Prospective Associations of Coping Styles With Depression and Suicide Risk Among Psychiatric Emergency Patients

Suicide is the second leading cause of death for those ages 13–25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult psychiatric emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.     

Stress, externality, and depression

Previous research has found mixed support for the possibility that locus of control moderates the effects of life stress on depression. Two methodological choices may have influenced previous findings: the use of a unidimensional rather than a multidimensional locus of control scale, and reliance on linear statistical methods using median splits. We attempted to correct these choices by using the Levenson IPC scale (1974) and multiple regression analyses in a female undergraduate population (N = 158). The results supported use of a multidimensional scale, since Stress, Internality, and Powerful Others were found to have main effects on depression whereas Chance interacted with life stress. The question of whether locus of control refers to responsibility for causing an event, i.e., self-blame, or belief in control over future events, i.e., coping behavior, was discussed.     

Self-blame, compliance, and distress among burn patients

This study addressed self-blame and adaptation by using data collected from 49 patients hospitalized for the treatment of acute burn wounds. Nurses and physical therapists rated patients' compliance with the therapeutic activities essential for proper healing, and they rated pain behavior. After controlling for burn severity and time since admission, regression analyses showed that behavioral self-blame for the burn accident was a significant predictor of poorer compliance with nurses, more pain behavior, and greater depression. People with a prior psychiatric history were also more depressed and more likely to blame themselves for the accident. These data are contrasted with research on the adaptive features of self-blame.     

STRUCTURAL MODELS OF THE RELATIONS OF ASSAULT SEVERITY, SOCIAL SUPPORT, AVOIDANCE COPING, SELF-BLAME, AND PTSD AMONG SEXUAL ASSAULT SURVIVORS

A number of studies have identified which survivors of sexual assault are more likely to develop symptoms of posttraumatic stress disorder (PTSD). Most correlates that have been identified have been at the individual level. Insufficient attention has been given to whether survivors' social interactions impact their individual responses to assault and subsequent levels of psychological symptomatology. In this study, a large, diverse sample of community-residing women ( N = 636) was surveyed. Structural equation modeling was used to examine the relationships between assault severity, global support, negative social reactions, avoidance coping, self-blame, traumatic life experiences, and PTSD symptoms. The results suggest that negative social reactions and avoidance coping are the strongest correlates of PTSD symptoms and that the association typically observed between victim self-blame and PTSD symptoms may be partially due to the effect of negative social reactions from others. These reactions may contribute to both self-blame and PTSD. Implications for future research and clinical practice are discussed.     

Coping with Severe Mental Illness: Relations of the Brief COPE with Symptoms, Functioning, and Well-Being

The way patients cope with the experience of having an episode and being hospitalized for psychiatric disorder may relate to symptom severity, social functioning, and psychological well-being. Coping was assessed among 70 psychiatric inpatients diagnosed primarily with schizophrenia, major depressive disorder, and schizoaffective disorder. The Brief COPE—a questionnaire developed in health psychology (C. S. Carver, 1997)—was administered in interviewer-assisted format during patients' stay on the ward. Thirty patients were re-interviewed an average of 6 weeks after discharge. Among patients with schizophrenia, schizophrenia symptom severity correlated inversely with adaptive coping (e.g., acceptance, planning, seeking support) but did not correlate with maladaptive coping (e.g., self-blame, denial). Among those with schizophrenia, deficits in adaptive coping also predicted relative increases in schizophrenia symptoms over time, controlling for intake symptom severity. Among patients without schizophrenia, maladaptive coping correlated concurrently with depressive symptoms. Several hypothesized associations between concurrent coping, functioning, and well-being were also documented.     

Attributions of Blame and Responsibility in Relation to Distress and Health Behavior Change in People with AIDS and AIDS-related Complex1

There are conflicting views expressed in the literature about whether and under what conditions attributions of self-responsibility or self-blame for one's health affect such variables as distress, emotional adjustment, and adaptive coping. This study examined the impact of attributions of blame and responsibility for the cause and course of disease in 103 persons with the Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related complex (ARC). Attributing the cause of disease to the self was significantly positively correlated with dysphoria (a combined measure of depression, anxiety, and negative mood) in persons with ADS, whereas possible improvement attributed to the self was significantly negatively correlated with dysphoria in the ARC group. Persons with AIDS who attributed more responsibility for improvement to themselves also made more health behavior changes. Conversely, in the ARC group, health behavior change was not associated with attributing possible improvement to the self. We found no relationship between self-blame and any of the distress or behavior measures. Our findings that the pattern of association between attribution of responsibility are different between persons with AIDS and ARC underscores the need to examine psychological processes within the context of particular health conditions. The results also suggest that attributing self-responsibility for improvement does not have the negative psychological effects of “blaming the victim” as does attributing responsibility for the cause of AIDS to the self.     

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.     

