Socioeconomic differences in adolescent stress: the role of psychological resources

Avoidance in hypochondriasis

The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears - one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported.

METHODS

195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale - Modified. To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models.

RESULTS

A two-class factor mixture model fit the data best, with Class 1 (n=147) exhibiting a greater level of severity of avoidance than Class 2 (n=48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life.

CONCLUSION

These results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder.

Family Environments and Children's Executive Function: The Mediating Role of Children's Affective State and Stress

There is increasing evidence that inadequate family environments (family material environment and family psychosocial environment) are not only social problems but also factors contributing to adverse neurocognitive outcomes. In the present study, the authors investigated the relationship among family environments, children's naturalistic affective state, self-reported stress, and executive functions in a sample of 157 Chinese families. These findings revealed that in inadequate family material environments, reduced children's cognitive flexibility is associated with increased naturalistic negative affectivity and self-reported stress. In addition, naturalistic negative affectivity mediated the association between family expressiveness and children's cognitive flexibility. The authors used a structural equation model to examine the mediation model hypothesis, and the results confirmed the mediating roles of naturalistic negative affectivity and self-reported stress between family environments and the cognitive flexibility of Chinese children. These findings indicate the importance of reducing stress and negative emotional state for improving cognitive functions in children of low socioeconomic status.

Do hospital shift charge nurses from different cultures experience similar stress? An international cross sectional study

BACKGROUND

There is a need to improve understanding of role stress and how it affects nurses' wellbeing, burnout and health; and hence the quality and safety of patients' care, organizational outcomes and costs. The focus is on shift charge nurses in hospitals who are accountable during a specific shift for the patients' care and staff functioning in accordance with hospital and unit policy.

OBJECTIVE

To compare perceptions of stress and its intensity among hospital shift charge nurses amongst three countries: Israel, USA (state of Ohio) and Thailand.

DESIGN

A cross-sectional study was performed across three countries, focusing on a convenience sample of 2616 hospital shift charge nurses recruited from 23 general hospitals.

METHODS

A validated shift Charge Nurse Stress Questionnaire was used to assess impacts of four factors: patient & family complaints, lack of resources, responsibility burden and professional conflict. Descriptive statistics were used to describe demographic and professional characteristics of the participants. Chi square and the Fisher Exact Test were performed to test for demographic differences amongst the three samples. Parametric and non-parametric tests were used to compare mean stress levels amongst the study samples.

RESULTS

The mean stress level for the total sample was 2.84 (±0.71) on a Likert scale of 1-5, implying moderate stress levels. Significant differences in stress levels were found among countries, with Thai nurses scoring the highest and Israeli nurses the lowest. Similar perceptions of stress intensity were found for all countries, with the factors "responsibility burden" and "lack of resources" considered the most stressful. Israeli and American nurses perceived similar situations as stressful and different from those perceived by Thai nurses. The findings can be partially explained by demographic, professional and cultural differences.

CONCLUSIONS

Similarities along with differences were found in the nature and levels of stress experienced across the studied countries. A prerequisite educational program should be mandatory for nurses prior to their nomination as shift charge nurses. Programs should be tailored to address the stress experienced by shift charge nurses. Ongoing mentorship and workshops are recommended to develop and maintain leadership abilities to cope with role stress. Future research should explore internationally the unique nature and stress of the shift charge nurse's role and replicate this study by using the Charge Nurse Stress Questionnaire in other countries. Further international comparative studies are recommended to evaluate stress perceptions of nurses in other roles and in different practice areas.

Frequency of Perceived Poststress Symptoms in Inpatients, Outpatients and Healthy Controls: The Role of Perceived Exhaustion and Stress

BACKGROUND

Poststress symptoms occur as a consequence of stress, most commonly during leisure periods such as weekends and vacations. However, the prevalence and the pathological mechanisms of poststress symptoms are poorly understood.

