Does the disposition of passive coping mediate the association between illness perception and symptoms of anxiety and depression in patients with spinal cord injury during first inpatient rehabilitation?

PURPOSE

To examine associations between illness perception, also called illness cognitions or appraisals, disposition of passive coping, and symptoms of anxiety and depression, and to test whether passive coping mediates the associations between illness perception and symptoms of anxiety and depression.

MATERIALS AND METHODS

Longitudinal, multicentre study. Participants were inpatients of spinal cord injury (SCI) rehabilitation. Measures included the Brief Illness Perception Questionnaire (B-IPQ), the Utrecht Coping List passive coping subscale (UCL-P), and the Hospital Anxiety and Depression Scale (HADS). Mediation was tested with the PROCESS tool.

RESULTS

The questionnaires were completed by 121 participants at admission and at discharge. Of them, 70% were male, 58% had a paraplegia, and 82% an incomplete lesion. Weak to strong (0.294-0.650) significant associations were found between each pair of study variables. The use of passive coping strategies mediated the associations between illness perception and symptoms of anxiety and depression.

CONCLUSION

Symptoms of anxiety and depression were more frequent in people who have a threatening illness perception combined with a lower use of passive coping strategies. Therefore, it is advised that patients are screened and treated for threatening illness perception and high use of passive coping strategies during rehabilitation after SCI.

The Wistar Kyoto Rat: A Model of Depression Traits

There is an ongoing debate about the value of animal research in psychiatry with valid lines of reasoning stating the limits of individual animal models compared to human psychiatric illnesses. Human depression is not a homogenous disorder; therefore, one cannot expect a single animal model to reflect depression heterogeneity. This limited review presents arguments that the Wistar Kyoto (WKY) rats show intrinsic depression traits. The phenotypes of WKY do not completely mirror those of human depression but clearly indicate characteristics that are common with it. WKYs present despair- like behavior, passive coping with stress, comorbid anxiety, and enhanced drug use compared to other routinely used inbred or outbred strains of rats. The commonly used tests identifying these phenotypes reflect exploratory, escape-oriented, and withdrawal-like behaviors. The WKYs consistently choose withdrawal or avoidance in novel environments and freezing behaviors in response to a challenge in these tests. The physiological response to a stressful environment is exaggerated in WKYs. Selective breeding generated two WKY substrains that are nearly isogenic but show clear behavioral differences, including that of depression-like behavior. WKY and its substrains may share characteristics of subgroups of depressed individuals with social withdrawal, low energy, weight loss, sleep disturbances, and specific cognitive dysfunction. The genomes of the WKY and WKY substrains contain variations that impact the function of many genes identified in recent human genetic studies of depression. Thus, these strains of rats share characteristics of human depression at both phenotypic and genetic levels, making them a model of depression traits.

Dissociation as a Distinct Peritraumatic Coping Response: A Preliminary Analysis

Research examining physiological responses to trauma cues in PTSD has identified a subset of "nonresponders" showing suppressed physiological reactivity. The defense cascade model posits that individuals respond to stressors by progressing through a series of defensive reactions, with nonresponders having advanced to a shutdown response. It remains unclear whether dissociation is at the end of a continuum of passive behavior, indicating full shutdown, or if it comprises a distinct response. The present study aimed to address this uncertainty, using EFA to compare a two-factor (active, passive) and three-factor (active, passive, dissociative) model of defensive responding. Eighty-nine female physical and sexual assault survivors reported their peritraumatic reactions within 1 month of their assault, which were entered into the EFA. The three-factor model was superior, suggesting dissociation is a distinct category of peritraumatic coping. Peritraumatic use of both passive and dissociative coping strategies were each significantly associated with ongoing use of passive coping and increased PTSD symptoms 1-month posttrauma; surprisingly, the use of passive peritraumatic coping strategies was a better indicator than peritraumatic dissociation. The inclusion of depression as a covariate removed the association of passive (but not dissociative) coping with PTSD symptom severity. Active coping use was not significantly associated with any outcome, suggesting that the presence of shutdown responses is more informative than the presence or absence of any active coping. These findings highlight the importance of differentiating peritraumatic coping responses and the need for increased attention to the comparatively neglected topic of passive coping.

