The Brief Approach/Avoidance Coping Questionnaire: Development and validation

Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study

BACKGROUND

Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones.

METHODS

People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE).

RESULTS

A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies.

CONCLUSION

Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

Revisiting the symptom iceberg based on the Danish symptom cohort - Symptom experiences and healthcare-seeking behaviour in the general Danish population in 2022

Introduction

Healthcare-seeking behaviour may change over time, and some groups are more likely to avoid relevant help seeking, which possibly contributes to social inequity in health. Thus, we developed an expansion of and follow-up to the Danish Symptom Cohort (DaSC) from 2012 and formed the DaSC II, which encompassed a population-based questionnaire study investigating symptoms and healthcare-seeking behaviour. In this paper, we describe the conceptual framework, development and content validity of the questionnaire and a responder analysis of the participants in the DaSC II. We present the symptom iceberg in the Danish general population by estimating the prevalence of symptoms and proportion of contacts to general practitioners (GPs) in 2022. Moreover, we discuss differences in healthcare-seeking behaviour with reference to the 2012 DaSC.

Methods

100,000 randomly selected Danish citizens aged ≥20 years, along with the 44,713 respondents from the 2012 cohort, were invited to participate in a survey. The questionnaire was pilot and field tested prior to distribution. Descriptive statistics were used to estimate symptom prevalence and proportion of GP contacts, and to execute the respondent analysis.

Results

Nine out of ten respondents reported at least one symptom within the preceding four weeks and reported an average of 4.6 symptoms. One in four symptoms were presented to a GP. The highest proportion of GP contacts was found for haematuria (63.3 %) and shortness of breath (51.8 %). For several symptoms, differences between the sexes were found in relation to both prevalence and GP contacts. The proportion of GP contacts was higher in 2022 than in 2012 and was most pronounced for general, frequently experienced symptoms and to a lesser extent for cancer alarm symptoms.

Conclusion

Many symptoms go unreported, which may delay relevant diagnosis; more research on certain symptom categories and population subgroups is needed. Future studies based on the DaSC II form a basis for interventions targeting symptom awareness, healthcare-seeking behaviour and social equity in society and health.

Coping strategies of school-going adolescents during the COVID-19 pandemic in the climate vulnerable Manafwa watershed, Uganda

BACKGROUND

The COVID-19 pandemic disrupted daily life, economies, and health, prompting strict government measures, including nationwide lockdowns and school closures in Uganda, resulting in significant academic setbacks for adolescents. The coping strategies employed by school-going adolescents in Uganda amidst the COVID-19 pandemic remain inadequately understood. This study aimed to assess the coping strategies adopted by school-going adolescents (early, middle and late adolescents) in the Manafwa watershed, recognized as one of Uganda's most vulnerable regions, during the COVID-19 pandemic.

METHODS

A cross sectional study design was conducted from I5th May, 2023 to 30th June, 2023 on 762 school going adolescents from government-aided secondary schools within the Manafwa watershed area. The adolescent version of the KidCope tool was used to evaluate adolescents' coping strategies. Factor analysis identified correlations among adolescents' coping strategies. Independent Samples t-Test and One-Way Variance of Analysis (ANOVA) was used for comparing the mean score differences of the coping strategies among the gender and adolescents' stages respectively.

RESULTS

Majority (n = 141, 36.2%) of the participants employed adaptive coping followed by negative-emotion coping (n = 127, 32.6%) and avoidant coping (n = 122, 31.3%). Females employed statistically higher resignation as a coping strategy compared to males, (mean of 1.2 vs. 1.0, respectively; P = 0.026). A higher proportion (n = 88, 69.3%) of middle age adolescents employed negative-emotion regulation (P-value = 0.040). However, those in early adolescence significantly utilized distraction as a coping strategy more than those in middle adolescence (mean difference = 0.36, p = 0.013).

CONCLUSION

During the pandemic, majority of school-going adolescents employed adaptive coping mechanisms, including positive emotional regulation and social support. However, compared to males, females employed resignation more frequently. Moreover, middle-aged adolescents had a greater propensity for negative emotion copying. Findings from this study contribute valuable information for the development of targeted interventions and support mechanisms for adolescents facing unprecedented challenges.

Path analysis of the role of coping strategies between emotional intelligence and lifestyle habits during COVID-19 lockdown

The relationship between Emotional Intelligence (EI) and lifestyle choices during the COVID-19 pandemic is obscure and not very well understood. To clarify the mechanisms underlying this relationship, we proposed to test the hypothesis that different coping styles (avoidant and approach) have an indirect effect on the association between EI and many types of lifestyle habits. A cross-sectional study was conducted between December 2020 and January 2021. Our target sample consisted of Lebanese adults from the general population. In path analysis, approach coping mediated the association between EI and different lifestyle habits (rest, nutrition, general physical conditions), but not exercise. Furthermore, avoidant coping did mediate the association between EI and general physical conditions, but not between EI and other lifestyle choices (namely rest, exercise, and nutrition). To conclude, individuals with high EI, and that are users of approach coping strategies to deal with stressors, have increased rest time, healthy nutrition and general physical conditions. This cautiously implies that fostering approach coping may help improve the positive effects of EI on healthy lifestyles during crises such as this pandemic.

Coping strategies and belief in COVID-19 conspiracy theories

Conspiracy beliefs have been related to aversive emotional experiences often accompanying major world events and have also been linked to maladaptive ways of coping with stress. In this research, we examined how different coping strategies (i.e. self-sufficient, social-support, avoidance and religious) predicted the adoption of COVID-19 conspiracy theories. In two studies (Study 1, n = 1000 and Study 2, n = 616) conducted among Polish participants, we found that avoidance and religious coping were positively linked to COVID-19 conspiracy beliefs. In Study 1, conspiracy beliefs also mediated the positive relationships between avoidance and religious coping and adherence to safety and self-isolation guidelines during the COVID-19 pandemic. Study 2 additionally showed that the relationship between fear, induced by reading threatening news on COVID-19, and conspiracy beliefs was the strongest among those high in avoidance coping. These studies highlight the role of coping strategies in the adoption of COVID-19 conspiracy beliefs.

Predictors of the likelihood that patients with rheumatoid arthritis will communicate information about rheumatoid arthritis risk to relatives: A quantitative assessment

First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) are increasingly recruited to prediction and prevention studies. Access to FDRs is usually via their proband with RA. Quantitative data on predictors of family risk communication are lacking. RA patients completed a questionnaire assessing likelihood of communicating RA risk information to their FDRs, demographic variables, disease impact, illness perceptions, autonomy preferences, interest in FDRs taking a predictive test for RA, dispositional openness, family functioning, and attitudes towards predictive testing. Ordinal regression examined associations between patients' characteristics and their median likelihood of communicating RA risk to FDRs. Questionnaires were completed by 482 patients. The majority (75.1%) were likely/extremely likely to communicate RA risk information to FDRs, especially their children. Decision-making preferences, interest in FDRs taking a predictive test, and beliefs that risk knowledge would increase people's empowerment over their health increased patients' odds of being likely to communicate RA risk information to FDRs. Beliefs that risk information would cause stress to their relatives decreased odds that patients would be likely to communicate RA risk. These findings will inform the development of resources to support family communication about RA risk.