METHODS

Here, we compared the frequency of poststress symptoms in healthy controls (n = 984), outpatients (n = 420), and inpatients (n = 101). In outpatients, demographic factors, psychosocial stress, and perceived exhaustion were tested as predictors of poststress symptoms with multivariate regression analysis. Poststress symptoms and perceived exhaustion were assessed using 2 Neuropattern Questionnaires (the NPQ - Patient Questionnaire and the NPQ - Symptom List), and psychosocial stress was evaluated using the Patient Health Questionnaire (PHQ).

RESULTS

Poststress symptoms appeared in 2.9% of healthy controls, 20.0% of outpatients, and 34.7% of inpatients. Predictors were educational level, psychosocial stress, and perceived exhaustion. Poststress symptoms differed primarily between exhausted (75.0%) and nonexhausted patients (25.0%).

CONCLUSION

Poststress symptoms are rather common in clinical populations, and they are primarily associated with the degree of perceived exhaustion. Preliminary evidence suggests that poststress symptoms are possibly related to depletion of norepinephrine stores, which may facilitate a stratified preventive and therapeutic treatment of these subjects.

Inter-relation between autonomic and HPA axis activity in children and adolescents

Stress research in youth typically considers either the autonomic nervous system or HPA axis. However, these systems are highly coordinated and physically interconnected. We examined whether the inter-relation between cardio-autonomic and HPA axis measures was better associated with perceived stress than their singular associations. Children and adolescents (N=201) collected saliva samples to measure cortisol (AUCAG, AUCI, maximum), wore an electrocardiogram monitor for 24h to derive heart rate variability (HRV; LF, HF, LF/HF ratio), and completed the Perceived Stress Scale. The interaction between sympathovagal modulation (LF, LF/HF ratio) and cortisol awakening response (AUCAG, AUCI, maximum) explained significantly greater variance in perceived stress than either stress system alone. Higher sympathovagal modulation combined with higher cortisol awakening response was associated with greater perceived stress. Findings suggest that the inter-relation between cardio-autonomic and HPA axis activity may advance our understanding of how stress impacts health.

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children's body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women's hair cortisol levels were not associated with their BMI or PSS scores. Women's PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children's hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child's zBMI. Children's hair cortisol levels were not associated with their zBMI or with their mother's PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk.

A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools

There is growing awareness that students' experiences of stress may impede academic success, compromise mental health, and promote substance use. We examined these factors in an under-studied population, private/independent high school students, using a multi-method (qualitative and quantitative), iterative data collection and analytic process. We first conducted qualitative interviews with faculty and staff at a number of highly competitive private schools, followed by an anonymous quantitative survey with 128 11th grade students from two of these settings. We then conducted a qualitative exploration of the quantitative results with a subset of students. Next, a set of Expert Panel members participated in qualitative interviews to reflect on and interpret study findings. Overall, we found students experienced high levels of chronic stress, particularly in relation to academic performance and the college admissions process. While students described a range of effective, adaptive coping strategies, they also commonly internalized these serious pressures and turned to alcohol and drugs to cope with chronic stress, although not typically at problematic levels. We discuss study implications for both schools and families derived from the Expert Panel.

What helps or undermines adolescents' anticipated capacity to cope with mental illness stigma following psychiatric hospitalization

BACKGROUND

Better understanding of the individual and environmental factors that promote adolescents' use of more or less adaptive coping strategies with mental illness stigma would inform interventions designed to bolster youth resilience.

AIMS

This cross-sectional study draws on data from research on adolescents' well-being after discharge from a first psychiatric hospitalization to explore the relationships between anticipated coping in reaction to a hypothetical social stigma scenario, and various factors conceptualized as 'coping resource' and 'coping vulnerability' factors. Focusing on coping strategies also identified in the companion article, we hypothesize that primary and secondary control engagement coping would relate to more coping resource and less coping vulnerability factors, and the opposite would be true for disengagement, aggression/confrontation and efforts to disconfirm stereotypes.