The Moderating Roles of Resilience and Coping Strategy on Well-Being of Victimized Forensic Workers

Previous research on workplace victimization has often disregarded forensic psychiatric populations and not yet been extended to the coronavirus pandemic. The present study expected the isolation of the government-issued lockdown to increase aggressive behavior in forensic patients, ultimately decreasing the general well-being of victimized forensic workers. Possible buffering protective factors (resilience and active coping) and enhancing risk factors (avoidant coping and passive coping) were investigated with the intention of optimizing the general well-being of at-risk forensic workers. The valid sample (N = 311) consisted of Dutch and Belgian forensic workers (74.6% females) with at least 9 hours of weekly patient contact, and with a mean age of 37.99 (SD = 12.20). Participants reported the number of violent incidents in the past 2 months, as well as completed a questionnaire battery including measures of well-being, resilience, and coping strategies. A significant increase of victimization during the lockdown compared to after it was lifted was found, however, the study did not find evidence to support that this negatively influenced the worker's general well-being. Active coping was found to be a significant moderator and protective factor for the general well-being of victimized forensic workers. In contrast, resilience, avoidant and passive coping were not significant moderators in this association. The present study has valuable clinical implications that could lead to preparatory and preventative measures for forensic workers at risk of being victimized. Future research may investigate constructs such as life satisfaction and post-traumatic growth, as well as be broadened into prison populations.

Active or passive pain coping: Which predicts daily physical and psychosocial functioning in people with chronic pain and spinal cord injury?

PURPOSE/OBJECTIVE

Despite medical and psychotherapeutic treatments, chronic pain is one of the most challenging and disabling conditions for individuals with spinal cord injury (SCI). A growing body of research has demonstrated that pain coping strategies are effective for the adjustment of pain. However, we still lack an understanding of how passive pain coping and active pain coping relate to daily physical and psychosocial functioning for people with chronic pain and SCI. The current study used end-of-day (EOD) diary data to examine associations of passive and active pain coping with same-day independence, positive affect and well-being, social participation, pain catastrophizing, depressive symptoms, and pain interference in adults with chronic pain and SCI.

RESEARCH METHOD/DESIGN

This observational study in N = 124 individuals with SCI (mean age = 47.53 years; 74.2% male, 25.8% female) used a combination of baseline surveys and seven consecutive days of end-of-day (EOD) diaries.

RESULTS

Results of multilevel modeling showed that, beyond the effects of key demographic variables, clinical variables (e.g., time since injury, mobility) and daily pain intensity, increased daily passive coping (from that person's average) related to increased same-day depressive symptoms (B = .29; p < .001), pain catastrophizing (B = .28; p < .001) and decreased same-day positive affect and well-being (B = -.31; p = .02). Increased daily active coping was related to higher same-day catastrophizing (B = .09; p < .05).

CONCLUSIONS/IMPLICATIONS

Behavioral interventions for pain often emphasize adoption and practice of new active coping strategies. Findings highlight the potential importance of also addressing passive coping strategies in services of improvement in physical and psychosocial outcomes in individuals with chronic pain and SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sex-Specific Behavioral Response to Early Adolescent Stress in the Genetically More Stress-Reactive Wistar Kyoto More Immobile, and Its Nearly Isogenic Wistar Kyoto Less Immobile Control Strain

Genetic predisposition and environmental stress are known etiologies of stress-related psychiatric disorders. Environmental stress during adolescence is assumed to be particularly detrimental for adult affective behaviors. To investigate how genetic stress-reactivity differences modify the effects of stress during adolescence on adult affective behaviors we employed two inbred strains with differing stress reactivity. The Wistar Kyoto More Immobile (WMI) rat strain show increased stress-reactivity and despair-like behaviors as well as passive coping compared to the nearly isogenic control strain, the Wistar Kyoto Less Immobile (WLI). Males and females of these strains were exposed to contextual fear conditioning (CFC) during early adolescence (EA), between 32 and 34 postnatal days (PND), and were tested for the consequences of this mild EA stress in adulthood. Early adolescent stress significantly decreased anxiety-like behavior, measured in the open field test (OFT) and increased social interaction and recognition in adult males of both strains compared to controls. In contrast, no significant effects of EA stress were observed in adult females in these behaviors. Both males and females of the genetically less stress-reactive WLI strain showed significantly increased immobility in the forced swim test (FST) after EA stress compared to controls. In contrast, immobility was significantly attenuated by EA stress in adult WMI females compared to controls. Transcriptomic changes of the glucocorticoid receptor (Nr3c1, GR) and the brain-derived neurotrophic factor (Bdnf) illuminate primarily strain and stress-dependent changes, respectively, in the prefrontal cortex and hippocampus of adults. These results suggest that contrary to expectations, limited adolescent stress is beneficial to males thru decreasing anxiety and enhancing social behaviors, and to the stress more-reactive WMI females by way of decreasing passive coping.

