Trajectories of resilience, depression, and anxiety following spinal cord injury

Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Depression, anxiety, hostility, and physical health

This study assessed the relationship of depression, anxiety, and hostility to physical health in a multicultural student population (N=106). When controlling for a variety of demographic and health risk factors (viz., age, sex, body mass, smoking, alcohol, salt, caffeine, and exercise), hostility, depression, and anxiety were related to higher reported incidences of physical symptoms and somatic illness. Depression and hostility had the strongest relationships with physical health, although the most striking single relationship was between depression and illness. Results suggest that it may be premature to focus our attention on hostility in research on the personality-illness relationship. They also suggest that the health behavior model of the relationship between personality and disease does not provide an adequate explanation, since negative affect was significantly associated with illness even when controlling for a variety of health risk factors. This work was supported, in part, by an intramural grant from the University of Hawaii, #R511.     

Depression,anxiety, hostility,and physical health

This study assessed the relationship of depression, anxiety, and hostility to physical health in a multicultural student population (N=106). When controlling for a variety of demographic and health risk factors (viz., age, sex, body mass, smoking, alcohol, salt, caffeine, and exercise), hostility, depression, and anxiety were related to higher reported incidences of physical symptoms and somatic illness. Depression and hostility had the strongest relationships with physical health, although the most striking single relationship was between depression and illness. Results suggest that it may be premature to focus our attention on hostility in research on the personality-illness relationship. They also suggest that the health behavior model of the relationship between personality and disease does not provide an adequate explanation, since negative affect was significantly associated with illness even when controlling for a variety of health risk factors. This work was supported, in part, by an intramural grant from the University of Hawaii, #R511.     

The Roles of Social Support and Self-Efficacy in Physical Health’s Impact on Depressive and Anxiety Symptoms in Older Adults

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

Interpretive bias,repressive coping,and trait anxiety

Objectives: According to vigilance–avoidance theory, repressors have an avoidant interpretive bias, i.e., they interpret ambiguous self-relevant situations in a nonthreatening fashion. This study sought to demarcate the range of situations associated with avoidant interpretive bias in repressors. Design: Four groups of participants, representing the four combinations of low- and high-trait anxiety and defensiveness, were identified. Those low in trait anxiety and high in defensiveness were categorized as repressors. Methods: Participants (N = 163) rated their likelihood of making both threatening and nonthreatening interpretations of 32 ambiguous scenarios over four domains: social, intellectual, physical, and health. Half the scenarios were self-relevant and half were other relevant. Brief measures of state anxiety were taken after each likelihood rating. Results: Repressors displayed an avoidant interpretive bias for ambiguous threats in the social and intellectual domains but not the health or physical domains. This was due to repressors' low level of trait anxiety rather than their high defensiveness. Conclusions: Individuals high in trait anxiety are especially sensitive to situations involving social evaluation but not those characterized by danger to their health or physical well-being.     

Effects of writing about emotions versus goals on psychological and physical health among third-year medical students

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the "best possible self" (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.     

Caretaker Psychological Factors Predicting Premature Termination of Children's Counseling

This study examines the psychological factors associated with caretakers' premature termination of counseling for their children. Data were collected on the 85 primary caretakers of 85 children in Texas who applied for counseling at community mental health centers or who received private practitioner care. The general hypothesis of the study was that scores on general hostility, intrapunitive hostility, extrapunitive hostility, paranoid ideation, depression, and anxiety would discriminate caretakers who prematurely terminated their children's counseling from both those caretakers whose children, in the judgment of the counselors, met therapeutic goals and those caretakers whose children did not meet therapeutic goals but who attended at least 10 counseling sessions. The effect size results suggest that counselors should primarily consider caretaker intrapunitive hostility when anticipating potential premature termination of counseling for children.     

Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.

OBJECTIVE: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. DESIGN: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. MAIN OUTCOME MEASURES: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. RESULTS: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. CONCLUSIONS: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.     

Trajectories of emotional well-being in mothers of adolescents and adults with autism

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families.     

