Life Circumstances and Personal Resources as Predictors of the Ten-Year Course of Depression

A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared with the controls and the remitted patients, the partially remitted and nonremitted patients consistently experienced more life stressors and fewer social resources, were less easygoing, and relied more on avoidance coping. A less easygoing disposition, fewer close relationships, and more reliance on avoidance coping were associated with higher odds of experiencing a course of partial remission or nonremission. In addition, more depressive symptoms and medical conditions predicted nonremission.     

Life stressors, personal and social resources, and depression: a 4-year structural model

By extending earlier stress-resistance research with a 1-year time lag, findings with 254 adults show that adaptive personality characteristics and positive family support operate prospectively over 4 years in predicting reduced depression, even when prior depression is controlled. By strengthening knowledge about the determinants and mediational role of coping, the results demonstrate in a 2-group LISREL analysis that the pattern of predictive relations differs under high and low stressors. Under high stressors, personal and social resources relate to future psychological health indirectly, through more adaptive coping strategies. Under low stressors, these resources relate directly to psychological health. The results support the idea that such resources play a causal role in maintaining psychological health, and they suggest the potential for a general, adaptively oriented framework applicable to adjustment under both high and low stressors.     

Psychiatric history and stress: predictors of severity of unipolar depression.

Unipolar depression is frequently a recurrent or chronic disorder. In studies on predicting its course, outcomes are typically linked to either psychiatric features or stressful life events. In order to integrate the 2 approaches, 51 unipolar patients were assessed periodically over at least 1 year for symptoms, stressful events, and chronic stressors. It was hypothesized that adverse family history and early age of onset impair role functioning and coping capabilities, thereby contributing to stressful circumstances that predict severity of depressive reactions. Results of causal modeling analyses supported a model in which background factors were associated with severity of depressive outcomes as mediated by their effects on stress variables. Such a model implicates the self-perpetuating nature of clinical depression, both for the individual and across generations.     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families.     

STRESS AMONG PALESTINIAN WOMEN UNDER MILITARY OCCUPATION; WOMEN'S APPRAISAL OF STRESSORS,THEIR COPING MODES,AND THEIR MENTAL HEALTH

Psychological responses and mental health of 174 Palestinian women living in the occupied West-Bank and the Gaza Strip were studied through a stress model. Thirty-five Palestinian women living in Israel proper who had not been exposed to military occupation were interviewed as a comparison group. The stress process studied consists of women's appraisal of threat and the importance of the stressors in their lives, the estimation of their own resources to cope with stress, actual coping modes, and mental health outcomes. Women living under military occupation tended to appraise their environment as highly threatening and their experiences as strain-producing. At the same time they believed they had sufficient assets, especially collective and ideological resources, to deal with the stressors. This tendency was particularly evident among victims of political violence. Women strongly exposed to hardships of military occupation tended to employ more social and political activity and less inactive and accommodative coping modes than did less traumatized women. Exposure to stressful events, characteristic to military occupation and armed conflict, tended to deteriorate women's mental health, as indicated by severe anxiety, depression, hostile feelings and psychiatric symptoms, and also deteriorating their general health. Multiple regression analysis of the data pertaining to the stress process indicated not only the existence of objective stressors but also the appraisal of their harmfulness, the coping modes as well as vulnerability-protective factors which determine the outcomes of the stress process. A good economic situation, sufficient social support, and religious commitment functioned as protective factors in stress process, i.e., they were able to diminish the impact of exposure to stressors on women's mental health. In the case of the Palestinian women the hardships due to military occupation and national struggle initiated a different stress process than did the daily life difficulties. This indicates that in studies on psychological functioning in a political and armed conflict, the collective level of coping, values, norms, ideology as well as the concrete political aims of the society should be included in analysis and interpretation.     

家庭压力源影响青少年抑郁体验:冗思的中介机制

采用方便抽样法从山东某初中和某高中抽取570名学生做问卷调查,考察家庭压力源对青少年抑郁体验的影响,特别是冗思作为应对方式的中介作用。路径分析的结果显示:(1)家庭冲突和父母期望均显著正向预测抑郁体验,且家庭冲突的预测作用更强,家庭规范对抑郁体验的预测作用不显著;(2)家庭冲突和父母期望均显著正向预测青少年冗思,家庭规范对冗思的预测作用不显著;(3)冗思显著正向预测抑郁体验;(4)冗思在家庭冲突与抑郁体验之间以及父母期望与抑郁体验之间均起中介作用。总体来看,冗思是家庭压力影响青少年抑郁体验的内部机制之一。     

Life stressors, resistance factors, and improved psychological functioning: an extension of the stress resistance paradigm

This study applied a set of factors previously identified as being linked with stress resistance to the prediction of both stable and improved psychological functioning over a 1-year interval with more than 400 community-resident adults. Stable psychological functioning under high stressors is predicted at the beginning of the year by personal and social resources that are linked to functioning through their influence on increased approach coping during the year. In contrast, improved psychological functioning under low stressors is predicted directly by initial resources. As predicted by crisis theory, improved functioning under high stressors is related to an increase in resources during the year. The findings are discussed in the context of an extension of the stress-resistance paradigm beyond illness prevention toward a general, adaptively oriented health framework.     