METHODS

Data were elicited from interviews with 102 adolescents within 7 days of discharge. Hypothesized coping resource factors included social resources, optimistic illness perceptions, better hospital experiences and higher self-esteem. Vulnerability factors included more previous stigma experiences, desire for concealment of treatment, more contingent self-worth, higher symptom levels and higher anticipated stress. Multivariate ordinary least squares (OLS) regression was used to analyze associations between coping strategy endorsement and correlates.

RESULTS

Although some coping correlates 'behaved' contrary to expectations, for the most part, our hypotheses were confirmed. As expected, youth anticipating reacting to the stigmatizing situation with greater disengagement, aggression/confrontation or efforts to disconfirm stenotypes rated significantly lower on 'coping resources' such as self-esteem and higher on vulnerability factors such as symptom severity. The opposite was true for youth who anticipated exercising more primary and secondary control engagement coping.

CONCLUSIONS

This study begins to identify factors that promote more and less adaptive coping strategies among youth at high risk for social stigma. Some factors that can be modified in the shorter term point to useful directions for clinical interventions.

Perceptions of social mobility: development of a new psychosocial indicator associated with adolescent risk behaviors

Social class gradients have been explored in adults and children, but not extensively during adolescence. The first objective of this study was to examine the association between adolescent risk behaviors and a new indicator of adolescent relative social position, adolescent "perceived social mobility." Second, it investigated potential underlying demographic, socioeconomic, and psychosocial determinants of this indicator. Data were taken from the 2004 urban adolescent module of Oportunidades, a cross-sectional study of Mexican adolescents living in poverty. Perceived social mobility was calculated for each subject by taking the difference between their rankings on two 10-rung ladder scales that measured (1) projected future social status and (2) current subjective social status within Mexican society. Adolescents with higher perceived social mobility were significantly less likely to report alcohol consumption, drinking with repercussions, compensated sex, police detainment, physical fighting, consumption of junk food or soda, or watching ≥4 h of television during the last viewing. They were significantly more likely to report exercising during the past week and using a condom during last sexual intercourse. These associations remained significant with the inclusion of covariates, including parental education and household expenditures. Multiple logistic regression analyses show higher perceived social mobility to be associated with staying in school longer and having higher perceived control. The present study provides evidence for the usefulness of perceived social mobility as an indicator for understanding the social gradient in health during adolescence. This research suggests the possibility of implementing policies and interventions that provide adolescents with real reasons to be hopeful about their trajectories.

Unequally distributed psychological assets: are there social disparities in optimism, life satisfaction, and positive affect?

Socioeconomic status is associated with health disparities, but underlying psychosocial mechanisms have not been fully identified. Dispositional optimism may be a psychosocial process linking socioeconomic status with health. We hypothesized that lower optimism would be associated with greater social disadvantage and poorer social mobility. We also investigated whether life satisfaction and positive affect showed similar patterns. Participants from the Midlife in the United States study self-reported their optimism, satisfaction, positive affect, and socioeconomic status (gender, race/ethnicity, education, occupational class and prestige, income). Social disparities in optimism were evident. Optimistic individuals tended to be white and highly educated, had an educated parent, belonged to higher occupational classes with more prestige, and had higher incomes. Findings were generally similar for satisfaction, but not positive affect. Greater optimism and satisfaction were also associated with educational achievement across generations. Optimism and life satisfaction are consistently linked with socioeconomic advantage and may be one conduit by which social disparities influence health.

Associations between air pollution and perceived stress: the Veterans Administration Normative Aging Study

BACKGROUND

There is mixed evidence suggesting that air pollution may be associated with increased risk of developing psychiatric disorders. We aimed to investigate the association between air pollution and non-specific perceived stress, often a precursor to development of affective psychiatric disorders.

