Caregiving styles and anxiety among couples: coping versus not coping with cardiac illness

Background and Objectives: partners’ caregiving efforts are not always beneficial to both recipient and provider. Bowlby’s conceptualization of caregiving style as a stable predisposition may clarify such caregiving effects. The relationship between caregiving style (compulsive and sensitive) and anxiety among couples coping with cardiac illness and a matching control group not coping with cardiac illness were assessed. We hypothesized that one’s compulsive caregiving would associate positively, and one’s sensitive caregiving would associate negatively, with one’s and one’s partner’s anxiety across contexts (cardiac and non-cardiac) and gender. Design: A comparative design of 131 couples with a diagnosis of husbands’ acute cardiac syndrome and 68 matched couples in the community was applied. Methods: The Adult Caregiving Questionnaire and the Brief Symptoms Inventory were administered. Results: Structural equation modeling revealed that one’s compulsive caregiving was positively associated with one’s anxiety, across most contexts. Multi-group analyses revealed that the associations between one’s compulsive caregiving and one’s partner’s anxiety levels differed depending on gender and context. Conclusions: The distress which emerges in an individual who takes on a caregiving role and in his/her partner seems to result not only from the demands of the concrete caregiving situation but also from one’s and one’s partner’s developmental history.     

Identifying the risk of deliberate self-harm among young prisoners by means of coping typologies

Self-harming behavior during incarceration has been a topic of increasing attention in recent years. Some authors attribute these episodes to the high level of stress that imprisonment generates coupled with a low quality of coping strategies employed by inmates. The main aim of this study was to identify, by means of coping typologies, prisoners at higher risk of self-harming behavior. The results highlighted the fact that coping typologies permitted the classification of inmates into four groups and the identification of those at lower and higher risk of self-harming. The group at greater risk was the one that used more avoidance and less approach coping.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.     

Painful engagement in deliberate self-harm: The role of conditional goal setting

Conditional goal setting is the tendency for people to see attainment of their future personal goals as necessary for their well-being. It has been argued that this represents an unhealthy way of relating to one’s goals, as well as being particularly problematic when goals are perceived as unlikely. High conditional goal setting has been found to be related to depression and to hopelessness. The present study examined conditional goal setting in deliberate self-harm, where problematic thinking about the future is very prominent. A group of individuals attending hospital for a recent episode of deliberate self-harm (N = 25) were compared with controls attending hospital for minor injuries (N = 25) as well as a psychologically disordered but non-suicidal control group (N = 25). Participants generated goals and rated goal likelihood, the extent to which those goals were seen as necessary for their future well-being (conditional goal setting), and also the extent to which the goals were seen as sufficient for their future well-being (goal sufficiency). Deliberate self-harm patients showed a higher degree of both conditional goal setting and goal sufficiency than did both of the other groups, further confirming the idea of painful engagement with personal goals, rather than disengagement, as characterising deliberate self-harm.     

Posttraumatic stress and physical health among adults: The role of coping mechanisms

The purpose of the present study was to examine whether coping mechanisms predict physical health, after controlling for posttraumatic stress disorder (PTSD) symptom clusters in a non-clinical sample of adults. Data were collected from 483 adults through an online survey. Most of the participants (66.7%) reported lifetime exposure to at least one traumatic event. The final sample of this study included 319 trauma-exposed individuals. Results indicated that PTSD symptoms on the avoidance and hyperarousal clusters had significant positive relationships with self-reported physical health symptoms. After controlling for gender and PTSD, denial, behavioral disengagement, and self-blame significantly and positively predicted physical health symptoms.     

Solving the puzzle of deliberate self-harm: the experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.     

