Health psychology. The science and the field

Reviews scientific and professional trends in the field of health psychology. I discuss recent research on health promotion, psychological factors in the development of illness, cognitive representations of health and illness, stress and coping, social support, interventions to promote coping, and trends that will affect progress in the field, such as the need for cost containment and the aging of the population.     

Psychosocial Perspectives on Pregnancy: Prenatal Maternal Stress and Coping

Pregnancy is a momentous life event experienced by most women that involves biomedical and psychosocial changes that are potentially stressful. High levels of maternal stress in pregnancy contribute to adverse fetal, infant, child, and adult outcomes, including cognitive, emotional, neurodevelopmental, and physical health effects. This article discusses definition, measurement, and effects of stress in pregnancy and describes current research questions such as whether the timing or pattern of prenatal stress accentuates its effects and whether prenatal stress accounts for ethnic disparities in adverse birth outcomes in the United States. We review research on the ways that women cope with prenatal stress and research examining associations of coping with maternal emotional state, health, and birth outcomes. Additionally, we describe important factors that improve women's psychosocial adaptation to pregnancy, their health, and their birth outcomes, specifically trait optimism, social support, and physical activity, and we emphasize interventions that utilize these factors.     

Coping Strategy Profiles Used by Salespeople: Their Relationships with Personal Characteristics and Work Outcomes

Sales research to date has focused on coping styles as measured by problem-focused coping (PFC) and emotion-focused coping (EFC), but it has excluded time management perceptions and behaviors as ways of coping with stress (Srivastava and Sager 1999; Strutton and Lumpkin 1993). This study examines a coping model that integrates EFC, PFC, and time management behaviors in the rubric of a profile. The profile allows for practice of several coping behaviors simultaneously. Using data gained from salespeople, four tentative coping strategy profiles are developed and examined relative to personal characteristics and job outcomes. Study results suggest that salespeople who are able to better handle stress use time management behaviors more often in addition to using high levels of PFC and low levels of EFC.     

Working With Suicidal Clients: Not Business as Usual

In this introduction to a special series of articles on working with suicidal clients, we note that much of the recent growth in theory and research pertaining to suicidal individuals has been contributed by cognitive-behavioral theorists and researchers. This work has established that suicidal people manifest important cognitive vulnerabilities that can be addressed in therapeutic interventions specifically designed for them. Studies to date have produced outcomes that support this framework. We provide brief previews of the collection of articles that follow, which cover safety planning, protocols for evaluating risk, the utility of health behavior theory for informing treatment, mindfulness-based approaches for suicidality, developmental and family considerations, intensive inpatient CBT for individuals in the military, integrated interventions for substance abuse and suicidal behaviors, and coping with the impact of client suicide. We conclude that clinicians are now in a position to begin moving beyond a “therapy as usual” mindset in working with suicidal clients.     

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.     

Collectivism and coping: Current theories,evidence, and measurements of collective coping

A burgeoning body of cultural coping research has begun to identify the prevalence and the functional importance of collective coping behaviors among culturally diverse populations in North America and internationally. These emerging findings are highly significant as they evidence culture's impacts on the stress‐coping process via collectivistic values and orientation. They provide a critical counterpoint to the prevailing Western, individualistic stress and coping paradigm. However, current research and understanding about collective coping appear to be piecemeal and not well integrated. To address this issue, this review attempts to comprehensively survey, summarize, and evaluate existing research related to collective coping and its implications for coping research with culturally diverse populations from multiple domains. Specifically, this paper reviews relevant research and knowledge on collective coping in terms of: (a) operational definitions; (b) theories; (c) empirical evidence based on studies of specific cultural groups and broad cultural values/dimensions; (d) measurements; and (e) implications for future cultural coping research. Overall, collective coping behaviors are conceived as a product of the communal/relational norms and values of a cultural group across studies. They also encompass a wide array of stress responses ranging from value‐driven to interpersonally based to culturally conditioned emotional/cognitive to religion‐ and spirituality‐grounded coping strategies. In addition, this review highlights: (a) the relevance and the potential of cultural coping theories to guide future collective coping research; (b) growing evidence for the prominence of collective coping behaviors particularly among Asian nationals, Asian Americans/Canadians and African Americans/Canadians; (c) preference for collective coping behaviors as a function of collectivism and interdependent cultural value and orientation; and (d) six cultural coping scales. This study brings to light the present theoretical and methodological contributions as well as limitations of this body of literature and the implications it holds for future coping research.     