METHODS

This longitudinal analysis consisted of 987 older men participating in at least one visit for the Veterans Administration Normative Aging Study between 1995 and 2007 (n = 2,244 visits). At each visit, participants were administered the 14-item Perceived Stress Scale (PSS), which quantifies stress experienced in the previous week. Scores ranged from 0-56 with higher scores indicating increased stress. Differences in PSS score per interquartile range increase in moving average (1, 2, and 4-weeks) of air pollution exposures were estimated using linear mixed-effects regression after adjustment for age, race, education, physical activity, anti-depressant medication use, seasonality, meteorology, and day of week. We also evaluated effect modification by season (April-September and March-October for warm and cold season, respectively).

RESULTS

Fine particles (PM2.5), black carbon (BC), nitrogen dioxide, and particle number counts (PNC) at moving averages of 1, 2, and 4-weeks were associated with higher perceived stress ratings. The strongest associations were observed for PNC; for example, a 15,997 counts/cm(3) interquartile range increase in 1-week average PNC was associated with a 3.2 point (95%CI: 2.1-4.3) increase in PSS score. Season modified the associations for specific pollutants; higher PSS scores in association with PM2.5, BC, and sulfate were observed mainly in colder months.

CONCLUSIONS

Air pollution was associated with higher levels of perceived stress in this sample of older men, particularly in colder months for specific pollutants.

Social emotional learning in a Guatemalan preschool sample: Does socioeconomic status moderate the effects of a school-based prevention program?

Researchers evaluated the effectiveness of a universal social skills program and compared social emotional knowledge on individual skills interviews with 100 Guatemalan preschool children from resource rich ( N = 47) and resource poor ( N = 53) backgrounds. Participant ages ranged from 3- to 6-years-old. SEL was evaluated prior and subsequent to receiving a school-based social emotional educational program. Results were analysed in terms of effectiveness of SEL by error type. Data show that preschool children from both poor and wealthy families made significant gains in social-emotional knowledge as a result of SEL instruction. In order to better understand where SEL might be improved, analyses of incorrect responses provided by children from each SES group were analysed. Findings demonstrated no significant differences between the two groups in terms of incorrect or socially unacceptable responses although, overall, the groups differed in depth of social emotional knowledge. Implications for ‘closing the gap’ between children’s social emotional development in high and low SES groups are discussed.

Stress reactions and coping strategies among Bedouin Arab adolescents exposed to demolition of houses

The aim of this study was to examine emotional reactions and coping strategies of Bedouin adolescents against the backdrop of house demolitions in the unrecognized Bedouin villages in the Negev, Israel. We compared two groups of adolescents living in unrecognized Bedouin villages, teenagers whose houses had been destroyed (acute + chronic group) and their counterparts whose houses had not been destroyed (chronic group). Data were gathered during October to December 2010 from 465 Bedouin adolescents aged 13-18 years. Adolescents filled out self-report questionnaires, which included demographics, objective and subjective exposure to house demolition, state anxiety, state anger, psychological distress and Adolescent Coping Scale. Results show differences between the two groups in stress reactions as well as in objective exposure to house demolition with the acute + chronic group reporting more stress and more exposure. In addition, different variables explained stress reactions in the different groups. Whereas in the acute + chronic group, objective and subjective exposure were the most significant variables, in the chronic group, the coping strategies explained stress with more variance. Results are discussed in terms of differentiating between types of stress, chronic versus acute + chronic and in relation to the interactionist model of coping with stress.

