Coping, routine activities, and recovery from acute distress among emergency medical personnel after a mass shooting incident

Emergency medical workers’ distress and recovery patterns after a mass shooting were related to their coping behaviors and routine daily activities. This longitudinal repeated measures study assessed 31 emergency medical workers’ psychological and psychosomatic symptoms self-rated for the weeks before, those just after, and one full month after the shooting. Coping behaviors and time in creative activities were related to increased acute distress; recovery was related to more time in constructive activities. Thinking about the incident was related to higher acute distress but better recovery on several SCL9OR scales. Exercise predicted recovery on Obsessive-Compulsive and Hostility scales. Studies evaluating emergency workers’ reactions to and recovery from critical incidents should use repeated measures designs, should assess short-term recovery, and should distinguish among symptoms.     

Catastrophizing as a Cognitive Vulnerability Factor Related to Depression in Workers’ Compensation Patients with Chronic Musculoskeletal Pain

The purpose of this study was to examine the role of catastrophizing as a mediator and moderator between life stress and depression in a sample of workers’ compensation patients with chronic musculoskeletal pain. Pain intensity, life stress (especially work and financial stress), and catastrophizing contributed significantly to depression. Catastrophizing was found to be partially mediating the relationship between life stress and depression and a moderator between social stress and depression. The results supported the role of catastrophizing as a cognitive vulnerability-stress factor related to depression in chronic pain patients. Screening for life stress and intervening early to prevent catastrophizing from occurring in the workers’ compensation rehabilitation process may reduce psychosocial distress and enhance the overall effectiveness of rehabilitation programming for workers’ compensation patients with chronic pain.     

Differential Predictors of Transient Stress Versus Posttraumatic Stress Disorder: Evaluating Risk Following Targeted Mass Violence

Schools have become a common incident site for targeted mass violence, including mass shootings. Although exposure to mass violence can result in significant distress, most individuals are able to fully recover over time, while a minority develop more pervasive pathology, such as PTSD. The present study investigated how several pre- and posttrauma factors predict posttraumatic stress symptoms (PTSS) in both the acute and distal aftermath of a campus mass shooting using a sample with known levels of pretrauma functioning (N = 573). Although the largest proportion of participants evidenced resilience following exposure to the event (46.1%), many reported high rates of PTSS shortly after the shooting (42.1%) and a smaller proportion (11.9%) met criteria for probable PTSD both in the acute and more distal aftermath of the event. While several preshooting factors predicted heightened PTSS after the shooting, prior trauma exposure was the only preshooting variable shown to significantly differentiate between those who experienced transient versus prolonged distress. Among postshooting predictors, individuals reporting greater emotion dysregulation and peritraumatic dissociative experiences were over four times more likely to have elevated PTSS 8 months postshooting compared with those reporting less dysregulation and dissociative experiences. Individuals with less exposure to the shooting, fewer prior traumatic experiences, and greater satisfaction with social support were more likely to recover from acute distress. Overall, results suggest that, while pretrauma factors may differentiate between those who are resilient in the aftermath of a mass shooting and those who experience heightened distress, several event-level and posttrauma coping factors help distinguish between those who eventually recover and those whose PTSD symptoms persist over time.     

Substance Use and Health and Safety among Homeless Youth

This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.     

Parental Experiences of Having a Child with Obsessive-Compulsive Disorder: Associations with Clinical Characteristics and Caregiver Adjustment

We examined parental experience of having a child with obsessive-compulsive disorder (OCD) in 62 parent–child dyads. Youth with a primary diagnosis of OCD and their parent(s) were administered the CY-BOCS jointly by a trained clinician. Parents completed several measures about their child’s OCD-related impairment and accommodation, emotional and behavioral functioning, parental distress, caregiver stress, and parental experiences of having a child with OCD. Results indicated that parents of children with OCD are considerably distressed about their child’s condition. As expected, negative parental experiences (e.g., anxiety about child’s condition, uncertainty about their future) were directly related to OCD symptom severity and impairment, as well as child internalizing and externalizing problems, family accommodation of symptoms, and caregiver strain. The presence of emotional resources was negatively related to most outcomes, although some of these relationships did not achieve statistical significance. The presence of internalizing symptoms mediated the relationship between parental experiences and parental distress. Given these findings, addressing parental experiences as part of a family based cognitive-behavioral treatment program for pediatric OCD may help reduce parental distress and improve patient prognosis.     