Social support-oriented coping and resilience for self-harm protection among adolescents

The study aimed to investigate the extent to which social support-focused coping and resilience can predict lower risk for self-harm by at-risk adolescents. Participants were 962 high school learners from nine high schools in the Free State Province, South Africa (female = 57.9 %; black = 70.7 %; mean age = 16.34 years). They completed the Revised Coping Schemas Inventory and the Resiliency Scale for Children and Adolescents. Logistic regression analysis was computed to predict risk for self-harm from social support-focused coping and resilience. The results indicate that higher levels of social support predict lower risk for adolescent self-harm. Social support-oriented coping and resilience predicted tension-reduction and emotional reactivity. Social support-focused coping seems to have an influence in lowering the risk of self-harm amongst adolescents.     

The role of coping styles as predictors of depressive symptoms among adolescents: a prospective study

The present study prospectively explored the main and interactive effect of approach and avoidant like coping styles, as well as school-related stress on depressive symptoms in a sample of 327 (167 females, 160 males) students in two Norwegian secondary schools. The results showed that seeking parental support as a coping style served as a negative predictor of later depression, and results give some support for aggressive coping styles being a risk factor for depressive symptoms. A significant interaction between aggressive coping style and stress in relation to depressive symptoms was found. We were also able to show that school-related stress at T(1) predicted depressive symptoms at T(2).     

Suicidal ideation in college students varies across semesters: the mediating role of belongingness

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.     

Schizophrenia and deliberate self-harm: a systematic review of risk factors

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.     

Cognitive coping and defense styles in patients with personality disorders

This study investigates the associations between cognitive coping (as measured with the Cognitive Emotion Regulation Questionnaire; CERQ), defense mechanisms (as measured with the Defense Style Questionnaire-60; DSQ-60) and personality disorders (PDs; as measured with the SIDP-IV interview) in a large sample of patients with PDs (n = 1,435). Explorative factor analyses indicated that the nine CERQ subscales can be clustered into three higher-order factors (adaptive coping, non-adaptive coping and external attribution style). When compared to a general population sample, the PD sample particularly scored higher on nonadaptive coping styles. A higher number of PDs was related to a particularly higher level of nonadaptive coping and less mature defensive functioning, but also to lower levels of adaptive coping and external attribution. This study is the first to suggest that three higher-order coping styles can be identified among PD patients, and that these coping styles are related to the presence and number of PDs.     

Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm

This study examined the point prevalence of Borderline Personality Disorder (BPD) and its clinical correlates in patients with recent deliberate self-harm (DSH) in Hong Kong. A representative consecutive sample (n = 160) of patients with DSH referred to Prince of Wales Hospital from April 1, 2007 to March 31, 2008 was recruited. Their BPD status was determined according to the BPD subscale of the Chinese version of Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). The point prevalence of BPD was calculated. Subjects with and without BPD were compared in terms of demographic and clinical characteristics. Thirty out of 160 (18.8%) DSH patients were found to suffer from BPD. DSH patients with BPD were more likely to be female (p = .020), more often reported history of childhood physical (p = 0.043) and sexual abuse (p < 0.001), history of past DSH (p = 0.010), being younger at first DSH (p = 0.039), and more likely to suffer from current alcohol and substance use disorder (p = 0.043) and eating disorder (p = 0.040) than those without BPD. Being female, having history of childhood sexual abuse and current alcohol and substance use disorder were found to be independent predictors of BPD status by binary logistic regression.     

Suicidal ideation, psychiatric disorder, and medical illness in a community epidemiological study.

Many epidemiological studies have analyzed suicidal ideation in clinical samples, but only a few have been performed in the general population. We present the results of a two-stage epidemiological study in the general population on the island of Formentera (Balearic Islands, Spain), which used the 28-item General Health Questionnaire (GHQ-28) in the first stage (n = 697) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in the second (n = 242). We also recorded medical illnesses diagnosed in the subjects at the second stage. Four items on the GHQ-28 ask directly about suicidal thoughts or ideation. From the sample, 6.5% have reported suicidal ideation. Mental disorders are the most important factor associated with suicidal ideation; medical illnesses seem to play a secondary role.     