Assessment of Frontal Hemispherical Lateralization in Plaque Psoriasis and Atopic Dermatitis

BACKGROUND

Each brain hemisphere plays a specialized role in cognitive and behavioral processes, known as hemispheric lateralization. In chronic skin diseases, such as plaque psoriasis (Pso) and atopic dermatitis (AD), the degree of lateralization between the frontal hemispheres may provide insight into specific connections between skin diseases and the psyche. This study aims to analyze the hemispherical lateralization, neurovegetative responses, and psychometric characteristics of patients with Pso and AD.

METHODS

The study included 46 patients with Pso, 56 patients with AD, and 29 healthy control (Ctrl) subjects. The participants underwent frontal electroencephalogram (EEG) measurement, heart rate variability (HRV) assessment, and psychological tests. Statistical analyses were performed using ANOVA, with Bonferroni correction applied for multiple comparisons.

RESULTS

This study shows a significant right-lateralized prefrontal activity in both AD patients (p < 0.001) and Pso patients (p = 0.045) compared with Ctrl, with no significant difference between the AD and Pso groups (p = 0.633). AD patients with right-hemispheric dominant prefrontal activation exhibited increased inhibition and avoidance markers, while Pso patients showed elevated sympathetic nervous system activity.

CONCLUSION

Psychophysiological and psychometric data suggest a shared prevalence of right-hemispheric dominance in both AD and Pso patient groups. However, the findings indicate distinct psychodermatological mechanisms in AD and Pso.

Teachers' perception of aggressive student behavior through the lens of chronic worry and resignation, and its association with psychophysiological stress: An observational study

Aggressive student behavior is considered a leading risk factor for teacher stress. However, teachers' coping styles may affect how they perceive and respond to aggressive student behavior. This study tests whether teachers' perceptions of aggressive student behavior mainly mirror objectively observed aggression in presence of the teacher (as coded by external observers) or whether teachers' perception of aggressive student behavior primarily reflects teachers' avoidant coping styles, such as chronic worry and resignation. Finally, we examine whether observed and teacher-perceived aggression relates to increased vital exhaustion and psychophysiological stress among teachers (i.e., higher hair cortisol concentration). In an ambulatory assessment study, we administered self-reports to 42 Swiss teachers to assess perceived student aggression, chronic worry, resignation, and vital exhaustion. Additionally, four consecutive lessons per teacher were filmed, and aggressive student behavior in presence of the teacher was coded by four trained external observers. The concentration of cortisol was assessed in hair samples. Results showed that teacher-perceived and observed aggression were moderately associated. Observed aggression was related to teacher perceptions to a much lesser extent than teachers' avoidant coping styles, that is, chronic worry and resignation. While teacher-perceived student aggression was associated with teachers' self-reported vital exhaustion, we did not find any significant association with hair-cortisol concentration. Our findings suggest that teachers perceive student aggression through the lens of their coping styles. Teachers' dysfunctional coping styles are associated with an overestimation of student aggression. Teachers' overestimation of student aggression relates to higher levels of vital exhaustion. Therefore, it is crucial to identify and change teachers' dysfunctional coping styles to prevent a vicious cycle of dysfunctional teacher-student interactions.

Coping strategies among individuals with multiple physical symptoms: A general population-based cross-sectional study

OBJECTIVE

Coping has been suggested as a perpetuating factor for physical symptoms. The aim of this study was to examine the use of the coping strategies approach, resignation, and diversion in individuals with multiple physical symptoms according to the construct of Bodily Distress Syndrome (BDS).

METHODS

This cross-sectional study was part of the nationwide web-based survey Danish Symptom Cohort (DaSC). In total, 100,000 individuals were invited to participate, and individuals eligible for the present study were respondents aged 20-64 years without a current or recent pregnancy. Multiple physical symptoms were identified using the BDS checklist, and coping was assessed by the Brief Approach/Avoidance Coping Questionnaire. Statistical analyses included descriptive statistics and multinomial and logistic regression.

RESULTS

A total of 35,810 respondents were included in the study, of which 8512 (23.8%) fulfilled the criteria for having multiple physical symptoms. This group of respondents had lower coping scores on approach and higher coping scores on resignation and diversion compared with the non-BDS group. The regression analyses showed that high scores on approach were associated with a lower probability of having multiple symptoms (adjusted OR 0.92, 95% CI: 0.91-0.92), whereas high scores on diversion and resignation were associated with a higher probability of having multiple symptoms (adjusted OR 1.10; 95% CI: 1.09-1.11 and adjusted OR 1.19; 95% CI: 1.18-1.20, respectively).

CONCLUSION

The study supports the hypothesis that experiencing multiple physical symptoms is associated with certain coping strategies. This is relevant knowledge for health care professionals who will be treating this patient group.

Gender differences in burden of care and coping strategies among caregivers of schizophrenia patients

Background

Caregivers of patients with schizophrenia have a considerable burden of care and develop different coping strategies to deal with the caregiving burden.

Aim

The aim of this article is to assess gender differences in the burden of care and coping strategies used among caregivers of clinically stable patients with schizophrenia.

Methods

In this cross-sectional study, a total of 57 caregivers (33 males and 24 females) of the patients with schizophrenia attending a psychiatric outpatient setting were included by purposive sampling. The caregivers were assessed with the Burden Assessment Schedule 20 items (BAS-20) and Brief Approach/Avoidance Coping Questionnaire (BACQ) to assess the burden of care and coping strategies, respectively.

Results

Average BAS-20 score was comparable between the male and female caregivers. If the patient was a spouse, the male caregivers had a significantly higher burden of the marital relationship than the female caregivers. On the BACQ, the socio-emotional approach subscale was significantly higher in female caregivers. The avoidance-oriented coping score and socio-emotional avoidance subscale were significantly higher in male caregivers. A significant positive correlation was found between BAS-20 score and avoidance-oriented coping scores in all caregivers except the females where a significant negative correlation was found between BAS score and socio-emotional avoidance type of coping.

Conclusion

There are no gender differences in the burden of care in caregivers of clinically stable patients with schizophrenia except the male caregivers have a higher burden in the domain of marital relationship. The socio-emotional approach type of coping is higher in females while the socio-emotional avoidance type of coping is lower in male caregivers.