Modeling heritability of temperamental differences, stress reactivity, and risk for anxiety and depression: Relevance to research domain criteria (RDoC)

Animal models provide important tools to study biological and environmental factors that shape brain function and behavior. These models can be effectively leveraged by drawing on concepts from the National Institute of Mental Health Research Domain Criteria (RDoC) Initiative, which aims to delineate molecular pathways and neural circuits that underpin behavioral anomalies that transcend psychiatric conditions. To study factors that contribute to individual differences in emotionality and stress reactivity, our laboratory utilized Sprague-Dawley rats that were selectively bred for differences in novelty exploration. Selective breeding for low versus high locomotor response to novelty produced rat lines that differ in behavioral domains relevant to anxiety and depression, particularly the RDoC Negative Valence domains, including acute threat, potential threat, and loss. Bred Low Novelty Responder (LR) rats, relative to their High Responder (HR) counterparts, display high levels of behavioral inhibition, conditioned and unconditioned fear, avoidance, passive stress coping, anhedonia, and psychomotor retardation. The HR/LR traits are heritable, emerge in the first weeks of life, and appear to be driven by alterations in the developing amygdala and hippocampus. Epigenomic and transcriptomic profiling in the developing and adult HR/LR brain suggest that DNA methylation and microRNAs, as well as differences in monoaminergic transmission (dopamine and serotonin in particular), contribute to their distinct behavioral phenotypes. This work exemplifies ways that animal models such as the HR/LR rats can be effectively used to study neural and molecular factors driving emotional behavior, which may pave the way toward improved understanding the neurobiological mechanisms involved in emotional disorders.

Ways of coping mediate the relationship between self-efficacy for managing HIV and acceptance of illness among people living with HIV

AIM

The purpose of this study was to examine the relationship between self-efficacy for managing HIV and acceptance of illness and to identify the potential mediation effect of active coping and passive coping on this relationship.

DESIGN

The study used a cross-sectional survey.

METHODS

A sample of 555 people living with HIV were recruited from September-December 2018 in the HIV clinic of a tertiary general hospital in Changsha, China. Survey data were collected through face-to-face interviews that included measures of sociodemographic and HIV-related clinical characteristics, Acceptance of Illness Scale, the Simplified Coping Style Questionnaire and the Self-efficacy for Managing Chronic Disease Scale. Step-by-step linear regression models combined with bootstrap testing were used to test the relationships when controlling for gender and HIV diagnosis duration.

RESULTS

Self-efficacy was positively related to acceptance of illness and this relationship was partially mediated by both active coping and passive coping. Acceptance of illness increased by 0.175 for every point increase in self-efficacy indirectly through active coping, while acceptance of illness decreased by 0.034 for every point increase in self-efficacy via passive coping.

CONCLUSION

The findings highlighted the importance of self-efficacy for managing HIV and ways of coping, especially active coping, for illness acceptance.

IMPACT

The findings suggested that interventions that improve confidence in managing HIV and active coping may enhance the illness acceptance of people living with HIV.

Prefrontal-Bed Nucleus Circuit Modulation of a Passive Coping Response Set

One of the challenges facing neuroscience entails localization of circuits and mechanisms accounting for how multiple features of stress responses are organized to promote survival during adverse experiences. The rodent medial prefrontal cortex (mPFC) is generally regarded as a key site for cognitive and affective information processing, and the anteroventral bed nuclei of the stria terminalis (avBST) integrates homeostatic information from a variety of sources, including the mPFC. Thus, we proposed that the mPFC is capable of generating multiple features (endocrine, behavioral) of adaptive responses via its influence over the avBST. To address this possibility, we first optogenetically inhibited input to avBST from the rostral prelimbic cortical region of mPFC and observed concurrent increases in immobility and hypothalamo-pituitary-adrenal (HPA) output in male rats during tail suspension, whereas photostimulation of this pathway decreased immobility during the same challenge. Anatomical tracing experiments confirmed projections from the rostral prelimbic subfield to separate populations of avBST neurons, and from these to HPA effector neurons in the paraventricular hypothalamic nucleus, and to aspects of the midbrain periaqueductal gray that coordinate passive defensive behaviors. Finally, stimulation and inhibition of the prelimbic-avBST pathway, respectively, decreased and increased passive coping in the shock-probe defensive burying test, without having any direct effect on active coping (burying) behavior. These results define a new neural substrate in the coordination of a response set that involves the gating of passive, rather than active, coping behaviors while restraining neuroendocrine activation to optimize adaptation during threat exposure.SIGNIFICANCE STATEMENT The circuits and mechanisms accounting for how multiple features of responses are organized to promote adaptation have yet to be elucidated. Our report identifies a prefrontal-bed nucleus pathway that organizes a response set capable of gating passive coping behaviors while concurrently restraining neuroendocrine activation during exposure to inescapable stressors. These data provide insight into the central organization of how multiple features of responses are integrated to promote adaptation during adverse experiences, and how disruption in one neural pathway may underlie a broad array of maladaptive responses in stress-related psychiatric disorders.