Approach and avoidance coping responses among older problem and nonproblem drinkers

The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence.     

Depressed mood: The role of negative thoughts,self-consciousness,and sex role stereotypes

Research typically finds that depression is twice as common among women as among men. This may relate to differences in socialization that result in different emotions, cognitions, and coping reactions. Sex-role stereotypes, employment and marital status, and differential social pressures may also be significant in making women more vulnerable to the development of depression. Women may have less decision-making power, face more adverse life events, and have limited access to resources, which may lead to feelings of helplessness and low self-esteem. Low self-esteem and negative cognitions about the self in turn may be proximal factors predictive of negative mood. Additionally, women may be more prone to ruminative self-focus rather than active coping, a significant risk factor for depression. This study examined individual predictors of depressed mood for each sex, including coping, self-esteem, negative thoughts, self-consciousness (rumination), as well as social factors such as the endorsement of sex-role stereotypes and decision-making power in the family. Results indicated that social factors were not related to depressed mood in either sex, but were related to coping styles and self-esteem. Depressed mood was associated with individual characteristics, such as avoidant coping styles, social anxiety for women, and ruminative self-focus for men. Regression analysis showed that coping through denial and negative thoughts explained depressed mood, and the latter was particularly true for men. These results point to the significance of examining both individual and social factors when attempting to understand depression in men and women.     

Life stressors, social resources, and late-life problem drinking

Life stressors and social resources among late-middle-aged problem and nonproblem drinkers were studied. Problem drinkers (n = 501) reported more negative life events, chronic stressors, and social resource deficits than did nonproblem drinkers (n = 609). In a comparison of problem drinkers, men reported more ongoing stressors involving finances and friends, and fewer resources from children, extended-family members, and friends than did women. Women who are problem drinkers reported more negative life events, more ongoing difficulties with spouses and extended-family members, and fewer resources from spouses. Among both the problem and nonproblem drinkers, more stressors were associated with fewer social resources, but only within certain life domains. Late-middle-aged adults' chronic stressors and social resources helped explain their drinking behavior, depression, and self-confidence even after sex, marital status, and negative life events were considered.     

Coping, stress, and social resources among adults with unipolar depression

We used a stress and coping paradigm to guide the development of indices of coping responses and to explore the roles of stress, social resources, and coping among 424 men and women entering treatment for depression. We also used an expanded concept of multiple domains of life stress to develop several indices of ongoing life strains. Although most prior studies have focused on acute life events, we found that chronic strains were somewhat more strongly and consistently related to the severity of dysfunction. The coping indices generally showed acceptable conceptual and psychometric characteristics and only moderate relationships to respondents' sociodemographic characteristics or to the severity of the stressful event for which coping was sampled. Coping responses directed toward problem solving and affective regulation were associated with less severe dysfunction, whereas emotional-discharge responses, more frequently used by women, were linked to greater dysfunction. Stressors, social resources, and coping were additively predictive of patient's functioning, but coping and social resources did not have stress-attenuation or buffering effects.     

Reduction of work-family conflict through the use of selection, optimization, and compensation behaviors

Prior research has examined both the antecedents to and outcomes of work-family conflict. However, little is known about the existence and efficacy of behavioral strategies that may be used by individuals to reduce the amount of stressors experienced both on the job and at home, which result in work-family conflict. The purpose of this study was to examine the role of selection, optimization, and compensation (SOC) behaviors in relation to both job and family stressors and work-in-family (WIF) conflict and family-in-work (FIW) conflict. Results suggest that the use of general SOC behaviors in both the work and family domains are related to lower amounts of job and family stressors and subsequently lower amounts of WIF conflict and FIW conflict. In general, these results held true even when additional variables (e.g., hours worked, gender, job involvement, family involvement, social support, and supervisor support) were controlled. Implications of these results are discussed.     

Predicting adolescent posttraumatic stress in the aftermath of war: Differential effects of coping strategies across trauma reminder,loss reminder,and family conflict domains

Background and Objectives: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Design: Regression analyses evaluated theorized differential relations between three types of post-war stressors – exposure to trauma reminders, loss reminders, and intrafamilial conflict – specific coping strategies, and posttraumatic stress symptom dimensions. Methods: We examined 555 Bosnian adolescents, aged 15–19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Results: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. Conclusions: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.     

Sensation seeking, stress, and adolescent injuries: a test of stress-buffering, risk-taking, and coping skills hypotheses.

The potential stress-buffering effects of sensation seeking were assessed in a prospective study involving high school athletes. A significant positive relation between major negative sport-specific life events and subsequent injury time-loss occurred only for athletes low in sensation seeking. No evidence was obtained for a competing hypothesis that high sensation seeking would constitute an injury vulnerability factor by increasing risk-taking behaviors. Although low sensation seekers reported poorer stress management coping skills, there was no evidence that differences in coping efficacy mediated the injury vulnerability difference. Results indicate that sensation seeking is a stress-resiliency factor and suggest the utility of assessing relations between life stressors and outcomes that occur within the same environmental context.     