Within- and between-person relationships between spontaneous self-affirmations, coping style, and wellbeing

Self-affirmations-responding to self-threatening information by reflecting on positive values or strengths-help to realign working self-concept and may support adaptive coping and wellbeing. Little research has been undertaken on spontaneous self-affirmations in response to everyday threats, and less has been undertaken on the relationships between spontaneous self-affirmations, coping, and wellbeing. This study aimed to test both within- and between-person relationships between spontaneous self-affirmations, coping, and wellbeing, controlling for threat intensity and other outcomes. A repeated survey assessment design was adopted to achieve these aims. Outcome measures included approach coping, avoidance coping, positive affect, negative affect, and eudaimonic wellbeing. It was found that spontaneous self-affirmations positively predicted approach coping and positive affect at both within- and between-person levels, and eudaimonic wellbeing at the between-person level. Overall, spontaneous self-affirmations were positively associated with approach coping and aspects of wellbeing.

Predictors of perceived risk in first-degree relatives of patients with rheumatoid arthritis

OBJECTIVES

To define variables associated with perceived risk of developing rheumatoid arthritis (RA) in first-degree relatives (FDRs) of patients with RA.

METHODS

Patients with RA and their FDRs were invited to complete cross-sectional surveys. FDR and index patient responses were linked. FDRs' perceived absolute risk, comparative risk, experiential risk and worry about risk were assessed using 5-point Likert scales. FDR predictor variables included demographics, illness perceptions and psychosocial variables. Patient predictors of FDR perceived risk were assessed. Binary logistic regression examined the relationship between FDR characteristics and perceived risk of RA. Generalised estimating equations assessed whether patient variables predicted FDR's perceived risk.

RESULTS

396 FDRs returned a survey. 395 FDRs provided sufficient data and were included in analysis. Paired data from 213 patients were available for 291 of these FDRs. All measures of perceived risk were inter-correlated. 65.2% of FDRs perceived themselves to be 'likely' or 'very likely' to develop RA in their lifetime. Relationship with index patient, high health anxiety, female gender, long perceived RA duration, high perceived concern about RA, negative perceived emotional impact of RA and low perceptions of how well treatment would control RA were all associated with increased FDRs' perceived risk. Patient characteristics did not associate with FDRs' risk perceptions.

CONCLUSIONS

FDRs' perceived risk of RA was high. Key predictors included being a child of a patient with RA, higher health anxiety and lower perceptions of RA treatment control. An understanding of these predictors will inform the development of tailored risk communication resources and preventive clinical strategies for RA.

Distressed (Type D) personality is predicted by avoidance: evidence from a computer-based avatar task

Background

One personality type associated with poor health outcomes is distressed (Type D) personality which involves high levels of both social inhibition (SI) and negative affectivity (NA). Type D is also linked to psychopathologies such as post-traumatic stress disorder (PTSD), anxiety disorders, and depression. One mechanism through which personality temperament may result in these psychopathologies is avoidance. Recently, a computer-based measure designed to assess avoidant behaviors, in which the participant guides the behavior of an avatar interacting with strangers in social situations, has been found to be related to various forms of avoidance. In the current study, we extended this work with the avatar avoidance task to determine its relationship to distressed (Type D) personality. We hypothesized that Type D personality, along with SI, but not NA, would be positively related to avatar avoidance scores. We also hypothesized that avatar avoidance scores would be higher in Type D individuals than non-Type D individuals.

Methods

A total of 302 undergraduates completed the Distressed Type D Personality Scale (DS-14), and a computer-based avatar avoidance task.

Results

Type D and SI, and NA to a lesser degree, were positively correlated with avoidance scores on the avatar task. Furthermore, regression analyses revealed that Type D and SI scores were best predicted by a model including avoidance scores and education level while NA scores were best predicted by a model including avoidance scores. Standard cut-off scores on the DS-14 scale resulted in four groups (i.e., low SI and NA, high SI, high NA, and Type D) which significantly differed in avoidance scores. Specifically, Type D individuals had higher avoidance scores than the other three groups. Taken together these findings support a role for avoidance in Type D personality. The computer-based avatar avoidance task may be particularly relevant as an ecologically valid measure to identify avoidance in a virtual setting for use with individuals expressing Type D personality who may be unwilling or unable to accurately self-report or describe their own avoidant tendencies.

COVID-19 related conspiracy beliefs and their relationship with defense strategies, emotions, powerlessness, attitudes, and time perspective

The COVID-19 pandemic has greatly impacted individual's life and society, and such an emergency has increased the likelihood of recurring conspiratorial thinking. There is much research on broader conspiratorial thinking and studies on COVID-19-related conspiratorial thinking has been growing worldwide, moreover, the negative consequences of COVID-19 specific conspiratorial beliefs for people's health are clear. However, person-centered research aiming at identify groups of individuals who share patterns of relations between COVID-19 specific conspiratorial beliefs and other psychological features is still scarce. A sample of 1.002 people (18-40 years old, M = 23; SD = 5.19) responded to a questionnaire administered online. The aim was to identify groups of individuals based on their beliefs about COVID-19 conspiracy theories and to compare the groups identified in terms of psychological characteristics associated such as automatic defense mechanisms, coping strategies, powerlessness, emotions, emotional regulation, attitudes toward the COVID-19, social distancing discontent, perceptions of COVID-19 severity and temporal perspective. A k-mean cluster analysis identified the groups of Believers (22.26%), Ambivalent believers (34.3%), and Non-believers (43.21%). The three groups differ particularly in terms of defense mechanisms, and time perspective. Results suggested the need to tailor interventions for individuals believing in COVID-19 conspiratorial theories based on differences in the psychological characteristics among the three groups.

Psychometric properties of the cultural mix coping inventory for stressful situations using physical education teachers: a multidimensional item response theory analysis

The incidence of the COVID-19 pandemic heightened the levels of stress of not only students but for teachers, particularly physical education (PE) teachers. The reference to PE teachers is due to their role in engaging students in practical in-person lessons after the resumption of school. Previous literature has revealed that PE teachers exhibit significantly increased levels of anxiety, fear, tension and uncertainty that they could contract the virus during these lessons. Given this scenario, there is a growing need for identifying a suitable coping scale which can accurately measure coping strategies employed these teachers. This research assessed the psychometric properties of the 16-item coping inventory using a multidimensional item response theory approach. The study surveyed 484 PE teachers through the convenience sampling technique, after which the cultural mix coping instrument was administered to them. The findings of this study confirmed the 4-factor structure of the coping measure which is consistent with the original measure. Results further revealed that a modified 14-item compared to the original 16-item coping inventory was optimal in measuring coping strategies among PE teachers. The study concluded that the 14-item cultural mix coping inventory was appropriate, applicable and reproducible to the PE teachers' population.

Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19

The Cultural Mix Coping Inventory for Stressful Situations is one of the recent coping measures developed to overcome the weaknesses of existing coping scales. Since its development and validation, the inventory has been used by previous studies to measure coping among teachers and students in stressful situations. Health professionals are workers who typically encounter stressful situations due to their work demands. In this study, we assessed the validity and reliability of cultural mix inventory for stressful situations among healthcare professionals in Ghana. The research was guided by three major objectives: (1) to assess the factor structure of the cultural mix coping inventory, (2) to evaluate the construct validity and reliability of the cultural mix coping inventory based on internal structure and (3) to test for evidence of criterion validity based on the external structure of the measure. Approximately 312 health workers were purposefully sampled to participate in the study. The study confirmed the original four-factor solution of the coping inventory with evidence of the construct validity based on the internal structure. Validity evidence based on the external structure of the measure was found to be sufficient. Given the COVID-19 pandemic and coupled with the stressful nature in the line of duty of healthcare professionals, this inventory provides a useful and sound measure of coping options among this cohort.