Development of a school-based program for adolescents at-risk for depression in India: results from a pilot study

A majority of adolescents in India, who are at risk for depression, do not receive treatment or receive it when the psychopathology has become entrenched and chronic. The present pilot study was an endeavor to assess the felt needs of adolescents vis-à-vis the difficulties and stressors experienced by them. For this purpose, 300 students across three schools were screened using standardized measures. Another objective of the study was to develop and test a school-based Coping Skills Program to address adolescents at-risk for depression. Schools were sequentially assigned to intervention or control conditions; students of index (n=13) and control (n=6) groups were assessed at baseline, post-intervention, and 3 months follow-up. At post-intervention for the index group, all outcomes measures except coping skills-including depressive symptoms, negative cognitions, academic stress, and social problem-solving-showed change in the expected direction, this difference assuming significance at follow-up. The program was rated positively by students using anonymous feedback and there was low to nil perceived stigmatization. Results are discussed in the context of need for such intervention programs in India, and future scope of research involving larger samples.

The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study

BACKGROUND

Most adults with common mental disorders report their first symptoms before 24 years of age. Although adolescent anxiety and depression are frequent, little clarity exists about which syndromes persist into adulthood or resolve before then. In this report, we aim to describe the patterns and predictors of persistence into adulthood.

METHODS

We recruited a stratified, random sample of 1943 adolescents from 44 secondary schools across the state of Victoria, Australia. Between August, 1992, and January, 2008, we assessed common mental disorder at five points in adolescence and three in young adulthood, commencing at a mean age of 15.5 years and ending at a mean age of 29.1 years. Adolescent disorders were defined on the Revised Clinical Interview Schedule (CIS-R) at five adolescent measurement points, with a primary cutoff score of 12 or higher representing a level at which a family doctor would be concerned. Secondary analyses addressed more severe disorders at a cutoff of 18 or higher.

FINDINGS

236 of 821 (29%; 95% CI 25-32) male participants and 498 of 929 (54%; 51-57) female participants reported high symptoms on the CIS-R (≥12) at least once during adolescence. Almost 60% (434/734) went on to report a further episode as a young adult. However, for adolescents with one episode of less than 6 months duration, just over half had no further common mental health disorder as a young adult. Longer duration of mental health disorders in adolescence was the strongest predictor of clear-cut young adult disorder (odds ratio [OR] for persistent young adult disorder vs none 3.16, 95% CI 1.86-5.37). Girls (2.12, 1.29-3.48) and adolescents with a background of parental separation or divorce (1.62, 1.03-2.53) also had a greater likelihood of having ongoing disorder into young adulthood than did those without such a background. Rates of adolescent onset disorder dropped sharply by the late 20s (0.57, 0.45-0.73), suggesting a further resolution for many patients whose symptoms had persisted into the early 20s.

INTERPRETATION

Episodes of adolescent mental disorder often precede mental disorders in young adults. However, many such disorders, especially when brief in duration, are limited to the teenage years, with further symptom remission common in the late 20s. The resolution of many adolescent disorders gives reason for optimism that interventions that shorten the duration of episodes could prevent much morbidity later in life.

FUNDING

Australia's National Health and Medical Research Council.

Poverty and Awakening Cortisol in Adolescence: The Importance of Timing in Early Life

The deleterious effects of poverty on mental and physical health are routinely argued to operate, at least in part, via dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis, although empirical examinations connecting poverty with HPA axis functioning are rare. Research on the effects of timing of poverty is a particularly neglected aspect of this relationship. This study uses 15 years of prospective data from the Study of Early Child Care and Youth Development to assess how exposure to poverty during infancy, childhood, and adolescence is related to awakening cortisol (n = 826), a marker of HPA axis functioning. Among female participants, poverty exposure in infancy and adolescence, but not childhood, was negatively associated with awakening cortisol. Poverty exposure was unrelated to cortisol among male participants. The importance of timing and gender differences are discussed along with directions for future research.