PTSD SYMPTOMS AND SELF-RATED RECOVERY AMONG ADULT SEXUAL ASSAULT SURVIVORS: THE EFFECTS OF TRAUMATIC LIFE EVENTS AND PSYCHOSOCIAL VARIABLES

Prior research has demonstrated that self-blame is predictive of more posttraumatic stress disorder (PTSD) symptoms and poorer recovery ( Frazier, 2003 ; Koss, Figueredo, & Prince, 2002 ), and perceived control over recovery is associated with less distress ( Frazier, 2003 ) in adult sexual assault (ASA) survivors. A structural equation model was tested to examine the role of traumatic events, self-blame, perceived control over recovery, and coping strategies on PTSD symptoms and self-rated recovery in women ASA survivors. Adaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on PTSD symptoms and showed a small positive association with increased PTSD symptoms. As hypothesized, maladaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on both PTSD symptoms and self-rated recovery; greater maladaptive coping was associated with increased PTSD symptoms and lower self-rated recovery. Implications and directions for future research are discussed.     

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

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

Adjustment to rape

This questionnaire study of rape victims' reactions, causal attributions for the rape, coping behaviors after the rape, and psychological adjustment to the rape were examined. As in previous research, high levels of behavioral and characterological self-blame for rape were found. Contrary to prior hypotheses, behavioral self-blame was not associated with good adjustment. Rather, both behavioral and characterological self-blame were associated with poor adjustment. Societal blame was the only causal attribution for rape that was unassociated with adjustment. Remaining at home and withdrawing from others were both associated with poor adjustment, and the use of stress reduction techniques was associated with good adjustment. The implications of the results for theories of victimization and for clinical interventions with rape victims are discussed.     

Cognitive,affective and social mechanisms in depression risk: Cognition,hostility, and coping style

Although some research has assessed cognitive variables in individuals at risk for depression, few studies have specifically assessed the role of automatic thinking, and virtually no studies have assessed anger and coping in this group. The current study compared measures of these variables in a high-risk group that was defined on the basis of a previous episode of depression, and a control group comprised of low-risk/never depressed individuals. Even though neither group evidenced depressive symptoms at the time of assessment, group comparisons and regression analyses indicated that high-risk individuals reported more negative automatic thoughts than did low-risk participants and that social support seeking, self-blame, and avoidance emerged as coping predictors of risk as did higher levels of anger and hostility. These data thus suggest patterns of interpersonal, behavioural, and cognitive variables that may characterise depression risk.     

Post-Traumatic Stress and World Assumptions: The Effects of Religious Coping

Religiosity has been shown to moderate the negative effects of traumatic event experiences. The current study was deigned to examine the relationship between post-traumatic stress (PTS) following traumatic event exposure; world assumptions defined as basic cognitive schemas regarding the world; and self and religious coping conceptualized as drawing on religious beliefs and practices for understanding and dealing with life stressors. This study examined 777 Israeli undergraduate students who completed several questionnaires which sampled individual world assumptions and religious coping in addition to measuring PTS, as manifested by the PTSD check list. Results indicate that positive religious coping was significantly associated with more positive world assumptions, while negative religious coping was significantly associated with more negative world assumptions. Additionally, negative world assumptions were significantly associated with more avoidance symptoms, while reporting higher rates of traumatic event exposure was significantly associated with more hyper-arousal. These findings suggest that religious-related cognitive schemas directly affect world assumptions by creating protective shields that may prevent the negative effects of confronting an extreme negative experience.     

Coping strategies in obsessive-compulsive patients during Covid-19 lockdown

Background/ObjectiveThe main aim of this study was to compare coping strategies in obsessive-compulsive disorder (OCD) patients and a healthy control group during COVID-19 lockdown and to analyze the relationship with some variables which may influence results (depression, anxiety, comorbidity, subtype of obsession-compulsion). Method: There were 237 participants, 122 OCD and 115 healthy controls, aged 17-61 years old (M = 33.48, SD = 11.13). Results: Groups showed differences in the use of some adaptive strategies (positive reinterpretation, acceptance, humor) and maladaptive (denial, self-blame). Within obsessive-compulsive group, comorbidity affected the greater use of inappropriate strategies (denial, substance abuse and self-blame) while type of obsession-compulsion did not influence use. Anxiety and depression levels were related to the use of less adaptive strategies. Conclusions: These findings strengthen the need for training in the use of effective and adaptive coping strategies, making it necessary to improve clinical follow-up of these patients. It is relevant to be in contact with healthcare professionals, review medication and observe the anxiety and depression levels.     

Adjustment to multiple sclerosis: application of a stress and coping model.

This study examined the use of a stress and coping model of adjustment to multiple sclerosis (MS). A total of 122 MS patients were interviewed and completed self-administered scales at Time 1 and 12 months later, Time 2 (n = 96). Predictors included stressful life events, illness (duration, severity, and disability), social support, appraisal (threat and control/challenge), and coping (problem focused and emotion [wishful thinking, self-blame, and avoidance] focused). Adjustment outcomes were Time 2 depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that after controlling for the effects of Time-1 adjustment, better Time-2 adjustment was related to less disability, greater reliance on problem-focused coping, and less reliance on emotion-focused coping. There was limited support for the stress buffering effects of coping and social support. Findings offer some support for the use of a stress and coping model of adaptation to MS.     