Rate and correlates of post-traumatic stress disorder (PTSD) following the Beirut blast and the economic crisis among Lebanese University students: a cross-sectional study

BACKGROUND

Post-traumatic stress disorder (PTSD) is a mental illness that develops in some people after they have experienced a stunning, scary, or dangerous incident. Due to major disasters like as the Economic Crisis and the Beirut Blast, Lebanese people are struggling with a variety of mental health issues. The study objectives were to find the rate of PTSD and its association with stress, anxiety, depression, financial well-being and coping strategies among university students in Lebanon.

METHODS

This is a cross-sectional study, conducted between May and August 2021, which enrolled 419 university students from all districts of Lebanon. The PTSD Checklist-Specific Version (PCL-S) was used to evaluate manifestation of PSTD.

RESULTS

The results showed that 132 (31.5%), 109 (26.0%) and 169 (40.3%) had PTSD from COVID, Beirut blast and economic crisis respectively. More avoidant coping (Beta = 0.52) and more anxiety (Beta = 0.62) were significantly associated with more PTSD from the Beirut Blast. More avoidant coping (Beta = 0.56), depression (Beta = 0.40) and anxiety (Beta = 0.49) were significantly associated with more PTSD from the economic crisis, whereas more financial wellbeing (Beta = - 0.31) was significantly associated with less PTSD from the economic crisis.

CONCLUSION

Significant rates of PTSD were found in our sample of Lebanese university students, whether from the Beirut blast, or from the current economic crisis. Significant correlations of these PTSD rates were found with factors such as avoidant coping, depression, anxiety and financial wellbeing. Such findings must raise the attention to serious mental and psychosocial alteration endured by Lebanese youth that are still under fatal cumulative traumatic events, that were and even may be, intergenerationally and unintentionally transmissible, therefore, affecting not only the present, but also the future of a whole nation.

Predictors of interest in predictive testing for rheumatoid arthritis among first degree relatives of rheumatoid arthritis patients

OBJECTIVES

There is increasing interest in prediction and prevention of RA. It is important to understand the views of those at risk to inform the development of effective approaches. First-degree relatives (FDRs) of RA patients are at increased risk of RA. This study assessed predictors of their interest in predictive testing for RA.

METHODS

Questionnaires were completed by RA patients (provided with their questionnaire by a healthcare professional) and their FDRs (provided with their questionnaire by their RA proband). FDR surveys assessed interest in taking a predictive test, demographic variables, perceived RA risk, attitudes about predictive testing, autonomy preferences, illness perceptions, avoidance coping and health anxiety. Patient surveys included demographic variables, disease impact, RA duration and treatment. Ordinal logistic regression examined the association between FDRs' characteristics and their interest in predictive testing. Generalized estimating equations assessed associations between patient characteristics and FDRs' interest in predictive testing.

RESULTS

Three hundred and ninety-six FDRs responded. Paired data from the RA proband were available for 292. The proportion of FDRs interested in predictive testing was 91.3%. Information-seeking preferences, beliefs that predictive testing can increase empowerment over health and positive attitudes about risk knowledge were associated with increased interest. Beliefs that predictive testing could cause psychological harm predicted lower interest. Patient characteristics of the proband were not associated with FDRs' interest.

CONCLUSIONS

FDRs' interest in predictive testing for RA was high, and factors associated with interest were identified. These findings will inform the development of predictive strategies and informational resources for those at risk.

A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations

Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into “positive” or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with “outcomes” to better inform management of mental health after SCI.

Longitudinal Associations Between Core Self-Evaluation, Vital Exhaustion and Hair Cortisol in Teachers and the Mediating Effects of Resignation Tendency

Work-related stress appears to be especially high among teachers. However, most research on teacher stress relies exclusively on teachers' self-reports. Little is known about the physiological correlates of affective stress in teachers. This longitudinal study investigates the relationship between core self-evaluation and adverse psychological and physiological stress outcomes in 42 teachers. Self-report questionnaires were used to assess core self-evaluation, vital exhaustion, and resignation tendency. The concentration of cortisol was assessed using hair samples. One year after the initial measurement, vital exhaustion and hair cortisol were assessed again. Path-analytic mediational models showed that core self-evaluation strongly predicted vital exhaustion, and resignation tendency partially mediated this relationship. However, core self-evaluation did not predict hair cortisol concentration. These findings suggest that core self-evaluation plays a crucial role in preventing vital exhaustion among teachers. A positive core self-evaluation seems beneficial for teachers' primary and secondary appraisal and an essential resource for the long-term prevention of self-reported vital exhaustion.

Coping strategies and mental health: A web-based survey among the Italian population dealing with COVID-19

Coronavirus disease (COVID-19) continues to be a highly stressful event with a major impact on psychological mental health worldwide. The use of different coping strategies may change the perception of psychological well-being during the pandemic. The present study aims to explore psychological mental health in relation to sociodemographic variables and to analyze the coping strategies of the Italian population in dealing with COVID-19. Implications for clinical interventions are reported. A total of 537 individuals (>18) participated in the survey completing measures of sociodemographic data, general psychological well-being, and coping strategies. Results found that females, students, and unmarried people reported the lowest levels of well-being. Specifically, the coping strategy called positive attitude was positively correlated with psychological well-being, whereas avoidance and social support strategies negatively influenced well-being. Understanding beneficial coping strategies is central to optimally manage the long-lasting of the current COVID-19 situation and may be useful for mental health professionals in treating patients suffering psychologically from the pandemic.

Coping with systemic lupus erythematosus in patients' words

OBJECTIVE

Previous research on coping strategies of patients with SLE showed that there are no absolute adaptive or maladaptive strategies and that the range of potential coping strategies is large and heterogeneous. In this paper, we aimed to identify, in a large sample of patients with SLE (N=3222), the most frequent words used by patients to describe their coping strategies, to group them into significant themes and to test their possible association with specific patient characteristics.

METHODS

Our analyses were based on the data set of the European survey 'Living with Lupus in 2020' (N=3222). Through the T-LAB software, we analysed the answers that adult participants gave to an open-ended question about how they cope with the disease. We identified the most frequent words, and with hierarchical cluster analysis we grouped them into semantic clusters (ie, themes) that were characterised by specific patterns of words. Finally, we tested the possible association between clusters and illustrative variables (sociodemographics, disease characteristics, quality of life).