Community resilience and sense of coherence as protective factors in explaining stress reactions: comparing cities and rural communities during missiles attacks

Based on the salutogenic theory, the aim of this study was to examine sense of coherence and communal resiliency as related to stress reactions during missile attacks. Data were gathered in August 2011 while missiles were being shot from Gaza to the Negev communities in Israel from approximately 150 participants, aged 15-85. Participants lived in cities and different types of small rural villages. Self reported questionnaires were administered via the internet and included demographic data, coping resource of sense of coherence and community resiliency as coping resources, as well as state anxiety, state anger and psychological distress as stress reaction outcomes. Overall, the participants in our study reported strong personal and communal resources and relatively low levels of stress reactions. Personal and communal resources were linked negatively to the different stress reactions. However, some differences emerged when we compared participants from different types of communities. The most resilient group was composed of people who lived in the rural and communal communities. Differences also emerged on patterns of relationships between the community resource and state anxiety. While among the rural citizens, community resilience was strongly linked to anxiety, no relationships were revealed in the urban citizens group.

Peer victimization and child physical health: the moderating role of pessimism

OBJECTIVE

Involvement in peer victimization has been associated with numerous negative consequences, including poor physical health. The purpose of this study is to improve on previous research evaluating the victimization-health relationship by examining the health (i.e., health-related quality of life [HRQoL], medical service utilization) of both victims and aggressors and examining individual variation in this relationship through the moderating effect of pessimism.

METHOD

The sample included 125 ethnically diverse youth aged 8-11 years recruited from a low-income medical practice. Child-report of involvement in peer victimization and pessimism was assessed along with parent-report of HRQoL. 2-year medical service utilization was extracted from medical records.

RESULTS

Although not all hypotheses were supported, victims and aggressors were found to be at increased risk for certain poor health outcomes, which were exacerbated by high levels of pessimism.

CONCLUSION

Findings expand on research into peer victimization and health and provide important implications for identification, prevention, and intervention strategies with at-risk youth.

The relationship of religious and general coping to psychological adjustment and distress in urban adolescents

The present study explored the relationships among stress, general and religious coping, and mental health in a sample of urban adolescents. The participants included 587 9th- through 12th-grade students attending two Catholic high schools in the New York City area. They completed a set of self-report measures assessing perceived stress, religious coping, general coping, clinical symptomology, positive and negative affect, and life satisfaction. Correlation and regression analyses were used to describe relationships among variables. Perceived stress, negative religious coping, and avoidant coping were significantly associated with indicators of psychological distress. Conversely, positive religious coping and active/engagement coping were significantly associated with indicators of psychological adjustment. Negative religious coping also was found to moderate the relationship between perceived stress and positive affect. Finally, partial correlational analyses revealed significant relationships between religious coping and mental health indicators, even after controlling for the contributions of general coping. Implications of the findings for research and clinical practice with adolescent populations are considered.

Can negative life events and coping style help explain socioeconomic differences in perceived stress among adolescents? A cross-sectional study based on the West Jutland cohort study

Background

Previous research suggests that perceived stress in adolescence is socially patterned, but that this relationship may depend on the measure of socioeconomic status (SES) used. This study examines if social gradients in perceived stress, negative life events, and coping exist amongst Danish adolescents, and, if life events and coping strategies can partly account for an association between SES and perceived stress. These relationships are studied separately for two different measures of SES.

Methods

Questionnaire data were collected from 3054 14–15 year old youths (83% response rate) during baseline measurement in the West Jutland birth cohort study. Parents were identified via the Central Office of Civil Registration in which the respondents are linked to their parents or guardians via their CPR-number, a personal identification number given to everyone in Denmark. The study employs data from two independent sources, adolescent self-report data (stress, life events and coping) and national registers (parental educational level, household income and confounder variables). Ordinary Least Squares regression estimated the effects of parental SES, negative life events and coping on perceived stress. Analyses were stratified by gender.

Results

Girls reported more perceived stress than boys. SES accounted for a small but significant amount of the variance in perceived stress. Lower parental education and lower household income were associated with higher stress levels irrespective of gender, but the social gradient was strongest amongst girls when parents’ education was used to measure SES, and strongest for boys when income was used. Life events and coping were also found to be associated with SES and both mediated part of the SES-perceived stress relationship. In general, the social gradient in perceived stress was accounted for by the study variables to a higher degree among girls than among boys.

