Depressive Symptomatology among HIV-Positive Women in the Era of HAART: A Stress and Coping Model

Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.     

Stress,coping, HIV status,psychosocial resources,and depressive mood in African American gay,bisexual, and heterosexual men

The associations between stress, physical health, psychosocial resources, coping, and depressive mood were examined in a community sample of African American gay, bisexual, and heterosexual men (N=139). Data were collected from physical exams and in-person interviews. In our theoretical framework, depressive mood scores were regressed first on stressors, next on psychosocial resources, and finally on coping strategy variables. Results revealed that psychosocial resources mediate the effects of stressors, including health symptoms, hassles, and life events, on depressive mood. There were no significant differences in depressive mood associated with HIV status or sexual orientation. Results are discussed in terms of community interventions needed to provide social support as a buffer between stress and psychological distress in African American men. The research was completed at the Center for AIDS Prevention Studies, University of California at San Francisco and was supported in part by National Institute of Mental Health Grants MH44045 and MH42459. The authors express their appreciation to the participants in this study.     

Social support and postpartum depressive symptomatology: The mediating role of maternal self‐efficacy

Research shows that social support and maternal self‐efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self‐efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192) . It was hypothesized that higher levels of parental support, partner support, and maternal self‐efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self‐efficacy. Results indicated that as expected, higher parental support and maternal self‐efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self‐efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self‐efficacy.     

Coping and physical health during caregiving: the roles of positive and negative affect

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the men's associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers.     

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.     

Resource loss,resource gain,and emotional outcomes among inner city women

The authors examined a dynamic conceptualization of stress by investigating how economic stress, measured in terms of material loss, alters women's personal and social resources and how these changed resources impact anger and depressive mood. Resource change in women's mastery and social support over 9 months was significantly associated with changes in depressive mood and anger among 714 inner city women. Greater loss of mastery and social support was associated with increased depressive mood and anger. Loss of mastery and social support also mediated the impact of material loss on depressive mood and anger. Resource loss and worsening economic circumstances had more negative impact than resource gain and improving economic circumstances had positive impact, suggesting the greater saliency of loss than gain.     

Expérience du stress à l'adolescence

This study concerns stress—protective factors—distress relationships with 297 adolescents. The first goal was to study if these relationships change depending on the sex of the participant. The second goal of the present research was to predict stress experience (frequency, intensity, severity) by depression, self‐esteem, social support and coping. Controlling the age of the participant, the results indicate that female teenagers are more threatened by chronic stress, more depressive, have more available persons in their social network, use social or avoidant coping more often whereas the male adolescents show a better self‐esteem. Concerning the second objective, self‐esteem and avoidant coping can predict stress experience (frequency and severity), while the state of depression is the only factor that can predict the three aspects of stress (frequency, intensity, severity), as opposed to social support, and social or problem‐solving coping.     

Childbearing depressive symptomatology in high–risk pregnancies: The roles of working models and social support

Guided by both attachment and social support theories, the authors conducted a longitudinal investigation exploring the concomitant effects of perceptions of spouse support (anticipated and received spouse support) and internal working models of attachment (positive–self and positive–other), on childbearing depressive symptomatology. Distinct main and interaction effects for attachment dimensions and perceived support variables were hypothesized for high– and low–risk pregnancies. Participants in the final sample were 200 pregnant women who completed the self–report between the 25th and the 29th weeks of pregnancy, and 8 weeks after childbirth. Controlling for initial levels of depressive symptoms and health conditions, results demonstrated the protective role of high levels of received support and of positive–other models on childbirth depressive symptoms. Moreover, received support and models of positive–other were found to interact with health conditions, producing distinct moderation effects: Received support was found to be a significantly stronger protective factor for childbearing depression among women with low–risk pregnancies; positive–other models were found to be a significantly stronger protective factor among women with high–risk pregnancies. The implications of these findings for the understanding of intrapersonal and interpersonal factors in successful coping with a health risk situation are discussed.     