RESULTS

Five coping strategies were identified, each of them constituting an important percentage of the total word occurrences: positive attitude (22.58%), social support (25.46%), medical treatments (10.77%), healthy habits (20.74%) and avoid stress (20.45%). Each strategy was statistically associated with specific patient characteristics, such as age and organ involvement.

CONCLUSIONS

Learning to adapt to a lifetime of having SLE may require replacing old coping strategies with more effective ones. Investigating patients' coping strategies in relation to different patient characteristics represents a useful starting point for developing more targeted and efficacious interventions.

Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care

Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed.

Development and Validation of an Inventory for Stressful Situations in University Students Involving Coping Mechanisms: An Interesting Cultural Mix in Ghana

Cognitive and behavioural coping strategies are relevant approaches for individuals such as university students as they attempt to manage stressful situations such as the COVID-19 pandemic and other academic-related pursuits within their social milieu. Although several instruments have been developed to measure the coping situations of such individuals, few studies have developed students’ specific coping inventories, with none in the African context. Of the few that exist, a culturally dominant code such as religion has been ignored by many scholars in the development of coping measures. In this study, a cultural-mix coping inventory was developed and validated using university students in Ghana. Two distinct interrelated objectives were addressed. First, the structure of the coping inventory was identified through principal component analysis. Further confirmatory factor as well as reliability analyses were then performed to provide evidence of construct validity of the scale. The outcome of the study revealed a sixteen-item psychometrically sound coping inventory with a four-dimensional structure, namely, active coping, religious coping, behaviour disengagement, and emotional support. The implications of the results are further discussed in detail.

Exploring the Mechanism of Pathological Gaming in Adolescents: Focused on the Mediation Paths and Latent Group Comparison

Pathological gaming among adolescents has been reported to hamper the achievement of a balanced life and to threaten the development of social competencies. Despite the increasing social concerns on the adolescent users, however, the mechanism of gaming behavior of adolescents has not been sufficiently examined. This study explored the mechanism of pathological gaming among adolescents from 3-year longitudinal data of 778 Korean adolescent gamers, by analyzing the effects of negative affects (i.e., anxiety, loneliness, and academic stress) on the degree of pathological gaming through the mediation variables (i.e., aggression and self-control) based on the stimulus-organism-response (S-O-R) framework. Latent class analysis (LCA) was used to uncover potential risk groups, and through partial least squares-structural equation modeling (PLS-SEM) analysis, the mediation pathways to pathological gaming were compared between the risk group and the non-risk group. The results highlighted the key role of academic stress on the degree of pathological gaming. In the entire group, academic stress primarily increased pathological gaming through self-control. The mediation path of self-control was the most influential result in the risk group. Aggression was the key mediator between loneliness and pathological gaming in the non-risk group. The theoretical and practical implications of the results were discussed.

The Influence of Video-Modeled Sexual Assault Disclosure and Self-Efficacy Messages on Sexual Assault Disclosure Efficacy of Adolescent Girls

Adolescent female victims of sexual assault must often disclose their victimization to trusted adults to seek positive physical and mental health outcomes; however, adolescent girls face unique barriers to disclosure, and they are less likely to disclose compared to adult women. Media interventions could be useful in motivating adolescent girls to feel more efficacious about disclosing sexual assaults. Self-efficacious messages in media that model disclosure behavior could motivate adolescent girls to feel more confident disclosing information about an assault and seeking positive health outcomes. This study used quasi-experimental methods to test the effect of a YouTube vlog containing a self-efficacy message about sexual assault disclosure. Results indicate that exposure to the self-efficacious message leads to higher sexual assault disclosure efficacy among adolescent girls who identify with self-efficacious media characters (B = -.0867, SE = .059, 95% CI [-.2318, -.0033]), albeit indirectly through perceived discrimination of sexual assault victims and approach coping behaviors. Appropriate interventions targeting disclosure of sexual assault by adolescent girls could include a more holistic view of disclosure and use new mediums like YouTube vlogs to deliver self-efficacious messages.

Explorations of avoidance and approach coping and perceived stress with a computer-based avatar task: detrimental effects of resignation and withdrawal

Background

Individuals differ in how they react to stress or trauma through different coping styles in which they may deal directly with a stressor by adopting approach coping styles or disengage with a stressor by utilizing avoidant coping styles. Avoidant coping styles have been linked to adverse outcomes including psychological distress, anxiety disorders, and post-traumatic stress disorder (PTSD). Recently, avoidance coping styles as measured by a subset of items on the Brief COPE were found to have a weak positive relationship with performance on a computer-based avatar task which is related to avoidant personality temperaments. This avatar task was developed as an alternative for paper and pencil self-report inventories for measuring avoidant tendencies based on possible response biases of avoidant individuals. In the current study, avoidance and approach coping styles as measured by the Brief Approach/Avoidance Coping Questionnaire (BACQ) were compared to avoidant coping as measured by the Brief COPE and performance on the avatar task. In addition to approach and avoidance coping, the BACQ also measures active avoidance coping (i.e., diversion) and passive avoidance coping (i.e., resignation and withdrawal). The relationships between approach and avoidance coping and performance on the avatar task were also analyzed with the outcome of perceived stress as measured by the Perceived Stress Scale (PSS).

Methods

One hundred undergraduates voluntarily completed the BACQ, the Brief COPE, and the PSS. Participants also completed a computer-based task in which they guided an avatar through a series of social situations where they indicated how they would interact with or avoid interacting with strangers.

Results

Approach coping had a weak negative relationship to avoidance coping as measured by the BACQ and the Brief COPE. Performance on the avatar task had a moderate positive relationship with avoidance coping (diversion as well as resignation and withdrawal) as measured by the BACQ and a moderate negative relationship with approach coping as measured by the BACQ. A model including only approach, diversion, and resignation and withdrawal coping best predicted performance on the avatar task in a linear regression model. While resignation and withdrawal coping and diversion coping had moderate positive relationships to avatar task scores, only resignation and withdrawal had a strong positive relationship to perceived stress. A model than included only resignation and withdrawal coping best predicted perceived stress in a linear regression model. Overall, passive avoidant coping styles (i.e., resignation and withdrawal), but not active avoidant coping style (i.e., diversion), were related to perceived stress. These results support the continued study of multiple aspects of avoidant coping styles as well as the avatar task to increase our understanding of the maladaptive effects of excessive avoidance in the face of stress.

Testing Kumpfer’s Resilience Model Among Adults With Serious Mental Illness

Having a serious mental illness (SMI) is often associated with significant adversities, and people respond differently to adversities. The existing research supports that people with SMI can achieve and maintain positive life outcomes despite experiencing adversities. Resilience, the ability to cope with (or bounce back quickly from) crisis, can help buffer the negative effects of various types of adversities, including chronic illness and disability, and facilitate the psychosocial adaptation process to SMI. Kumpfer’s resilience model, a person-process-context framework, has been widely used to conceptualize, and assess for, resilience in various populations, including people with chronic illnesses and disabilities. However, the research in resilience among people with SMI is very limited. The purpose of this study was to empirically assess the utility of Kumpfer’s resilience model and its proposed predictive components for conceptualizing the adaptation process to SMI. One hundred forty-four participants completed a Qualtrics survey containing demographic questions and a series of validated instruments representing the major components of Kumpfer’s resilience model. Hierarchical regression analysis was used to analyze the data, and the final model explained 71% of the variance of the dependent variable—adaptation to disability. Avoidance coping, internalized stigma, and optimism were significant independent predictors of adaptation to disability. This study supports the utilization of Kumpfer’s resilience model to conceptualize the adaptation to disability process among people with SMI. Implications for rehabilitation counseling practices are discussed.