Conclusions

Lower parental education and household income are associated with higher levels of perceived stress amongst Danish adolescents. Furthermore, both life events and coping appear to mediate this relation. Gender differences in the ways SES and stress are related may exist.

Factor Structure of the Adolescent Coping Orientation for Problem Experiences in Spanish Adolescents

The present study aimed to identify the best structure of the Adolescent Coping Orientation for Problem Experiences when applied to Spanish adolescents. A confirmatory factor analysis of five previous factor structures was conducted. As the data did not fit previous factor models, two exploratory factor analyses (first- and second-order) were carried out to identify the structure for Spanish adolescents and to analyse its criterion validity in relation to mental health, which was assessed by means of the Youth Self-Report. A first-wave sample of 1,152 secondary education pupils (645 boys, 56%; 507 girls, 44%; M age = 14.4 yr., SD = 1.4) was involved in the confirmatory and exploratory factor analyses. A second-wave sample of = 374 secondary education pupils (188 boys, 50.5%; 186 girls, 49.5%; M age = 15.4 yr., SD = 1.1) was used to assess criterion validity. The results yielded eight first-order factors with Cronbach's α ranging from .63 to .79, and two second-order factors that replicated the Approach and Avoidance focus of coping. The paper discusses both the content of the extracted factors and mental health issues.

Psychological resources as mediators of the association between social class and health: comparative findings from Japan and the USA

BACKGROUND

Recently, researchers have proposed that psychological resources might be key concept in explaining the association between social class and health. However, empirical examinations of the extent to which psychological resources to social class in health are still few.

PURPOSE

This study investigated mediating effects of selected psychological resources (sense of control, self-esteem, optimism, and neuroticism) on the association of social class [education and subjective social status (SSS)] with current health status (self-rated health and the number of chronic conditions).

METHOD

This sample consisted of 1,805 Americans (818 males and 987 females) from the Midlife in the United States (MIDUS) survey, 2004-2006 and 1,027 Japanese (505 males and 522 females) from the Midlife in Japan (MIDJA) survey in Tokyo, Japan, 2008-2010. Information on social class, psychological resources, and health status was obtained using telephone interviews or written questionnaires.

RESULTS

A mediation analysis was conducted separately for males and females in Japan and the USA. Neuroticism significantly mediated the association of education and SSS with self-rated health and chronic conditions among males and females in both countries, with one exception (not for chronic conditions among Japanese females). Sense of control significantly mediated the association of education and SSS with self-rated health among males and females in both countries. As hypothesized, self-esteem significantly mediated almost all of the associations of education and SSS with self-rated health and chronic conditions among men and women in the USA, but very few such associations in Japan. Optimism significantly mediated most associations of social class and health status in both countries, but only among females.

CONCLUSIONS

Overall, the findings underscore important culture- and gender specificity in the ways in which psychosocial resources mediate the links between social class and health.

The prevalence of physical, sexual and mental abuse among adolescents and the association with BMI status

BACKGROUND

Studies among adults show an association between abuse and Body Mass Index (BMI) status. When an aberrant BMI status as a consequence of abuse is already prevalent in adolescence, early detection and treatment of abuse might prevent these adolescents from developing serious weight problems and other long-term social, emotional and physical problems in adulthood. Therefore, this study investigated the prevalence of physical, sexual and mental abuse among adolescents and examined the association of these abuse subtypes with BMI status.

METHODS

In total, data of 51,856 secondary school students aged 13-16 who had completed a questionnaire on health, well-being and lifestyle were used. BMI was classified into four categories, underweight, normal weight, overweight and obesity. Adolescents reported if they had ever been physically, sexually or mentally abused. Crude and adjusted General Estimation Equation (GEE) analyses were performed to investigate the association between abuse subtypes and BMI status. Analyses were adjusted for ethnicity and parental communication, and stratified for gender and educational level.

