PTSD and Emotional Distress Symptoms Measured After a Motor Vehicle Accident: Relationships with Pain Coping Profiles

This study explored differences among pain patients classified as Dysfunctional, Interpersonally Distressed, and Adaptive Copers on the Multidimensional Pain Inventory with respect to PTSD symptomatology, anxiety, and depression. Eighty-five patients with pain complaints who had experienced a serious motor vehicle accident were classified into these three pain coping categories and assessed using clinician and self-report measures. Results indicated that patients classified as Adaptive Copers (n = 24) showed less PTSD symptomatology, anxiety, and depressed mood, relative to individuals classified as Dysfunctional (n = 36) and as Interpersonally Distressed (n = 25), who did not differ on these dimensions. Emotional responses during the accident (fear, helplessness, danger, perceived control, and certainty that one would die) did not differentiate the groups. Pain profiles contributed to the prediction of self-reported PTSD symptoms, controlling for state anxiety. These data suggest that pain patients with both Dysfunctional and Interpersonally Distressed coping profiles are at elevated risk for a range of posttrauma problems following a serious motor vehicle accident.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

The role of optimism and pessimism in chronic pain patients adjustment

This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment.     

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups were compared on the Pain Behavior Checklist, Behavioral Observation Measure of Pain Behavior, Revised Coping Strategies Questionnaire, and Chronic Disease Index. The Dysfunctional subgroup reported significantly more pain behavior, disability, affective distress, and catastrophizing than either the Interpersonally Distressed subgroup or Adaptive Copers, but were not significantly different on measures of adaptive coping strategies. The percentage of dropouts from treatment was significantly less among Adaptive Copers (11%) than among the Dysfunctional (33%) or Interpersonally Distressed (47%) subgroups. Differences in affective distress found among the MPI subgroups at baseline were not evident at the posttreatment assessment. The present findings support the use of MPI psychosocial subgroup analysis to enhance our understanding of differential response to chronic pain and pain management intervention.     

Depressive Symptoms in African-American Women

This project examined the prevalence of depressive symptoms in an African-American female college student sample. Concordance rates between two of the most widely used psychometric instruments in clinical settings, the Minnesota Multiphasic Personality Inventory, revised edition (MMPI-2; Hathway & McKinley, 1967) and the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mack, & Erbaugh, 1961), were examined. Results revealed that the MMPI-2 was a more conservative scale than the BDI in identifying depressive symptom levels. Both scales, however, identified 12% to 18% of the sample as experiencing severe symptoms. Results were interpreted in light of the stress model of depression. Participants who experienced many symptoms also had high levels of anxiety and passive coping styles. One significant covariate in this sample was mother's education level. Participants whose mothers had college experience had fewer depressive symptoms than their first-generation college-experience peers. Results were interpreted in light of the possible ways mothers inoculate their daughters from stressful environments because of their experiences and possible ways to use this process to assist first-generation college students.     

Problem-Solving Appraisal and Psychological Adjustment of Persons with Chronic Low-Back Pain

To examine the role of self-appraised problem-solving ability in the prediction of psychosocial impairment, depression, hopelessness, average pain unpleasantness, and current pain ratings among persons with chronic low-back pain. A second purpose was to enhance theoretical understanding of the mechanisms by which problem-solving appraisal influences adjustment. Correlational and regression procedures were used to test the hypothesized relations procedures between elements of self-appraised problem-solving ability and each criterion variable. Seventy-eight persons enrolled in an inpatient multidisciplinary chronic pain management program. The psychosocial subscale of the Sickness Impact Profile, the Beck Depression Inventory, the Beck Hopelessness Scale, the McGill Pain Questionnaire, and Visual Analogue Scales of Pain Sensory Intensity and Affective Response were the main outcome measures. After first controlling demographic characteristics, elements of self-appraised problem-solving ability assessed by the Problem-Solving Inventory were significantly predictive of depression, hopelessness, psychosocial impairment, and average pain unpleasantness (accounting for 20, 26, 29, and 11% of the respective variance in these constructs). Results indicate complex relations among the elements of problem-solving appraisal, suggesting that the Approach–Avoidance link to psychological adjustment was mediated by Problem-Solving Confidence. Comprehensive problem-solving interventions may be beneficial to persons with chronic pain     

The role of coping, anxiety, and stress in depression post-acute coronary syndrome

Depressive symptoms are common and can affect prognosis following acute coronary syndromes (ACS). This study examined the psychological factors, coping, anxiety, and perceived stress associated with depression following ACS. Psychological variables were assessed in 15 females and 66 males (M = 57 years, SD = 12). Repeated measures at 2, 12, and 24 weeks post-ACS compared depression, anxiety, perceived stress, and coping resources as determined by the Cardiac Depression Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, Perceived Stress Scale, and Coping Resources Inventory. Depression, anxiety, and perceived stress remained high in the depressed group across time. Coping scores at 2 weeks post-ACS predicted depression scores at 24 weeks post-ACS. It appears that trait anxiety and coping resources are related to depressive symptoms post-ACS.     