Coping with Stress During the Coronavirus Outbreak: the Contribution of Big Five Personality Traits and Social Support

This study investigated the relationships between active, problem-focused, and maladaptive coping with stress during the Coronavirus outbreak, the Big Five personality traits, and social support among Israeli-Palestinian college students (n = 625). Emotion-focused coping negatively correlated with social support, openness, extraversion, conscientiousness, and agreeableness, while it positively correlated with neuroticism. On the other hand, problem-focused coping was found to positively correlate with social support, openness, extraversion, conscientiousness, and agreeableness, but negatively correlate with neuroticism. Thus, positive social support may increase one's ability to cope actively, adaptively, and efficiently. In addition, Israeli-Palestinian college students high in openness, extraversion, agreeableness, and conscientiousness tend to use active problem-focused coping while those high in neuroticism tend to use maladaptive emotion-focused coping.

Contextualising video game engagement and addiction in mental health: the mediating roles of coping and social support

INTRODUCTION

A challenge in defining Internet Gaming Disorder (IGD) is discriminating pathological gameplay from an excessive, yet benign, involvement in video games. Although previous research has explored this theoretical distinction in the context of general computing activities, it merits consideration with regards to online gaming. Additionally, whilst comorbidities of addicted gaming and mental health outcomes have been robustly demonstrated, few studies have examined the role of mediating factors that may contextualise this relationship. As such, the present study aims to validate the distinction between addiction and engagement in online gaming, by considering the mediating roles of coping and social online and offline support in mental health.

METHOD

One hundred and thirty-five participants completed the Computer Engagement/Addiction Questionnaire (CEAS), Depression-Anxiety-Stress Scale (DASS-21), Brief Approach-Avoidance Coping Questionnaire (BACQ) and two versions of the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Correlational analyses showed a clear distinction between gaming addiction and engagement in the context of all of depression, stress and in particular anxiety (DAS) not found in previous studies. Multiple mediation analysis showed a significant mediating effect of coping, (specifically withdrawal/resignation coping) on the relationship between video game addiction and symptoms of DAS. Offline perceived social support was a significant partial mediator in the relationship between gaming addiction and depression, as compared to any kind of online social support. The results support the distinction of the addiction and engagement concepts in gaming. This study may inform future clinical classifications of IGD, with implications on how pathological gaming is treated.

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.

Gaming addiction and perceived stress among Saudi adolescents

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5% of Saudi adolescents (grade 7–12) were addicted to gaming.

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11% were suffering from a high level of stress.

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Gaming addiction was strongly associated with moderate- and high-level stress.

Introduction

Adolescents (age: 10–19 years) make up 15% of the Saudi population and have easy access to electronic gadgets and the Internet, yet data on gaming addiction among adolescents are negligible. We aimed to determine the prevalence of gaming addiction and its association with stress among Saudi school students.

Methods

In this cross-sectional survey, 2675 school students (grades 7–12) from 40 randomly selected schools in four main cities of Al-Qassim province in Saudi Arabia participated. The questionnaire inquired about demography, lifestyle, gaming addiction (7-item Game Addiction Scale), and stress (10-item Perceived Stress Scale). Multinomial logistic regression assessed the association between gaming addiction (yes, no) and stress (high, moderate, low).

Results

Participants’ mean age was 16.1 (SD = 1.6) years; 50% were female; 64% reported >3 h of daily screen time; 5% were addicted to gaming; 11.4% had high-level stress. Addiction to gaming was strongly associated with stress in the adjusted analysis (moderate OR = 6.7, 95% CI = 2.9–15.5; high OR = 11.9, 95% CI = 4.7–30.1). Additionally, those who were older, female, had poor grades, unhealthy dietary habits, an inactive lifestyle, and smoked were more likely to experience high stress.

Conclusions

Gaming addiction is strongly associated with stress among Saudi adolescents.

Social courage fosters both voice and silence in the workplace

Purpose

One of the strongest and most important outcomes of trait social courage is employee voice, but researchers have only studied this relationship with unidimensional conceptualizations of voice. The purpose of this paper is to apply Van Dyne et al.’s (2003) three-dimensional conceptualization of voice, which also distinguishes three dimensions of silence, to provide a nuanced understanding of the relationship of social courage with voice and silence. The authors also test for the moderating effect of three contextual influences: top management attitudes toward voice and silence, supervisor attitudes toward voice and silence, as well as communication opportunities.

Design/methodology/approach

The authors conducted a four-timepoint survey with each measurement occasion separated by one week. A total of 134 participants completed all four timepoints.

Findings

The results support that social courage positively relates to prosocial voice and silence, whereas it negatively relates to defensive voice and silence as well as acquiescent voice and silence. In other words, social courage positively relates to beneficial voice and silence as well as negatively relates to detrimental voice and silence. The results also failed to support any moderating effects, suggesting that the relationships of social courage are very resilient to outside forces.

Practical implications

These findings both test prior results and discover new relationships of social courage, which can further stress the importance of courage. The authors also draw direct connections between the influence of social courage on the surrounding workplace environment – as well as the influences of the environment on social courage. While the current paper provides insights into social courage, it also directs future researchers toward new insights of their own.

Originality/value

Courage is an emergent research topic within organizations. While many authors have assumed that courage is important to work, the current paper is among the few to empirically support this notion.

Prevalence and characteristics of prediabetes in workers in industry

AIM

To examine the prevalence of work stress and prediabetes in computer technology company employees; to analyse the relationships among stress, work stress, and prediabetes; and to explore the potential mediating effects sleep on the relationship between work stress and prediabetes.

DESIGN

A descriptive, cross-sectional design was used. A convenience sample included employees from a large computer technology company in central Texas.

METHODS

Data collection during March-October 2015 included: retrospective electronic medical record review and online surveys. Electronic medical record review data included: height, weight, waist circumference, blood pressure, high-density lipids, triglycerides, and fasting glucose. Online surveys collected demographic, global stress, diet, exercise, coping, sleep and work stress data from participants. Spearman rho calculations analyzed associations between demographic, socio-cultural factors, health behaviours, work stress, and prediabetes variables. Logistic regression analyses identified probability variables. A structural equation model examined mediating variables.