Alltag mit der Depression des Partners

Objective. Clinical research on the quality of interpersonal relationships in individuals with unipolar depression supports the idea that the family plays a major role in the development and the course of major depression. In order to further explore how family functioning relates to unipolar depression, the authors examined changes in family functioning as viewed by the patients' spouses. Methods. Interview data from 54 spouses of patients with unipolar depression were analysed as part of the baseline assessment of a study on the economic and health burden experienced by families with mentally ill relatives. Results. Having a family member with a current major depressive disorder is a general stressor for families and has implications for the health and well-being of the patient's spouse. Depressive symptoms affect a wide range of aspects of marriage and family life and result in a process of adaptation and transformation of the patient's family. Thus, in assessing burden experienced by spouses particular attention should be paid both to the social environments and to different aspects of the relationship as perceived by the patient's spouse in order to further understand the factors mediating the interaction between major depression and family functioning.     

The contexts of adolescents' chronic life stressors

Proposed and tested a model of the determinants of adolescents' chronic life stressors, consisting of sociodemographic, personal, and contextual stress and coping factors, using baseline and 1-year follow-up data from 259 adolescents who varied in their psychological and physical health. Concurrent regression analyses at Time 1 and at Time 2, and longitudinal regressions that controlled for the levels of chronic stressors 1 year earlier, showed that sociodemographic, personal, and contextual factors each made a significant contribution to predicting adolescents' ongoing stressors with their mother, father, siblings friends and classmates and teachers at school. Personal factors of an emotional temperament and low perceived self-worth, and contextual factors of more negative life events and fewer social resources, were related to more chronic stressors. Suggestions for further development of the model are discussed. This research was supported by the William T. Grant Foundation, NIAAA Grants AA02863 and AA06699, and Department of Veterans Affairs Medical and Health Services Research and Development Services research funds. We thank Bernice Moos for setting up the data files.     

Associations of Stress Exposures and Social Support With Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans

The long-term mental health effects of war-zone deployment in the Iraq and Afghanistan wars on military personnel are a significant public health concern. Using data collected prospectively at three distinct assessments during 2003–2014 as part of the Neurocognition Deployment Health Study and VA Cooperative Studies Program Study #566, we explored how stress exposures prior, during, and after return from deployment influence the long-term mental health outcomes of posttraumatic stress disorder (PTSD), depression, anxiety disorders, and problem drinking. Longer-term mental health outcomes were assessed in 375 service members and military veterans an average of 7.5 years (standard deviation = 1.0 year) after the initial (i.e., “index”) Iraq deployment following their predeployment assessment. Anxiety disorder was the most commonly observed long-term mental health outcome (36.0%), followed by depression (24.5%), PTSD (24.3%), and problem drinking (21.0%). Multivariable regression models showed that greater postdeployment stressors, as measured by the Post-Deployment Life Events scale, were associated with greater risk of depression, anxiety disorders, and problem drinking. Anxiety disorder was the only outcome affected by predeployment stress concerns. In addition, greater postdeployment social support was associated with lower risk of all outcomes except problem drinking. These findings highlight the importance of assessing postdeployment stress exposures, such as stressful or traumatic life events, given the potential impact of these stressors on long-term mental health outcomes. This study also highlights the importance of postdeployment social support as a modifiable protective factor that can be used to help mitigate risk of long-term adverse mental health outcomes following war-zone exposure.     

Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis

Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.     

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

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

Workplace Deviance as a Possible “Maladaptive Coping” Behavior Displayed in Association with Workplace Stressors

ABSTRACT

The Threat Appraisal and Coping Theory suggests that in response to environmental stressors, individuals sometimes display “maladaptive coping” behaviors that may vent frustration immediately but worsen later psychosocial well-being. For example, employees exposed to workplace stressors may vent their frustration with workplace deviance including intentional poor performance, abuse of organizational resources, disrespect, and disruption of co-workers, but such workplace deviance may worsen their later psychological well-being. The present study examined workplace deviance as a possible “maladaptive coping” behavior displayed by 293 university employees (74.7% female; 90.4% White; mean age = 45.8 years; 43 administrators, 127 staff, 84 faculty). When three workplace stressors (high demand, low control, low support) were compared for their association with workplace deviance, only low support was significant. Furthermore, workplace deviance was significantly associated with negative psychosocial outcomes [poor self-esteem, health concerns, anger, post-traumatic stress disorder (PTSD) symptoms, poor job satisfaction, work-home conflict]. Finally, bootstrapping mediational analysis revealed that workplace deviance was a significant mediator between low support and each of the negative psychosocial outcomes. Results support the idea that workplace deviance is an example of “maladaptive coping” behavior that, when displayed in response to perceptions of low support from supervisors and co-workers, is associated with worse psychosocial outcomes for employees who display it. Stress reduction programs could educate employees that displaying workplace deviance in response to workplace stressors may harm their psychosocial well-being. Such programs could also guide employees to more “adaptive coping” behaviors in response to workplace stressors (such as seeking social support, exercise, and yoga).