高血压患者应激反应特点及行为人格的关系研究

为了解高血压患者心血管反应的特征及与健康人群的差异,使用实验和问卷调查的方法对高血压患者和健康居民进行研究。结果显示,两组在任务期和恢复期的心血管反应差异显著（P〈0．05）;病例组的健康实践行为和消极应对方式水平较高,积极应对方式有待提升;健康实践行为和恢复期舒张压呈负相关,积极应对方式和任务期收缩压呈正相关（P〈0...     

Review of Interventions to Improve Family Engagement and Retention in Parent and Child Mental Health Programs

Engaging and retaining families in mental health prevention and intervention programs is critically important to insure maximum public health impact. We evaluated randomized-controlled trials testing methods to improve family engagement and retention in child mental health programs published since 1980 (N = 17). Brief, intensive engagement interventions in which providers explicitly addressed families’ practical (e.g. schedules, transportation) and psychological (e.g. family members’ resistance, beliefs about the treatment process) barriers as they entered treatment were effective in improving engagement in early sessions. The few interventions found to produce long-term impact on engagement and retention integrated motivational interviewing, family systems, and enhanced family stress and coping support strategies at multiple points throughout treatment. Few interventions have been tested in the context of prevention programs. There are promising approaches to increasing engagement and retention; they should be replicated and used as a foundation for future research in this area.     

Spirituality and Healthy Lifestyle Behaviors: Stress Counter-balancing Effects on the Well-being of Older Adults

The goal of this study was to examine stress-ameliorating effects of religiosity, spirituality, and healthy lifestyle behaviors on the stressful relationship of chronic illness and the subjective physical well-being of 221 older adults. We also investigated whether the intervening variables functioned as coping behaviors and orientations or as adaptations in late life. Guided by the stress paradigm, path analysis was used to assess these relationships in a stress suppressor model and a distress deterrent model. No suppressor effects were found; however a number of distress deterrent relationships were detected. Spirituality, physical activities, and healthy diet all contributed to higher subjective physical well-being, as counter-balancing effects, in the distress deterrent model. The findings have implications for future research on the role of spirituality, religiosity and lifestyle behaviors on the well-being of chronically ill older adults. Findings also support the need for studying different dimensions of religiosity and spirituality in an effort to understand coping versus adaptation in behaviors and orientations. Gracie H. Boswell, Ph.D., M.Ed. (Case Western Reserve University) and (M. Ed.- Kent State University). She is a Carolina Program in Health and Aging Research Scientist at the Institute on Aging- University of North Carolina at Chapel Hill. Her research interests have been social gerontology and quality of life, emphasizing religiosity/spirituality. Eva Kahana, Ph.D. (University of Chicago) is Pierce T. and Elizabeth D. Robson Professor of Humanities and Director of the Elderly Care Research Center- Case Western Reserve University. Her research concentration has been the sociology of aging (coping & stress and institutionalization). Peggye Dilworth-Anderson, Ph.D. (Northwestern University) is Director- Center for Aging and Diversity, Institute on Aging, Professor- School of Public Health, Department of Health Policy and Administration at University of North Carolina at Chapel Hill. Her research interests have been caregiving and minority health disparities.     

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants

This paper applies the Minority Stress framework to data collected from an ongoing community-based participatory research project with health and social service agencies in Southeast Michigan. We examine the stressors and coping strategies employed by undocumented Latinx immigrants and their families to manage immigration-related stress. We conducted in-depth interviews with 23 immigrant clients at Federally Qualified Health Care Centers (FQHC) in Southeast Michigan and 28 in-depth interviews with staff at two FQHC's and a non-profit agency serving immigrants. Findings suggest that immigrants face heightened anxiety and adverse mental health outcomes because of unique minority identity-related stressors created by a growing anti-immigrant social environment. Chronic stress experienced stems from restrictive immigration policies, anti-immigrant rhetoric in the media and by political leaders, fear of deportation, discriminatory events, concealment, and internalized anti-immigrant sentiment. Though identity can be an important effect modifier in the stress process, social isolation in the immigrant community has heightened the impact of stress and impeded coping strategies. These stressors have resulted in distrust in community resources, uncertainty about future health benefits, delayed medical care, and adverse mental health outcomes. Findings provide a framework for understanding the unique stressors experienced by immigrants and strategies for interventions by social service agencies.     