Do Cardiovascular Responses to Active and Passive Coping Tasks predict Future Blood Pressure over a 10-Month Later?

The study examined whether cardiovascular responses to active or passive coping tasks and single or multiple tasks predicted changes in resting blood pressure (BP) over a ten-month period. Heart rate (HR), BP, cardiac output (CO), and total peripheral resistance (TPR) were measured at rest, and during mental stress tests (mental arithmetic, speech, and cold pressor tasks). A total of 104 eligible participants participated in the initial study, and 77 (74.04%) normotensive adult participants’ resting BP were re-evaluated at ten-month follow-up. Regression analyses indicated that after adjustment for baseline BP, initial age, gender, body mass index, family history of cardiovascular disease, and current cigarette smoking, heighted systolic blood pressure (SBP) and HR responses to an active coping task (mental arithmetic) were associated with increased future SBP (ΔR2 = .060, ΔR2 = .045, respectively). Further, aggregated SBP responsivity (over the three tasks) to the predictor models resulted in significant, but smaller increases in ΔR2 accounting for .040 of the variance of follow-up SBP. These findings suggest that cardiovascular responses to active coping tasks predict future SBP. Further, compared with single tasks, the findings revealed that SBP responses to three tasks were less predictive compared to an individual task (i.e., mental arithmetic). Of importance, hemodynamic reactivity (namely CO and TPR) did not predict future BP suggesting that more general psychophysiological processes (e.g., inflammation, platelet aggregation) may be implicated, or that BP, but not hemodynamic reactivity may be a marker of hypertension.

Passive coping response to depressive symptoms among low-income homebound older adults: does it affect depression severity and treatment outcome?

Due to their homebound state, lack of financial resources, and/or other life demands, a significant proportion of depressed, low-income homebound older adults experience depression. Because of their limited access to psychotherapy, most of these older adults self-manage their depressive symptoms. The purposes of this study were to examine (1) the relationship between homebound older adults' coping responses to depressed mood and the severity of their depressive symptoms at baseline (n = 121), and (2) the moderating effect of passive coping responses on the relationship between participation in problem-solving therapy (PST: in-person or telehealth delivery) and depressive symptoms at 12- and 24-week follow-ups. Controlling for the effects of demographic and disability characteristics, cognitive passive coping was significantly associated with baseline depressive symptoms, while behavioral passive coping was not. The main effect of baseline cognitive passive coping response was also significant in mixed-effects regression analysis, but the interaction between coping pattern and group was not significant. The results point to a possibility that cognitive passive copers may have benefited as much from PST as the rest of the PST participants. Further research needs to examine the moderating effect of coping responses to depressive symptoms on treatment efficacy of PST and other psychosocial interventions for late-life depression.

Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain

OBJECTIVE

To test the hypothesis that pain patients differ from well children in their appraisal and coping with daily stressors and to test a model of the relation of stress appraisal and coping to symptoms and disability.

METHODS

Pediatric patients with chronic abdominal pain (n = 143) and well children (n = 104) completed a 5-day diary study regarding their appraisal and coping with daily stressors. Somatic symptoms, depressive symptoms, and functional disability were assessed 2 months later.

RESULTS

Compared to well children, pain patients were less confident of their ability either to change or to adapt to stress and were less likely to use accommodative coping strategies. Different patterns of stress appraisal were associated with active, passive, and accommodative coping. Both appraisals and coping were significantly related to symptoms and disability.

CONCLUSIONS

The relation between stress and symptoms in pediatric pain patients may be explained in part by their appraisal and coping with stressors. The relation between appraisal and coping was consistent with Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.