To Add Insight to Injury: Childhood Abuse,Abuse Perceptions,and the Emotional and Physical Health of Young Adults

Although childhood abuse is strongly associated with psychological difficulties, survivors may not perceive their experiences as abusive. Depression, anxiety, dissociation, and physical health complaints may decrease perceptions of abuse and may also be exacerbated by individuals' abuse perceptions. The current study examined abuse perceptions, abuse experiences, and current symptoms among 185 university students. Ninety-six participants repeated the study 1–2 years later. At Time 1, self-labeling as “abused” or “maltreated” was not related to psychological or physical health symptoms. At Time 2, self-labeling as “abused” or “maltreated” was positively related to depression, anxiety, and dissociation. Results indicate that abuse perceptions may change over time and may be connected with emotional and physical symptoms.     

Religious orientation and mental health: a study with Turkish university students

The present study examined the relationship between religious orientation and mental health symptoms among Turkish students. A total of 341 undergraduate students between the ages of 18 and 26 completed the Brief Symptom Inventory and Age Universal Intrinsic-Extrinsic Scale. Extrinsic orientation was found to be correlated positively with symptoms of anxiety and depression. There were also significant correlations between hostility scores and both intrinsic and extrinsic religious orientations. Patterns were similar to those reported previously, but correlations were mostly in the .10-.14 range. In multiple-regression models, extrinsic orientation emerged as the only significant predictor for hostility, anxiety, and depression; however, only 2% of the variance was explained.     

Patterns of psychological distress in mothers of preterm infants

Mothers of preterm infants experience significant psychological distress, with elevated levels of inter-correlated depressive, stress, anxiety and post-traumatic stress symptoms. In a sample of racially and ethnically diverse mothers of preterm infants, we identified differing patterns of psychological distress during infant hospitalization and examined the effect of these psychological distress patterns on longitudinal trajectories of each psychological distress measure and on maternal perceptions of the child over the first year of the infant's life. Mothers of preterm infants (N = 232) completed five questionnaires assessing depressive symptoms, anxiety, post-traumatic stress symptoms, stress due to infant appearance, and stress due to parental role alteration during enrollment during the neonatal hospitalization, discharge, and at 2, 6, and 12 months of age adjusted for prematurity. Latent class analysis on the enrollment psychological distress variables allowed us to identify five sub-groups of mothers exhibiting similar patterns of psychological distress, differing primarily in degree and type: low distress, moderate distress, high NICU-related distress, high depressive and anxiety symptoms, and extreme distress. These classes continued to show different longitudinal trajectories for the psychological distress measures through 12 months corrected age. Mothers in the extreme distress class and, to a lesser degree, mothers in the high depressive and anxiety symptom class remained at risk of significant psychological distress one year after discharge and had less positive perceptions of their child (greater worry and higher perceptions of child vulnerability). In conclusion, distinctive sub-groups of mothers during hospitalization had different patterns of psychological distress throughout the 12-month period and may require different interventions in the NICU.     

Faces of Shame: Implications for Self-Esteem,Emotion Regulation,Aggression, and Well-Being

There is an increasing interest in psychological research on shame experiences and their associations with other aspects of psychological functioning and well-being, as well as with possible maladaptive outcomes. In an attempt to confirm and extend previous knowledge on this topic, we investigated the nomological network of shame experiences in a large community sample (N = 380; 66.1% females), adopting a multidimensional conceptualization of shame. Females reported higher levels of shame (in particular, bodily and behavioral shame), guilt, psychological distress, emotional reappraisal, and hostility. Males had higher levels of self-esteem, emotional suppression, and physical aggression. Shame feelings were associated with low self-esteem, hostility, and psychological distress in a consistent way across gender. Associations between characterological shame and emotional suppression, as well as between bodily shame and anger occurred only among females. Moreover, characterological and bodily shame added to the prediction of low self-esteem, hostility, and psychological distress above and beyond the influence of trait shame. Finally, among females, emotional suppression mediated the influence of characterological shame on hostility and psychological distress. These findings extend current knowledge on the nomological net surrounding shame experiences in everyday life, supporting the added value of a multidimensional conceptualization of shame feelings.     