Emotional antecedents and consequences of deliberate self-harm and suicide attempts

Emotional experiences immediately prior to (emotional antecedents) and following (emotional consequences) deliberate self-harm and suicide attempts in female inmates (N = 63) were examined. Anger was the antecedent emotion reported by the largest proportion of individuals who had engaged in deliberate self-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts (30%). Relief and other positive emotional shifts were more common in deliberate self-harm (41.94%) (involving no intent to die) than in suicide attempts or ambivalent suicide attempts, particularly for persons with borderline personality disorder. These findings underscore the utility of discriminating between deliberate self-harm and suicidal behavior and highlight the potential role of anger in triggering such behaviors.     

Relationships among mental health,coping styles,and mood

The present study investigated the relationships between mental health (measured by the General Health Questionnaire--6 factors: General Illness, Somatic Symptoms, Sleep Disturbance, Social Dysfunction, Anxiety and Dysphoria, Suicidal Depression), coping styles (two strategies: Cognitive centered, Emotional centered), and mood (Tense Arousal, Energetic Arousal). 96 students answered questionnaires before their semester test which was a stressor. Analysis showed that (1) Tense Arousal scores correlated positively with overall General Health scores and all General Health factor scores, and Energetic Arousal scores correlated negatively with overall General Health scores and all General Health factor scores except one; (2) Anxiety and Dysphoria scores predicted Tense Arousal scores the best of General Health factor scores, while both Social Dysfunction scores and General Illness scores predicted Energetic Arousal scores. (3) Participants with high Energetic Arousal scores used a Cognitive centered coping strategy much more than an Emotional centered coping strategy. That is, people with low Energetic Arousal scores seem to use the Emotional centered coping strategy and have anxiety/dysphoria, while people with high Energetic Arousal scores seem to use a Cognitive centered coping strategy and have good health and social activity. These results suggest that there are small but significant relationships among mental health, coping styles, and mood.     

Psychosocial and pharmacological treatment of patients following deliberate self-harm: the methodological issues involved in evaluating effectiveness.

Development of effective treatments for patients following deliberate self-harm (self-poisoning or self-injury) is a very important element in suicide prevention. The randomized controlled trial (RCT) is the mainstay of evaluation of treatments. In a systematic review of the literature, the effectiveness of treatments based on RCTs was examined and the quality of the RCTs was assessed. Twenty trials were identified, and where possible, these were grouped on the basis of similarities among the types of treatment. In this paper, we examine the methodological aspects of the trials and consider what may be learned that will assist in the design of future studies in this field. The methodological quality of the trials was reasonable, but most trials included too few participants to detect clinically important differences in rates of repeated self-harm. In planning future trials, the following major issues should be addressed: investigators should perform power calculations to determine the number of subjects necessary to detect clinically important effects, provide information on method of randomization and interventions, use standard measures of outcome, and focus on homogeneous subgroups of patients. Improving the methodology of future studies in this field will be essential if sound evidence is to be obtained which can inform effective service provision for deliberate self-harm patients.     

the relationship between pain and coping styles among hiv-positive men and women

Abstract

Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS. However, further research is necessary to determine the causal relationship between pain and coping through denial. These findings also point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.     

Belief systems and coping styles as mediating variables in the relationship between hostility and illness

The present study investigated the relationship between hostility, belief systems, coping styles, and illness. Hostility is of interest when considering the stress-illness relationship because it has been associated with increased risk for coronary heart disease as well as general mortality. The results suggest that individuals prone toward hostility are more likely to succumb to illness and adhere to irrational beliefs than individuals not so oriented. In addition, hostile individuals were found to employ different, and perhaps less adaptive, coping styles than their low hostility counterparts. It was concluded that the belief systems and coping styles typically employed by individuals prone toward hostility may be important mediating variables in the relationship between hostility and illness. These factors may also be important to take into account in treatment programs designed to reduce illness risks for such individuals. Finally, this study suggests that stress-induced impairment of health for hostility-prone individuals may begin much earlier than the vast majority of the literature currently suggests.