Social Support,Conflict, and Integration Among Women Living With HIV/AIDS1

The relationship between depressive symptoms and perceptions of available social support, social conflict, and subjective social integration were examined as part of a psychosocial study of Puerto Rican, African American, and non‐Hispanic White women living with HIV/AIDS (N= 146) in New York City. Lower levels of subjective social integration and higher levels of social conflict were associated with more depressive symptoms. Perceived availability of social support was not significantly associated with depression in comparison with these other forms of support. No evidence was found for a stress‐buffering or a stress‐amplification effect. Significant ethnic differences in levels of social integration and social conflict also were noted. Results suggest that intervention efforts should go beyond addressing support to further address the conflict and lack, of integration experienced.     

Positive affect and psychosocial processes related to health

Positive affect is associated with longevity and favourable physiological function. We tested the hypothesis that positive affect is related to health‐protective psychosocial characteristics independently of negative affect and socio‐economic status. Both positive and negative affect were measured by aggregating momentary samples collected repeatedly over 1 day, and health‐related psychosocial factors were assessed by questionnaire in a sample of 716 men and women aged 58–72 years. Positive affect was associated with greater social connectedness, emotional and practical support, optimism and adaptive coping responses, and lower depression, independently of age, gender, household income, paid employment, smoking status, and negative affect. Negative affect was independently associated with negative relationships, greater exposure to chronic stress, depressed mood, pessimism, and avoidant coping. Positive affect may be beneficial for health outcomes in part because it is a component of a profile of protective psychosocial characteristics.     

Children's coping with peer rejection: the role of depressive symptoms,social competence,and gender

The present study investigated children's anticipated emotional response and anticipated coping in response to peer rejection, as well as the qualifying effects of gender, depressive symptoms, and perceived social competence. Participants (N = 234), ranging in age between 10 and 13 years, were presented with two written vignettes depicting peer rejection. The most highly endorsed coping strategies were behavioural distraction, problem‐focused behaviour, and positive reappraisal. Results indicate that children higher in depressive symptoms reported a more negative anticipated mood impact. Moreover, children higher in depressive symptoms were less inclined to endorse behavioural and cognitive coping strategies typically associated with mood improvement (e.g., behavioural distraction, positive reappraisal). Independent of depression, children scoring higher on perceived social competence reported more active, problem‐oriented coping behaviour in response to the stressors. Types of coping were largely unaffected by gender, however girls reported higher levels of anticipated sadness than boys in response to the rejection vignettes. Theoretical and clinical implications are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Profiles of Resilience and Psychosocial Outcomes among Young Black Gay and Bisexual Men

Young Black gay/bisexual men (YBGBM) are affected by contextual stressors—namely syndemic conditions and minority stress—that threaten their health and well‐being. Resilience is a process through which YBGBM achieve positive psychosocial outcomes in the face of adverse conditions. Self‐efficacy, hardiness and adaptive coping, and social support may be important resilience factors for YBGBM. This study explores different profiles of these resilience factors in 228 YBGBM in New York City and compares profiles on psychological distress, mental health, and other psychosocial factors. Four profiles of resilience were identified: (a) Low self‐efficacy and hardiness/adaptive coping (23.5%); (b) Low peer and parental support (21.2%); (c) High peer support, low father support (34.5%); and (d) High father and mother support, self‐efficacy, and hardiness/adaptive coping (20.8%). YBGBM in profile 1 scored markedly higher on distress (d = .74) and lower on mental health functioning (d = .93) compared to men in the other profiles. Results suggest that self‐efficacy and hardiness/adaptive coping may play a more important role in protecting YBGBM from risks compared to social support and should be targeted in interventions. The findings show that resilience is a multidimensional construct and support the notion that there are different patterns of resilience among YBGBM.     

UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF‐EFFICACY IN DEPRESSED MOTHERS

Maternal self‐efficacy predicts sensitive and responsive caregiving. Low maternal self‐efficacy is associated with a higher incidence of postpartum depression. Maternal self‐efficacy and postpartum depression can both be buffered by social support. Maternal self‐efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self‐efficacy, with emotional support as a moderator. Participants were 278 first‐time mothers of infants under 14 months. Cross‐sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self‐efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus’ estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self‐efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self‐efficacy. Attachment trauma's implications for maternal self‐efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self‐efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.     

Stress and Health in Spanish Women1

This study examines the relationship between stress and health in a sample of 1,566 women aged between 18 and 65 years. Multiple regression analyses were conducted using the scaled version of the General Health Questionnaire (GHQ‐28) scales as the dependent variables, and 21 personal and social variables as predictors. The women with more severe depression, anxiety, and somatic and social dysfunction symptoms were those who had a more emotional coping style and greater work role dissatisfaction. Moreover, depression, anxiety, and social dysfunction symptoms were predicted by low self‐esteem, while depression, anxiety, and somatic symptoms were predicted by chronic stress. The women with more symptoms of anxiety and depression were those who have experienced more life events and have low perceived social support. Women with Type‐A behavior patterns were found to suffer more anxiety and somatic symptoms. Women who exercise more hours per week had fewer somatic symptoms, and those with a more rational coping style suffered less social dysfunction.     

Perfectionistic Self‐Presentation and Trait Perfectionism in Social Problem‐Solving Ability and Depressive Symptoms

This study examined social problem solving and perfectionistic self‐presentation, and assessed whether social problem solving mediates the association between perfectionism and depression. A sample of 200 community members completed measures of perfectionistic self‐presentation, trait perfectionism, social problem‐solving ability, and depression. Correlational analyses confirmed that perfectionistic self‐presentation and socially prescribed perfectionism are both associated with a negative problem‐solving orientation. Tests of mediating effects revealed that negative problem‐solving ability mediates the associations of socially prescribed perfectionism and perfectionistic self‐presentation with depressive symptoms, particularly among women. The findings support further exploration of mediational models linking perfectionism, problem‐solving ability, and depression and suggest that people who display high perfectionistic self‐presentation are particularly vulnerable to stress and distress and should benefit from problem‐solving training.     

Application of a stress and coping model to antenatal depressive symptomatology

This study examined the utility of a stress/coping model of antenatal depressive symptomatology. The direct and moderating effects of appraisal, coping resources and coping strategies on depression were explored. A total of 242 primiparous women completed questionnaires during the third trimester of pregnancy. Predictors included life events, coping resources (social support, quality of women's earlier relationships with parents), appraisal (threat, self-efficacy) and coping strategies (wishful thinking, positive reappraisal, problem solving, emotional approach). Results of regression analyses indicated that higher depression was related to higher stressful life events, threat appraisal and wishful thinking coping, and lower positive reappraisal coping. The expected stress exacerbation effects of wishful thinking on depression were supported. There was no support for the expected stress buffering effects of coping resources and coping strategies on depression. Findings provide preliminary support for the use of a stress/coping model to guide future research into psychosocial predictors of antenatal depression.     

Social anxiety and related social impairment are linked to self‐efficacy and dysfunctional coping

Thomasson, P. & Psouni, E. (2010). Social anxiety and related social impairment are linked to self‐efficacy and dysfunctional coping. Scandinavian Journal of Psychology, 51, 171–178. This study investigated relationships between severity of social anxiety as well as related experiences of social impairment and self‐efficacy, social control and coping strategies. Social anxiety was regarded as a continuum ranging from mild social discomfort to totally inhibiting anxiety. Participants (N = 113, ages 19–60 years), recruited from a forum for individuals with social phobia and among university students, responded to a self‐administered questionnaire. Besides the expected association between a low sense of social control and more severe social anxiety and related social impairment, we found severity of social anxiety and related impairment to be associated with low self‐efficacy. This relationship was partly mediated by dysfunctional coping strategies. We suggest that low self‐efficacy may increase an individual’s tendency to rely on dysfunctional coping strategies for dealing with anxiety experienced in social situations. In turn, using dysfunctional coping strategies appears to exacerbate the experience of impairment from social anxiety.     

