HIV/AIDS knowledge. The need for interventions to help injection drug users (IDUs) cope subsequent to testing HIV seropositive is discussed.

Bereavement coping self-efficacy in cancer widows

This study applied social cognitive theory to help explain the differential outcomes observed in conjugal bereavement. Specifically, a measure of bereavement coping self-efficacy was created and relationships tested with psychological, spiritual, and physical health outcomes. One hundred and one women whose husbands had died from cancer within the last year served as participants. Mean age of this relatively well-educated, predominately Caucasian sample was 54 years old. Median time since death was between 6 months and a year. Results supported the hypotheses that bereavement coping self-efficacy was a significant predictor of emotional distress, psychological well-being, spiritual well-being, and physical health perceptions after controlling for several other important factors. Theoretical and clinical ramifications of these findings are discussed.

Psychometric properties of a hurricane coping self-efficacy measure

This brief report describes the psychometric properties of an instrument designed to measure Hurricane Coping Self-Efficacy (HCSE). Survivors of Hurricane Andrew (n = 165) and Hurricane Opal (n = 63) completed the HCSE and assessments of optimism, social support, distress, and resource loss. Principal components factor analyses revealed a unidimensional structure for the HCSE. Internal consistency of the HCSE was strong. In both samples, HCSE was positively associated with optimism and social support, but negatively associated with general psychological distress, trauma related distress, and resource loss. Finally, hierarchical regression analyses demonstrated that the HCSE explained a significant amount of experimental variance for intrusive thoughts and avoidance after controlling for social support, lost resources, and optimism.