RESULTS

Prediabetes prevalence was lower and prevalence of work stress was higher in the participant sample than in the USA population. Findings suggested that low job imbalance increases the probability for prediabetes. Job imbalance was inversely related to prediabetes. Three variables increased the probability prediabetes: alcohol, job imbalance, and sleep. Sleep potentially modified the relationship between job imbalance and prediabetes. Participants were college-educated males working in white-collar, technical jobs. Participants had high rates of work stress. Job imbalance was inversely related to prediabetes, which challenges previous empirical data. Future research should continue to explore the relationship between work stress and prediabetes in this population.

CONCLUSIONS

This study explored the relationship between work stress and prediabetes in a white-collar worker population in technical industry. Findings suggested that workers in industry have a unique type of stress. Nurses who learn to recognize the non-traditional risk factors for prediabetes can improve screening for prediabetes by including work stress and poor sleep questions.

The Coping Circumplex Model: An Integrative Model of the Structure of Coping With Stress

It seems obvious that the identification of coping structure is necessary to understand how stress affects human health and functioning. Despite numerous coping conceptualization proposals, there is no agreement as to the core coping categories. This article presents the Coping Circumplex Model (CCM), which is designed to integrate various coping distinctions, drawing inspiration from the tradition of circumplex models in psychology. The model is based on the assumption that individuals in stressful situations face two tasks: they need to solve the problem and regulate their emotions, which are reflected in two corresponding dimensions, that is, the problem coping dimension and emotion coping dimension. Problem coping and emotion coping are interpreted as bipolar dimensions. Importantly, these dimensions define a space for other coping categories. The model contains a total of eight coping styles forming a circumplex: positive emotional coping, efficiency, problem solving, preoccupation with the problem, negative emotional coping, helplessness, problem avoidance, and hedonic disengagement. The paper discusses the potential of the CCM to overcome some of the problems of stress psychology by: (a) supplementing the set of coping categories (i.e., process, strategy, style) with coping mode; (b) providing a foundation for the integration of numerous coping constructs; (c) enabling the interpretation of results obtained by means of different coping measures, thus facilitating knowledge consolidation; (d) explaining relationships between coping and adjustment after trauma, as well as explaining the mechanisms of psychological interventions (e.g., cognitive therapy, exposure therapy); (e) clarifying linkages between the effectiveness of coping strategies and situation controllability. Moreover, the CCM may elucidate the relationship between coping and emotion regulation (e.g., cognitive reappraisal and expressive suppression).

Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study

This study explored how coping with war-related traumatic events in Sierra Leone impacted mental health outcomes among 529 youth (aged 10–17 at baseline; 25% female) using longitudinal data from three time points (Time 1 in 2002, Time 2 in 2004, and Time 3 in 2008). We examined two types of coping items (approach and avoidance); used multiple regression models to test their relations with long-term mental health outcomes (internalizing behaviors, externalizing behaviors, adaptive/prosocial behaviors, and posttraumatic stress symptoms); and used mediation analyses to test whether coping explained the relation between previous war exposures (being raped, death of parent(s), or killing/injuring someone during the war) and those outcomes. We found that avoidance coping items were associated with lower internalizing and posttraumatic stress behaviors at Time 3, and provided some evidence of mediating the relation between death of parent(s) during the war and the two outcomes mentioned above. Approach coping was associated with higher Time 3 adaptive/prosocial behaviors, whereas avoidance coping was associated with lower Time 3 adaptive/prosocial behaviors. Avoidance coping may be a protective factor against mental illness, whereas approach coping may be a promotive factor for adaptive/prosocial behaviors in war-affected societies. This study has important implications for designing and implementing mental health interventions for youth in postconflict settings.

Effectively Coping With Task Stress: A Study of the Validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF)

In this study, we investigated the validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF; Petrides, 2009) in the context of task-induced stress. We used a total sample of 225 volunteers to investigate (a) the incremental validity of the TEIQue-SF over other predictors of coping with task-induced stress, and (b) the construct validity of the TEIQue-SF by examining the mechanisms via which scores from the TEIQue-SF predict coping outcomes. Results demonstrated that the TEIQue-SF possessed incremental validity over the Big Five personality traits in the prediction of emotion-focused coping. Results also provided support for the construct validity of the TEIQue-SF by demonstrating that this measure predicted adaptive coping via emotion-focused channels. Specifically, results showed that, following a task stressor, the TEIQue-SF predicted low negative affect and high task performance via high levels of emotion-focused coping. Consistent with the purported theoretical nature of the trait emotional intelligence (EI) construct, trait EI as assessed by the TEIQue-SF primarily enhances affect and performance in stressful situations by regulating negative emotions.

Physical and mental health 10 years after multiple trauma: A prospective cohort study

BACKGROUND

People who have sustained severe multiple injuries have reduced health and functioning years after the injury. For people who have sustained severe injuries, an optimal degree of predictability in future functioning and health-related quality of life is important. The main aim was to study the impacts of demographic- and injury-related factors as well as functioning at 1 year and 2 years after injury on physical and mental health 10 years after injury.

METHODS

Fifty-eight participants completed a 10-year follow-up (55.2% of all included patients). Demographic and injury severity characteristics were collected, and assessments at 1, 2, 5, and 10 years after injury were performed. Patient-reported outcome measures were the Short Form 36 (SF-36), the Brief Approach/Avoidance Coping Questionnaire, and the cognitive function scale (COG). The SF-36 Physical and Mental Component Summaries (PCS and MCS, respectively) were the main outcome variables. We performed hierarchical multiple regression analyses to assess functioning on the PCS and MCS.

RESULTS

Mean (SD) age at injury was 37.8 (14.7) years, 74% were male. Mean (SD) New Injury Severity Score (NISS) was 33.7 (13.0). Mean (SD) PCS score was 41.8 (11.7). Mean (SD) MCS was 48.8 (10.7). Predictors of the PCS were change in coping from 2 years to 10 years (p = 0.032), physical functioning (p < 0.001) and cognitive functioning at 1 year (p = 0.011), as well as bodily pain at 2 years (p = 0.005). Adjusted R was 0.57. Predictors of the MCS were change in coping (p = 0.031), vitality (p = 0.008) at 1 year, as well as social functioning (p = 0.034) and mental health (p = 0.043) at 2 years. Adjusted R was 0.64.

CONCLUSION

Physical health was reduced compared with the adjusted general population at 10 years after injury. The mental health did not differ from that of the general population. In addition to physical functioning, coping strategies, vitality, social functioning, and mental health should be considered in the long-term rehabilitation perspective. A more comprehensive approach should be used for rehabilitation after multiple injuries.