Social anxiety mediates the effect of autism spectrum disorder characteristics on hostility in young adults

Problems with social anxiety are frequently reported in people with autism spectrum disorders (ASD). It is possible that social anxiety, when present, exacerbates the experience of hostility and other forms of aggression in relation to ASD symptoms. This study sought to determine if social anxiety symptoms mediate the relationship between features of ASD and feelings of hostility in young adults. Self-report measures of social anxiety, ASD, and facets of aggression were collected in a non-clinical sample (n = 618) of college students. Social anxiety was found to partially mediate the relationship between ASD features and self-reported hostility. There was also evidence for inconsistent mediation, such that social anxiety dampened the strength of the relationship between ASD symptoms and verbal and physical aggression. Findings highlight the potential influence of associated psychiatric symptoms in people with ASD. In addition, dimensional conceptualization of ASD symptoms, as opposed to a categorical approach solely, may be a useful approach to studying complex personality processes.     

Hostility and health: Mediating effects of belief systems and coping styles

The present study investigates the relationship between hostility, health, belief systems, and ways of coping with anger, anxiety, and sadness in a college student sample. Hostility is of interest in the health psychology literature because it has been associated with coronary heart disease, other illnesses, and general mortality. The results reveal that relative to their low-hostility counterparts, individuals scoring high on the Cook and Medley Hostility Scale report poorer physical health and a belief system characterized by vindictiveness, pessimism, unrealistic expectations of the self and others, and a desire to avoid difficulties. They were also more likely to employ confrontive and escape-avoidance coping styles when dealing with anger and escapeavoidance strategies in coping with anxiety and sadness. Irrational beliefs and escapeavoidance coping with anger were found to play a mediating role in the relationship between hostility and health. Clinical implications of the findings are discussed.     

Hostility and health: Mediating effects of belief systems and coping styles

The present study investigates the relationship between hostility, health, belief systems, and ways of coping with anger, anxiety, and sadness in a college student sample. Hostility is of interest in the health psychology literature because it has been associated with coronary heart disease, other illnesses, and general mortality. The results reveal that relative to their low-hostility counterparts, individuals scoring high on the Cook and Medley Hostility Scale report poorer physical health and a belief system characterized by vindictiveness, pessimism, unrealistic expectations of the self and others, and a desire to avoid difficulties. They were also more likely to employ confrontive and escape-avoidance coping styles when dealing with anger and escapeavoidance strategies in coping with anxiety and sadness. Irrational beliefs and escapeavoidance coping with anger were found to play a mediating role in the relationship between hostility and health. Clinical implications of the findings are discussed.     

Depression, self-esteem, and anger in emerging adulthood: seven-year trajectories

This study used a school-based community sample (N=920) to examine trajectories of depressive symptoms, self-esteem, and expressed anger in the critical years of emerging adulthood (ages 18-25). Using data from 5 waves, the authors discovered that multilevel models indicated that, on average, depressive symptoms and expressed anger declined, whereas self-esteem increased. Between-persons predictors of variability in trajectories included gender (gender gaps in depressive symptoms and self-esteem narrowed), parents' education, and conflict with parents (depressive symptoms and expressed anger improved fastest in participants with highly educated parents and in those with higher conflict). Across time, increases in social support and marriage were associated with increased psychological well-being, whereas longer periods of unemployment were connected with higher depression and lower self-esteem. Emerging adulthood is a time of improving psychological well-being, but individual trajectories depend on specific individual and family characteristics as well as role changes.     

Diet, exercise, and physical discomfort in college students

778 students in a 4-yr. urban commuter college were tested to determine the effects of exercise and diet on self-reported discomfort. High exercisers reported significantly less physical discomfort than moderate or low exercisers. Greater consumption of sweets and fast food were significantly related to reported physical discomfort regardless of levels of exercise. High levels of fruit and vegetable consumption were associated with less discomfort in high exercisers. High dairy consumption was significantly related to fewer symptoms for high exercisers. Men who reported high ingestion of caffeine had significantly more discomfort than those who reported moderate to lower ingestion of caffeine.