压力对大学生抑郁的影响机制:领悟社会支持与应对方式的中介作用

基于心理应激理论、素质-压力三模式以及社会支持主效果模型考察领悟社会支持、积极应对方式和消极应对方式在压力与抑郁关系中的链式中介效应,使用压力量表、领悟社会支持量表、应对方式量表和抑郁量表对抽取的641名大学生进行调查。研究显示:(1)领悟社会支持中介了压力对大学生抑郁的影响;(2)积极应对方式、消极应对方式中介了领悟社会支持对大学生抑郁的影响。因此,领悟社会支持以及应对方式在压力与大学生抑郁之间起链式中介作用。     

Personal versus interpersonal contributions to depressive symptoms among Hong Kong adolescents

Cross‐cultural theory proposes that an essential distinction between cultures lies in the extent to which individual members see themselves as either independent agents preferentially valuing agency and efficacy, or as embedded within a social context preferentially valuing interpersonal relationships. A nonreferred sample of 605 boys and 503 girls from Hong Kong provided information regarding: (1) perceptions of their personal self‐efficacy or beliefs regarding their own ability to master challenges they face; (2) the degree of harmony in their interpersonal (peer and family) relationships; and (3) depressive symptoms as an assessment of their mood. Cognitive theories of emotions propose that both the individual's assessment of his/her self‐efficacy and of his/her relationships influence mood. Hypotheses, based on cross‐cultural theory, were that in this collective culture, interpersonal evaluations would predict more of the variance in mood than would personal self‐efficacy. Contrary to Western sex‐differences literature, it was predicted that the effect of interpersonal harmony on mood would be equally pronounced for girls and for boys. Structural equation modelling was used to test causal models. Consistent with findings from the West, evaluations of personal self‐efficacy as well as interpersonal relationship harmony were significantly associated with depressed mood. Consistent with cultural theory, interpersonal relationship harmony was more strongly associated with mood than was personal self‐efficacy for the entire sample of adolescents. In contrast to findings of sex differences in the salience of relationships in the West, the prediction of interpersonal relationships to mood was equal for boys and girls in Hong Kong. This preliminary study extends models of cognitive concomitants of mood disruption to a non‐Western culture, and provides a framework to understand relative contnbutors to mood in adolescence. The findings tentatively suggest that treatment for depressive mood in Chinese populations should prioritize enhancement of the perceived quality of interpersonal relationships over increasing a sense of mastery.     

Coping and Positive Affect in Adolescents of Mothers With and Without a History of Depression

The adolescent children of depressed mothers are at increased risk for depression, but little is known about protective factors for these children. Maintenance of positive affect in a stressful context may be an important marker of resilience. Mothers with (n = 34) and without (n = 38) a history of depression and their adolescent children completed questionnaires regarding adolescents’ coping and depressive symptoms and engaged in a 15 min videotaped interaction about family stress. Adolescents’ observed behaviors were coded using the Iowa Family Interaction Rating Scales. No significant differences emerged in observed behavior between adolescents of mothers with and without a history of depression. Higher levels of primary and secondary control coping and lower levels of disengagement coping were related to higher levels of observed positive mood and fewer depressive symptoms in adolescents. Observed positive mood was related to fewer depressive symptoms in adolescents, even after accounting for maternal history of depression and current maternal depressive symptoms. Results suggest the importance of considering positive affect in the context of family stress as a marker of resilience in adolescents at risk for depression. The current study provides evidence for coping as a protective factor, related to higher levels of positive affect and fewer depressive symptoms, in adolescents exposed to maternal depressive symptoms.