The Danish Symptom Cohort: Questionnaire and Feasibility in the Nationwide Study on Symptom Experience and Healthcare-Seeking among 100 000 Individuals

Introduction. In order to develop strategies to prevent delay in diagnosis, it is important to gain knowledge of symptoms and healthcare-seeking processes in the population. This paper describes a combined survey and register-based study with (1) focus on development of a questionnaire concerning experience of symptoms and subsequent consequences and (2) feasibility of the study. Methods. The study is a nationwide cohort study of 100 000 individuals randomly selected from the Danish general population. A comprehensive questionnaire concerning experience of symptoms and subsequent consequences was developed. The methodological framework for the development included defining the domains to be measured, identification of previous items, scales and questionnaires in the literature, and pilot and field testing. Results. A total of five domains and 16 subdomains were defined covering the area of symptom experience, symptom characteristics, reaction in response to symptom experience, external factors, and personality characteristics with potential influence on the symptom experience. In total, 49 706 questionnaires were completed, yielding a response rate of 52.2%. Conclusion. We developed a comprehensive questionnaire used in a large combined survey and register-based study concerning experience of symptoms and subsequent consequences of symptom experiences. We succeeded in conducting a large survey providing the groundwork for The Danish Symptom Cohort.

Stalking experiences and associated factors--a controlled population-based study from Norway

BACKGROUND

Stalking is a considerable health problem. In order to develop interventions for victims, more knowledge is needed concerning prevalence, stress and coping related to stalking as well as associated symptomatology in the victims. This is the first population-based study of stalking in Norway.

AIMS

To examine the prevalence of stalking in relation to gender and time, and the association with indicators of socio-demographic status and mental health.

METHODS

A cross-sectional case-control questionnaire design. The sample, 5000 Norwegians aged 20-59 years, was nationally representative according to gender, 10-year age groups and county of living. A total of 248 (5%) of the mailed envelops were returned due to wrong address, leaving 4752 individuals as possible respondents. Among them 1520 (32%) returned the questionnaire, but 98 of them had to be discarded due to lack of completion, giving a sample of 1422 valid questionnaires (30%).

RESULTS

The total weighted lifetime prevalence of stalking was 8.1% (95% CI 6.6-9.4%), for females 11.8% (95% CI 10.2-13.5%) and for males 4.3% (95% CI 3.2-5.3%) [corrected]. The point prevalence of current stalking was 2.8% (95% CI 2.0-3.7%). The stalked individuals had a significantly poorer social situation and mental health than the controls. Few significant group differences were observed between males and females exposed to stalking.

CONCLUSIONS

The prevalence of stalking was within the range observed by questionnaire studies in other cultures.

The decision to vaccinate or not during the H1N1 pandemic: selecting the lesser of two evils?

BACKGROUND

With the release of the H1N1 vaccine, there was much controversy surrounding its use despite strong encouragements to be vaccinated in the media. Though studies have examined factors influencing people's decision to be vaccinated, few have focused on how general beliefs about the world or where an individual gathers information might influence that decision.

METHODOLOGY/PRINCIPAL FINDINGS

A cross-sectional web-based survey (N = 817) was conducted during the H1N1 outbreak after the vaccine was available. Variables examined included sociodemographic information, health related behaviours, specific beliefs concerning the H1N1 virus and its vaccine, as well as general beliefs, such as fear of contamination, intolerance of uncertainty, emotional states, coping behaviour, and the source of information concerning the virus. Three converging statistical methods were used to examine the associations - analysis of variance, logistic regression, and recursive partition modelling. The most consistent and strongest association was that negative beliefs about the H1N1 vaccine (e.g. fear of its side effects) was related to the decision not to be vaccinated, whereas beliefs about the dangers of the H1N1 virus was related to the decision to be vaccinated. Most notably, having very strong negative beliefs about the vaccine was a more powerful predictor than even strong beliefs about the dangers of the H1N1 virus. Furthermore, obtaining information from the Internet, as compared to more traditional sources of information (e.g., TV, newspapers) was related to the decision not to be vaccinated.

CONCLUSIONS/SIGNIFICANCE

These results are consistent with the Health Belief Model. Importantly they suggest that during future pandemics public health officials should not only discuss the dangers of the pandemic but also (i) take additional steps to reassure the public about the safety of vaccines and (ii) monitor the information disseminated over the Internet rather than strictly relying on the more traditional mass media.

Coping strategies in female survivors of childhood sexual abuse from two Canadian and two New Zealand cultural groups

Individuals from some minority cultures are at greater risk of experiencing childhood sexual abuse (CSA) and are also at heightened risk of negative outcomes from abuse. Coping strategies, which may mediate the relationship between CSA and outcomes, are also impacted by culture. This study examined the use of coping strategies in female survivors of CSA across 4 cultural groupings from 2 countries-86 European Canadians, 40 Native Canadians, 129 European New Zealanders, and 35 Māori New Zealanders-who all completed the Coping Responses Inventory. The 4 groups differed significantly on 7 of the 8 Coping Responses Inventory scales (Logical Analysis, Positive Reappraisal, Problem Solving, Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, Emotional Discharge). Whereas New Zealanders differed significantly from Canadians (p<.001), Europeans did not differ significantly from indigenous cultural groups, nor did nationality and culture grouping interact (p>.05). The profile of coping in New Zealand Europeans was relatively flat, with average scores across coping types close to the mean of the t-score distribution. Māori New Zealanders produced a similar profile, with only slight increases on 2 scales of avoidant coping. The findings raise questions about the extent to which generalizations can be made about there being either a "Western/European" culture or a particular "indigenous" culture. This in turn also raises the issue of whether cross-validation and replication of findings are needed if the findings are to be applied outside of the country in which the data were gathered.

Long-term effects of coping with extreme stress: longitudinal study of Vietnam-era repatriated prisoners of war

Captivity stressors and coping strategies were assessed shortly after the repatriation of Vietnam-era prisoners of war, and physical and mental health were assessed almost three decades later. Given research on coping goodness-of-fit, specifically the extent to which coping effects depend on situational controllability, we proposed that endorsement of the usefulness of avoidance-based strategies in captivity would be predictive of better later-life health. Findings indicated that approach-based and avoidance-based coping both moderated the link between physical torture and later physical health functional status, whereas approach-based coping moderated the link between injuries at capture and later mental health. Specifically, greater endorsement of avoidance-based coping was associated with better long-term physical health for prisoners who experienced the most physical torture. Lower endorsement of approach-based coping was associated with better long-term mental health for prisoners who reported the most injuries at the time of capture.

Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway

Purpose

To explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population.

Methods

A cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style.

Results

Respondents scored lower on all the HRQoL sub-domains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores.

Conclusion

Personal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons.

Approach and avoidance coping and regulatory focus in patients having coronary artery bypass graft surgery

Coronary artery bypass graft (CABG) surgery is stressful, and the patient's coping affects recovery and outcome. The aim of the study was to identify patients' thoughts and concerns, and explore the relevance of approach/avoidant coping and Regulatory Focus Theory (RFT). Nine patients were interviewed, using an interpretative phenomenological approach. The patients made use of various avoidant (e.g. neglecting symptoms, delaying help-seeking, avoiding thoughts) and approach strategies (e.g. persistent search for the diagnosis, mental preparation for surgery). RFT versus approach/avoidant coping is discussed. RFT may contribute to our understanding of motivational cognitions in patients' coping with illness and treatment.