Depression and coping in candidates for kidney transplantation: Racial and ethnic differences

Subjects were 288 adolescents and adults with end-stage renal disease who were candidates for kidney transplantation, a group identified at risk for noncompliance. The purpose was to examine racial and ethnic variations in coping—variables that may underlie noncompliance and impact upon health outcome. Secondarily, the relationship between depression and particular styles of coping was investigated. Race/Ethnicity was divided into three categories: Black/Non-Hispanic, White/Non-Hispanic, and Hispanic. Coping and depression were assessed using the COPE and Beck Depression Inventory, respectively. Results indicated that Hispanic and Black subjects were more likely to use maladaptive styles of coping and less likely to use adaptive coping than were White subjects and that Black subjects reported more physical symptoms of depression. These findings point to possible mechanisms underlying the occurrence of noncompliance and resulting poorer health outcome for individuals of different racial and ethnic groups.     

The Effectiveness of Mindfulness Training on the Grieving Process and Emotional Well-Being of Chronic Pain Patients

Losses in relationships, work, and other areas of life often accompany the physical discomfort of chronic pain. Often the depth and intensity of the grief associated with chronic pain are overlooked or possibly misdiagnosed and treated as depression. We used an 8-week mindfulness meditation program to determine its effectiveness in addressing the grieving process among 39 patients diagnosed with chronic pain. Eighteen patients volunteered to be in a comparison group. The study was conducted in a regional hospital's pain clinic and patients completed the Response to Loss Scale (measuring grief), the Beck Depression Inventory, and the State Trait Anxiety Inventory. Results indicated that the treatment group advanced significantly more quickly through the initial stages of grieving than the comparison group. In addition, the treatment group demonstrated significant reductions in depression and state anxiety, but no significant differences emerged when comparing groups on the final stages of grieving or trait anxiety.     

Ruminative Thoughts and Their Relation to Depression and Anxiety1

Although past research has shown a correlation between ruminative response style and depression (Nolen-Hoeksema, 1991), the basic relationships among amount of ruminative thoughts, depression, and anxiety has not been established. Scores from the Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996), the Beck Anxiety Inventory (BAI; Beck & Steer, 1993), and the McIntosh and Martin (1992) Rumination Scale were analyzed for 199 participants. The correlation between rumination and depression was .33, between rumination and anxiety was .32, and between depression and anxiety was .56. The partial correlation between rumination and depression (controlling for anxiety level) was .20, and the partial correlation between rumination and anxiety (controlling for depression level) was .17. The finding that rumination is not unique to depression but is also associated with the specific negative affect of anxiety alone might also suggest new treatments of these two prevalent disorders.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.     

Stress and coping strategies in spouses of depressed patients.

The relationships between the coping strategies used by spouses of clinically depressed patients and spouses' anxiety, depression, and marital maladjustment were investigated. Fifty spouses of clinically depressed patients completed a biographical questionnaire, the Coping Strategy Indicator (J. H. Amirkhan, 1990, 1994), the Beck Depression Inventory (A. T. Beck, 1967; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961), the State-Trait Anxiety Inventory (C. D. Spielberger, R. E. Lushene, B. A. Vagg, & E. Jacobs, 1983), and the Locke-Wallace Marital Adjustment Test (H. J. Locke & K. M. Wallace, 1959, 1987). Anxiety was highly prevalent in the spouses; more than half were depressed, and half showed marital maladjustment. Significant positive correlations were found between an avoidant coping strategy and anxiety as well as depression, and a significant negative correlation was found between an avoidant coping strategy and marital adjustment. These findings indicate the ineffectiveness of an avoidant coping strategy for spouses of clinically depressed patients.     

Catastrophizing,Depression and Anxiety During Pregnancy: Relation Between Lumbopelvic Pain and Physical/Social Functioning

Catastrophizing, a cognitive behavioral aspect of pain, is defined as an excessively negative orientation against a noxious stimulus. The primary goal of the present study is to assess the association between catastrophizing and lumbopelvic pain intensity during the pregnancy period, the secondary goal is to explore the variation of pain catastrophizing, anxiety and depression, and the tertiary goal is to investigate the relationship between catastrophizing and quality of life. After approval, pregnant women with lumbopelvic pain were invited to join in the study. During admission, participants were asked to complete questionnaires including Pain Catastrophizing Scale, Beck Anxiety Inventory, Beck Depression Inventory-II, and Short Form-36. Age, gravida, parity, number of abortus, number of live-births and the pain intensity score were recorded. A total of 429 women were enrolled in the study. Pain catastrophizing scores showed a fluctuation during pregnancy, and were significantly correlated with the scores of Beck Anxiety Inventory, Beck Depression Inventory, Visual Analog Scale, and Short Form-36 sub-scales including social functioning, vitality, physical functioning and mental health. The present study demonstrated that catastrophizing level shows an alteration throughout the pregnancy period, and variation in catastrophizing shows an approximately similar course with pain intensity, depression and anxiety.     