Parent Anxiety and Infant Pain During Pediatric Immunizations

Infants’ procedural pain and parents’ treatment room anxiety has been largely ignored in the research and clinical domains. To understand and manage infant procedural pain, it is essential to examine the correlates and potential predictors of this pain. Given that parent anxiety is a strong predictor of preschoolers’ procedural anxiety and pain, it is likely that parents play a role in infants’ distress during medical procedures. The purpose of this study was to thoroughly examine parent anxiety and its effects on infant procedural pain for 37 parent-infant dyads. Results demonstrated that only parent self-report measures were intercorrelated and several measures of parent distress correlated with measures of infant distress. Treatment implications and recommendations for future research are discussed.This article is based on the master's thesis of the first author under the direction of the second, at West Virginia University.     

Symptoms of Psychological Distress Among Mothers and their Adult Offspring: A Longitudinal Examination

We examined the association between maternal psychological distress during offspring’s early development and offspring’s later distress in adulthood, as well as the influence of maternal characteristics at offspring’s birth and offspring’s characteristics in adulthood on distress. Data were obtained from the British Cohort Study, a longitudinal study of children born in a one-week period in 1970. Children were followed up multiple times from birth through to age 30. Results indicate that greater symptoms of maternal psychological distress during offspring’s early childhood are associated with greater symptoms of distress in adult offspring. A large component of this association is indirect, occurring through mother’s distress in later childhood and offspring’s problem behavior during adolescence. Findings that the association between maternal and offspring’s distress is more indirect than direct support arguments that early maternal distress has long-term consequences for offspring.     

Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

Depression in patients with spinal cord injuries: A synthesis of cognitive and somatic processes

Depression in some patients with spinal cord injuries may be clinically significant and, when present, should be treated to decrease morbidity including decreased physical functioning. Depression associated with spinal cord injury (SCI) may be misevaluated, due to (1) nonspecific multifactorial production of depression symptoms and (2) SCI-specific decrease in somatic sensory central nervous system input. The Somatic Suppression Hypothesis suggests that SCI patients have difficulty experiencing any intense emotion because of suppression of physiological arousal. In addition, cognitive processes that may reduce depression in SCI patients include: (1) attribution of somatic symptoms of depression to medical (biological) causes, (2) realistic, positive expectations for physical improvement, and (3) the perception that the disability of the SCI is only minimally related to the patient’s self-care after complete evaluation. Health personnel should accept lack of depression in SCI, and should encourage positive realistic expectations of recovery.     

The Influence of Psychological Contract Breach on Temporary Workers’ Commitment and Behaviors: A Multiple Agency Perspective

Purpose  

The purpose of this study was to examine the influence of psychological contract breach on the commitment and behaviors of temporary workers engaged in a multiple agency relationship. Specifically, it aimed to measure the influence of contract breach by the employing agency and the client organization on temporary workers’ trust and affective commitment to the respective party, and on their adoption of discretionary behaviors at the client site.     

Patterns of adolescent involvement in problem behaviors: Relationship to self-efficacy,social competence,and life events

Using a sample of 556 adolescents from a suburban community, patterns of various adolescent problem behaviors (e.g., delinquent behavior, smoking, use of alcohol or drugs) and their links to self-efficacy, social competence, and life events were examined. Cluster analysis was conducted to identify four subgroups of adolescents who showed distinct patterns of problem behaviors. These clusters were compared on the measures of self-efficacy, social competence, and life events. Overall results suggest there are meaningful links between adolescents’ problem behavior patterns and self-efficacy, the amount and quality of participation in various after school activities, and life events. For example, a subgroup of adolescents who showed uniformly low prevalence of all problem behaviors reported more positive academic self-efficacy, more active participation in sports and nonsports activities, more positive life events, and fewer negative events than adolescents who were involved in multiple problem behaviors. Implications for prevention and future research on adolescent problem behaviors are discussed.     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Peer Influence and Nonsuicidal Self Injury: Longitudinal Results in Community and Clinically-Referred Adolescent Samples