Dimensions of Religiousness and Cancer Screening Behaviors Among Church-Going Latinas

Churches are a promising setting through which to reach Latinas with cancer control efforts. A better understanding of the dimensions of religiousness that impact health behaviors could inform efforts to tailor cancer control programs for this setting. The purpose of this study was to explore relationships between dimensions of religiousness with adherence to cancer screening recommendations among church-going Latinas. Female Spanish-speaking members, aged 18 and older from a Baptist church in Boston, Massachusetts (N = 78), were interviewed about cancer screening behaviors and dimensions of religiousness. We examined adherence to individual cancer screening tests (mammography, Pap test, and colonoscopy), as well as adherence to all screening tests for which participants were age-eligible. Dimensions of religiousness assessed included church participation, religious support, active and passive spiritual health locus of control, and positive and negative religious coping. Results showed that roughly half (46 %) of the sample had not received all of the cancer screening tests for which they were age-eligible. In multivariate analyses, positive religious coping was significantly associated with adherence to all age-appropriate screening (OR = 5.30, p < .01). Additional research is warranted to replicate these results in larger, more representative samples and to examine the extent to which enhancement of religious coping could increase the impact of cancer control interventions for Latinas.     

The effects of stressful life events,coping, and cortisol on HIV infection

What is the role of stress and coping in changes in immunologic and clinical indicators of human immunodeficiency virus disease progression? There is substantial evidence that stressful life events and passive coping strategies, such as denial, may have a detrimental effect on HIV disease progression. Given the harmful effects of stress and passive coping, the author reviews the limited research testing the efficacy of interventions, such as cognitive-behavioral therapies for HIV-infected persons. Finally, in trying to understand psychoimmune relationships in HIV, the evidence is examined for the mediating and direct effects of cortisol, a hormone associated with stress, on HIV disease progression. Delineating the role of psychosocial factors and cortisol on HIV disease progression may aid in the development of new interventions for this devastating disease.     

The Relationship between Religious Coping and Self-Care Behaviors in Iranian Medical Students

In recent years, researchers have identified that coping strategies are an important contributor to an individual’s life satisfaction and ability to manage stress. The positive relationship between religious copings, specifically, with physical and mental health has also been identified in some studies. Spirituality and religion have been discussed rigorously in research, but very few studies exist on religious coping. The aim of this study was to determine the relationship between religious coping methods (i.e., positive and negative religious coping) and self-care behaviors in Iranian medical students. This study used a cross-sectional design of 335 randomly selected students from Mazandaran University of Medical Sciences, Iran. A data collection tool comprised of the standard questionnaire of religious coping methods and questionnaire of self-care behaviors assessment was utilized. Data were analyzed using a two-sample t test assuming equal variances. Adjusted linear regression was used to evaluate the independent association of religious copings with self-care. Adjusted linear regression model indicated an independent significant association between positive (b = 4.616, 95% CI 4.234–4.999) and negative (b = ?3.726, 95% CI ?4.311 to ?3.141) religious coping with self-care behaviors. Findings showed a linear relationship between religious coping and self-care behaviors. Further research with larger sample sizes in diverse populations is recommended.     

Aging and Loneliness: Downhill Quickly?

ABSTRACT— Levels of loneliness are relatively stable across most of adult life, but correlates of loneliness show age differences. We review evidence of age differences in associations between loneliness and individual differences in health behaviors, stress exposure, physiological stress responses, appraisal and coping, and restorative processes. The effects of each of these pathways endow loneliness with the capacity to accelerate the rate of physiological decline with age. Additional research across the lifespan is required to understand the nature of accrued loneliness effects on health behavior and physiology in the short and long term.     

Common factors in the enhancement of dyadic coping

Stress and coping are important constructs in understanding the dynamics of close relationships. Couple therapy and marital distress prevention approaches have become increasingly focused on these variables to gain knowledge of how stress and coping may impact the quality and stability of close relationships. In this paper, we outline couple's coping enhancement training (CCET) and the coping-oriented couple's therapy (COCT); both, couple interventions derived from stress and coping research. We address specific features of each approach and report data on their efficacy and effectiveness. We also examine both the common and specific factors that may play a role in the effectiveness of these approaches.     