Interpersonal Trauma and Physical Health Symptoms in College Students: Mediating Effects of Substance Use and Self-Blame

The present study examined the mediating effect of two coping mechanisms (substance use and self-blame) on the relationship between interpersonal trauma (IPT) exposure and self-reported physical health symptoms in college students. Participants included 365 trauma-exposed college students. We used multigroup structural equation modeling to test our hypothesized model and to determine whether the hypothesized relationships were moderated by gender. Results indicated that IPT exposure was associated with increased substance-use coping and self-blame. These two coping mechanisms, in turn, predicted increased physical health symptoms. The results of the moderation analysis indicated no significant gender differences in the hypothesized relationships.     

Holding it together: Coping with vicarious trauma in sport

ObjectivesVicarious trauma refers to the negative effects that may be experienced after witnessing trauma (such as actual or threatened injury) in others. This study aims to examine vicarious trauma in sports coaches by drawing on the experiences of two trampoline coaches who have witnessed a serious athletic injury. In particular, this study focuses on how these coaches have responded to and coped with this traumatic event.DesignThe study draws on data from thematic, semi-structured, life history interviews that focus on the occurrence of one particular sports accident witnessed by both coaches.MethodMultiple interviews were conducted in which participants were invited to recall the accident, their own responses to the accident, and the coping strategies employed. Interviews were analyzed using a holistic-content analysis in which thematic similarities and differences between the narratives emerged.ResultsThere were three main themes that emerged, these were the need to make meaning following trauma, re-experiencing trauma, and acceptance and avoidance coping. Participants demonstrated the individual nature of coping with trauma. While one participant avoided the trauma by minimizing the events, blocking her emotions and giving support to others; the second participant showed acceptance of the trauma, was highly emotional, and received support from others.ConclusionsThis study demonstrates the difficulties that may be faced by coaches following vicarious trauma. Although each coach presents different experiences and coping strategies they provide some indications of the level and type of support that may be required after witnessing athletic injury.     

Coping, stress, and social resources among adults with unipolar depression

We used a stress and coping paradigm to guide the development of indices of coping responses and to explore the roles of stress, social resources, and coping among 424 men and women entering treatment for depression. We also used an expanded concept of multiple domains of life stress to develop several indices of ongoing life strains. Although most prior studies have focused on acute life events, we found that chronic strains were somewhat more strongly and consistently related to the severity of dysfunction. The coping indices generally showed acceptable conceptual and psychometric characteristics and only moderate relationships to respondents' sociodemographic characteristics or to the severity of the stressful event for which coping was sampled. Coping responses directed toward problem solving and affective regulation were associated with less severe dysfunction, whereas emotional-discharge responses, more frequently used by women, were linked to greater dysfunction. Stressors, social resources, and coping were additively predictive of patient's functioning, but coping and social resources did not have stress-attenuation or buffering effects.     

Adverse Life Events, Coping and Internalizing and Externalizing Behaviors in Urban African American Youth

African American youth residing in low income urban neighborhoods are at increased risk of experiencing negative life events in multiple domains, increasing their risk for internalizing and externalizing behaviors. However, little is known about youth’s differential responses to life event stress, or protective processes and coping strategies for urban African American youth exposed to adverse life events. Thus, the present study examined whether variability in predominantly low income, urban African American youth’s responses to life event stress are accounted for by the type of life event experienced or the type of coping strategies used. Participants were a community sample of 353 urban African American youth (52.8 % girls; age range 8–12 years) who participated in the Multiple Opportunities to Reach Excellence (MORE) Project. Youth reported about their experiences with adverse life events, coping strategies, and internalizing and externalizing symptoms. Results indicated that violent life events were uniquely associated with externalizing behavior, while discrimination and economic stress were uniquely associated with internalizing behavior. The utility of coping strategies varied by gender, such that avoiding problems was protective for girls who experienced violent life events, but not for boys. For boys, exposure to violence was significantly positively associated with externalizing symptoms regardless of the amount of avoiding problems coping used. Findings suggest that interventions to develop coping strategies may need to be gender-specific as well as tailored for the types of stressors common for low income urban youth.     

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.     

Barriers to Reporting Sexual Victimization: Prevalence and Correlates among Undergraduate Women

This study examined the frequency and correlates of barriers to reporting sexual victimization to law enforcement. Participants were 127 female undergraduate sexual assault victims who completed self-report surveys. The most frequently reported barriers were “I handled it myself” and “I didn't think it was serious enough.” Factor analysis of the reported barriers items revealed two factors: shame/not wanting others involved and did not acknowledge the event as a crime?/handled it myself. Shame/not wanting others involved was positively associated with physical injury, being victimized by a relative, and self-blame. Acknowledgment/handled it myself was negatively associated with being victimized by a relative. Findings suggest that intervention efforts should focus on increasing acknowledgment, decreasing negative reactions to disclosure, and decreasing victims' self-blame.