Research suggests that adolescents’ engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents’ NSSI was examined at baseline and one year later. Adolescents’ nominated best friend reported their own levels of NSSI. In Study 2, adolescents’ NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents’ perceptions of their friends’ engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends’ self-injurious behavior on adolescents’ own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents’ NSSI was associated with increasing perceptions of their friends’ engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence.     

Parents, children, and trauma: Parent role perceptions and behaviors related to the 9/11 tragedy

The trauma associated with 9/11 affected and continues to influence children, families, and other groups of people. While research is cataloging the various coping difficulties experienced, few studies specifically address issues related to parenting perceptions and related activities or behaviors. We examined individuals employed in close proximity to Ground Zero and considered these individuals’ perspectives regarding their parenting perceptions and behaviors. In addition to capturing parenting subsequent to 9/11, the researchers also asked participants about their parenting beliefs and behaviors prior to and immediately after 9/11. Additional variables, such as directly viewing 9/11 and participating in the evacuation, parent age and gender, child age and gender, and ethnicity, were considered in light of parenting beliefs and practices. The retrospective questions, while not ideal methodologically, reveal that some parent characteristics and behaviors changed immediately following 9/11 and subsequently returned to pre-9/11 levels, others changed and remain altered, while others stayed relatively stable over time. Implications of this research for further study as well as mental health practice related to children and families are presented.     

Maternal Depression,Locus of Control,and Emotion Regulatory Strategy as Predictors of Preschoolers’ Internalizing Problems

Childhood internalizing problems may occur as early as preschool, tend to be stable over time, and undermine social and academic functioning. Parent emotion regulatory behaviors may contribute to child internalizing problems and may be especially important during the preschool years when parents model emotion coping and regulation for their children. Parents who feel out of control of their preschoolers’ behavior and emotional states may adopt avoidant emotion regulatory strategies. We proposed that parent depression, perceived locus of control, and experiential avoidance would be linked with internalizing symptoms in a high-risk sample of preschool-aged children. We also expected that locus of control would mediate the relationship between maternal depression, experiential avoidance, and child internalizing problems. Seventy-four urban, low-income, diverse mothers of Head Start preschool children completed rating scales measuring their own depression, locus of control, experiential avoidance, and their children’s internalizing behaviors. Correlational analyses revealed that mothers reporting higher levels of depression were more likely to report experiential avoidance, feeling out of control in their parenting role, and internalizing symptoms in their children. Hierarchical multiple regressions showed that locus of control explained additional unique variance in child internalizing problems over and above that explained by maternal depression. Locus of control mediated the relationship between maternal depression and child internalizing symptoms. The importance of considering parent locus of control and its relation to children’s internalizing symptoms is discussed as a potential target for early childhood prevention programs.     

Residents’ reactions to environmental stressors in Kathmandu: A Comparison of the inner city versus the outskirts

Residents of eight different locations in Kathmandu, four in the inner city and four on the outskirts, were interviewed about environmental stressors, mental distress, and physical symptoms. There were significant gender and location differences on all three measures. Compared to men, women reported more mental distress and more physical symptoms, but fewer environmental stressors. Compared to residents of the inner city, residents of the outskirts reported more mental distress, more physical symptoms, and fewer environmental stressors. Environmental stressors were linked to mental distress among residents in the outskirts but were not linked to mental distress among residents in the inner city. Results suggested that residents’ belief in perceived control of their lives by God partially explained this effect.     