Self-Report Differentiation of Anxiety and Depression in Chronic Pain

The psychometric distinctiveness of self-reported anxiety and depression in patients with chronic pain was investigated. The item-level responses of 220 patients with heterogeneous pain conditions from the Beck Depression Inventory and State-Trait Anxiety Inventory State-Anxiety scale were submitted to common factor analysis. Three first-order factors were identified: depression, anxiety-absent, and anxiety-present. One second-order factor of negative affect was also identified. Correlations of first-order factor scores with other psychometric measures suggested only minor distinctiveness. The findings indicated that it is possible to distinguish anxiety and depression psychometrically in patients with chronic pain but suggested that negative affect may be the primary underlying construct of the affective experience of these patients.     

Parental Alcoholism and Coping: A Comparison of Female Children of Alcoholics With Female Children of Nonalcoholics

The authors assessed potential differences between children of alcoholics and children of nonalcoholics in depression and choice of coping strategies. Although significant group differences were detected for level of depression, mean depression scores for both groups fell within the no depression range on the Beck Depression Inventory. No significant differences in coping strategies were detected.     

MBMD Coping Styles and Psychiatric Indicators and Response to a Multidisciplinary Pain Treatment Program

Psychosocial and personality factors are known to contribute to the maintenance of and recovery from chronic pain conditions but less is known about their influence on the efficacy of pain treatment programs. The purpose of the present study is to examine the ability of the Millon Behavioral Medicine Diagnostic (MBMD), a broadband measure of personality and psychosocial characteristics, to predict response to multidisciplinary pain treatment. 93 patients completed the MBMD, and ratings of current pain and average pain on an 11 point scale, prior to a multidisciplinary pain management program. Ratings of current and average pain were completed upon program completion. Participants were classified as “successful” or “unsuccessful” program completers based on pain reductions of ≥2 points. After program completion, 47 % of participants evidenced successful pain reductions. These successful participants had lower scores on depression and on coping style scales measuring introversive, inhibited, and dejected tendencies at baseline. Additionally, lower pre-treatment depression scores and lower scores on each of these coping style scales predicted lower pain ratings at discharge independent of educational level and pre-treatment pain ratings. The MBMD may be a useful tool to delineate patients who are likely to make significant treatment gains in intense, multidisciplinary pain treatment programs.     

Relationship between sleep disturbance,depression and anxiety in the 12 months following a cardiac event

We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.     

Emotional vulnerability and coping styles for resolving decisional conflict

This investigation supplements the study by D. Bouckenooghe, K. Vanderheyden, S. Mestdagh, and S. van Laethem (2007) on the role of cognitive dispositions in coping patterns for resolving decisional conflict. Literature suggests emotional vulnerabilities may significantly affect decision making. Thus, the present authors assessed the role of trait anxiety and depression in decision coping styles as specified by I. L. Janis and L. Mann's (1977) conflict-theory model. The participants--100 young adults--completed the Taylor Manifest Anxiety Scale (J. A. Taylor, 1953), Beck's Depression Inventory (A. T. Beck, R. A. Steer, & G. M. Garbin, 1988), and the Melbourne Decision-Making Questionnaire (L. Mann et al., 1998), which measures 4 coping strategies: vigilance, buck-passing, procrastination, and hypervigilance. Hierarchical multiple regression analysis, controlling for demographic and lifestyle factors, revealed trait anxiety and depression as significant predictors of procrastination and hypervigilance. Depression failed to predict buck-passing but functioned as an important moderator variable whereby trait anxiety better predicted hypervigilance in nondepressed participants. Consistent with past research, emotional dispositions failed to predict vigilance. Overall, these findings implicate emotional vulnerabilities in the quality of decision making but raise important questions about their unique and conditional effects.     

Implicit theories of mental health predict anxiety and depression during the COVID-19 pandemic in China: The mediating effect of coping styles

This research investigated how implicit theories of mental health (ITMH) influence people's experience of anxiety and depression symptoms during the COVID-19 pandemic in China. Two thousand and 44 Chinese completed the study during an emergent outbreak of the COVID-19 pandemic in Shaanxi, China. The results suggested that ITMH significantly influence people's experience of anxiety and depression symptoms. Both active and passive coping styles significantly mediated the relationship between ITMH and anxiety/depression, with active coping style as a stronger mediator than passive coping style. Implications of the current research for improving people's mental health during pandemics of infectious diseases and directions for future research are discussed.