Nonverbal Interactional Behavior in the Families of Persons with Schizophrenic and Bipolar Disorders

Whereas verbal interactional behaviors have been repeatedly found to distinguish the families of persons with and without major psychiatric disorders, there has been comparatively little examination of the discriminative value of nonverbal interactional behaviors. We developed the Nonverbal Interactional Coding System to measure “affiliative” and “distancing” nonverbal behaviors in 18 schizophrenic and 18 bipolar patients and their parents during 10-minute interactions conducted during a posthospital period. Bipolar patients and their parents displayed affiliative nonverbal behaviors (“illustrator gestures” or “prosocial behaviors”) for longer durations than schizophrenic patients and their parents. In contrast, parents of schizophrenic patients displayed distancing nonverbal behaviors (looking away) for longer durations than those of bipolar patients. The nonverbal interactional data added to the statistical strength of patients’ and parents’ verbal interactional data in distinguishing between these diagnostic groups. Nonverbal interactional behaviors are important variables to consider in interventions aimed at improving the communication skills of families coping with psychiatric disorders.     

Does coping help? A reexamination of the relation between coping and mental health

In a longitudinal community survey of 291 adults, we explored the relation between coping strategies and psychological symptoms. Respondents completed the revised Ways of Coping Scale (Folkman & Lazarus, 1985) for a self-named stressful episode. Factor analysis produced eight coping factors: three problem focused, four emotion focused, and one (support mobilization) that contained elements of both. Multiple regression analyses indicated bidirectionality in the relation between coping and psychological symptoms. Those in poorer mental health and under greater stress used less adaptive coping strategies, such as escapism, but coping efforts still affected mental health independent of prior symptom levels and degree of stress. We compared main versus interactive effects models of stress buffering. Main effects were confined primarily to the emotion-focused coping scales and showed little or negative impacts of coping on mental health; interactive effects, though small, were found with the problem-focused scales. The direction of the relation between problem-focused scales and symptoms may depend in part on perceived efficacy, or how the respondent thought he or she handled the problem. Implications for the measurement of adaptive coping mechanisms and their contextual appropriateness are discussed.     

Cross-sectional and Longitudinal associations in coping strategies and physical health outcomes among HIV-Positive youth

This study assessed whether coping styles had an influence on physical health outcomes either concurrently or longitudinally in a sample of HIV-positive youth. Coping styles were characterized as positive, passive, depressive withdrawal, and escapist. A cross-sectional latent variable analysis (N = 279) assessed associations among environmental stress, self-esteem, social support, coping styles, AIDS symptoms, and CD4 count. A more restricted longitudinal analysis (N = 174) tested associations among earlier environmental stress, self-esteem, coping styles, and AIDS symptoms at follow-up. CD4 count was not associated with coping styles in the cross-sectional analysis. Concurrent AIDS symptoms were significantly predicted by depressive withdrawal and environmental stress. A passive coping style modestly predicted more AIDS symptoms longitudinally. Correlates of perceived health and well-being of persons with HIV/AIDS are important to investigate in addition to more objective measures such as CD4 count that may not be amenable to change through coping style interventions alone.     

LGBT Community, Social Network Characteristics, and Smoking Behaviors in Young Sexual Minority Women

Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW’s (age 18–24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW’s social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW’s smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW’s connections to the LGBT community and their social networks.     

Posttraumatic Growth in the Context of Heart Disease

The concept of positive consequences arising as a result of coping with traumatic experiences, such as life-threatening illness, represents an emerging area of empirical study in the stress and health literature. This study investigates three specific psychosocial variables (personality, social support, and coping) in relation to posttraumatic growth in a population of individuals coping with heart disease. The results indicate that Extraversion was the most significant predictor of growth, and there is evidence that Problem-Focused Coping partially mediated this relationship between Extraversion and posttraumatic growth. The role of Social Support Satisfaction in predicting growth remains unclear. Findings emphasize the importance of personal and environmental factors in psychological interventions aimed at improving the adjustment and posttraumatic growth of heart patients. Directions for future research are proposed.