Relationships with Parents, Spousal Reciprocity, and Psychological Distress in Middle-Age Adults

Data from 301 middle-age couples were employed to investigate links between their recalled parents’ parenting styles and perceptions of reciprocity with their parents, as well as their current perceptions of spousal reciprocity, on their psychological distress. The research extends Baumrind’s theory of childhood parenting styles and Youniss’ theory of late adolescents’ perceived reciprocity to a developmental model for middle-age psychological distress. Differential effects were found according to the gender of both the offspring and the parent. There were significant positive findings only if the opposite-sex parent was perceived as authoritative, and significant negative findings if the same-sex parent was perceived as authoritarian. Regression models indicated mediated, integrated relationships (through maternal and spousal reciprocity) for females, but no mediations were found for males. Significantly more variance in emotional distress was explained by spousal reciprocity than by the parent related variables, and for the men than for the women.     

Mothers' affect dysregulation,depressive symptoms,and emotional availability during mother–infant interaction

Maternal affect dysregulation and maternal depressive symptoms were examined as predictors of maternal emotional availability (EA) during mother–infant interaction in a nonclinical sample. In particular, we investigated if affect dysregulation predicts EA and is more important than are depressive symptoms in predicting EA. Questionnaire measures and 30 min of free play were obtained from 46 mothers of 4‐ to 5‐month‐old infants. Mothers' self‐reported affect dysregulation was inversely related to EA, but mothers' depressive symptoms were not related to EA. More specifically, mothers' tendency to use unhealthy externalizing behaviors to reduce tension and distress predicted less EA. These results suggested that even in relatively low‐risk samples, mothers' self‐reported affect dysregulation, particularly the tendency to act out inappropriately in response to tension and distress, may be a more proximal predictor of EA than are depressive symptoms.     

The Mediating Effects of Psychological Contracts on the Relationship Between Human Resource Systems and Role Behaviors: A Multilevel Analysis

Purpose  The purpose of this study was to examine the mediating effect of the psychological contracts on the relationship between human resource (HR) systems and role behavior. Design/Methodology/Approach  Multilevel analyses were conducted on data gathered from 146 knowledge workers and 28 immediate managers in 25 Taiwanese high-tech firms. Findings  Relational psychological contracts mediated the relationship between commitment-based HR systems and in-role behaviors, as well as organizational citizenship behaviors. Transactional psychological contracts did not significantly mediate these relationships. In addition, the results also indicated that commitment-based HR systems related positively to relational psychological contracts and negatively to transactional psychological contracts. Practical Implications  Commitment-based HR systems could elicit a wide range of knowledge workers’ behaviors that are beneficial to the goals of the firms. Furthermore, our findings also provide insight into, how HR systems potentially elicit employees’ role behaviors. Organizations could elicit employees’ in-role behaviors by providing financial and other non-financial, but tangible, inducements and facilitate employees’ extra-role behaviors by providing positive experiences, such as respect, commitment, and support. Originality/Value  The study is one of the primary studies to empirically examine the mediating effect of psychological contracts on HR systems and employee behaviors.

Maternal Symptoms of Attention-Deficit/Hyperactivity Disorder and Maternal Language: Implications for Infant Language Development

The relationship between maternal ADHD symptoms and maternal language was examined in a community sample of 50 mothers of infants age 3–12 months. It was hypothesized that higher maternal symptoms of ADHD would be related to lower quality of maternal language use. Recordings of mothers’ speech were coded for complexity and elaboration of speech and vocabulary diversity during an interview with an adult and during mother–infant play interactions in the home. Hierarchical regression analysis revealed that maternal ADHD symptoms were significantly related to mothers’ lower mean length of utterances during the interview and during mother–infant play interactions. Maternal ADHD symptoms were not related to maternal vocabulary use in either of these situations. Our findings suggest that mothers with higher ADHD symptoms may display exiguous language behaviors when interacting with their infants and with adults. In addition, findings suggest one reason why current parent-management programs for children with ADHD, which are verbally based and rely heavily on the parent’s communication skills, are relatively ineffective when ADHD may be present in the parent.