RESULTS

Eighteen percent of the adolescents reported mental abuse, 7% reported sexual abuse, and 6% reported physical abuse. For underweight, overweight and obese adolescents these percentages were 17%, 25%, and 44%; 7%, 8%, and 16%; and 6%, 8%, 18% respectively. For the entire population, all these subtypes of abuse were associated with being overweight and obese (OR=3.67, 1.79 and 1.50) and all but sexual abuse were associated with underweight (OR=1.21 and 1.12). Stratified analyses showed that physical and sexual abuse were significantly associated with obesity among boys (OR=1.77 and 2.49) and among vocational school students (OR=1.60 and 1.69), and with underweight among girls (OR=1.26 and 0.83).

CONCLUSION

Mental abuse was reported by almost half of the obese adolescents and associated with underweight, overweight and obesity. Longitudinal analyses are recommended to explore the causality of and the mechanisms explaining this association between abuse and overweight.

Optimismus und Pessimismus bei Vorschulkindern

Zusammenfassung. Ziel der vorliegenden Studie ist die Untersuchung der psychometrischen Eigenschaften, faktoriellen Struktur und konvergenten Validität der deutschsprachigen Version des Parent Rated Life Orientation Test of Children (PLOT) zur Messung von Optimismus und Pessimismus bei 4 bis 6-jährigen Vorschulkindern. Eltern von 145 Kindergartenkindern (77 Mädchen; Alter: M = 5.0, SD = 0.6 Jahre) schätzten Optimismus und Pessimismus sowie Emotionsregulation der Kinder ein. Außerdem wurde das Problemverhalten der Kinder (Eltern- und Erzieherinneneinschätzung) erfasst. Konsistent zu Studien mit Schulkindern und Jugendlichen zeigte sich eine zweidimensionale Faktorenstruktur mit einem Optimismus- und einem Pessimismusfaktor. Die Ergebnisse ergaben theoriekonforme Zusammenhänge mit Problemverhalten und Emotionsregulation der Kinder. Insgesamt weisen die gefundenen Reliabilitäts- und Validitätswerte auf eine gute Verwendbarkeit des PLOT bei Vorschulkindern hin. Das neue Messverfahren kann einen Beitrag zum besseren Verständnis von Zukunftserwartungen bei Vorschulkindern leisten und als Screening-Instrument zur Identifikation von Kindern mit einem Entwicklungsrisiko dienen.

Optimism and the socioeconomic status gradient in adolescent adiposity

PURPOSE

To assess whether dispositional optimism is associated with adiposity and to explore whether dispositional optimism mediates the relationship between parent education and adiposity (body mass index [BMI] z-score).

METHODS

Multivariate regression analyses of data were collected from 1,298 non-Hispanic black and white adolescents aged 12-19 years from a single Midwestern public school district.

RESULTS

Less optimistic adolescents had higher BMI z-scores (r = -.09, p < .001). Addition of dispositional optimism to the regression model caused an approximately 10% attenuation of the parent education and BMI z-score relationship. Sobel tests confirmed that this attenuation indicated partial mediation.

CONCLUSION

Lower dispositional optimism is associated with higher adiposity and this association accounts for some of the influence of parent education on adolescent adiposity.

Oxytocin receptor gene (OXTR) is related to psychological resources

Psychological resources--optimism, mastery, and self-esteem--buffer the deleterious effects of stress and are predictors of neurophysiological and psychological health-related outcomes. These resources have been shown to be highly heritable, yet the genetic basis for this heritability remains unknown. Here, we report a link between the oxytocin receptor (OXTR) SNP rs53576 and psychological resources, such that carriers of the "A" allele have lower levels of optimism, mastery, and self-esteem, relative to G/G homozygotes. OXTR was also associated with depressive symptomatology. Mediation analysis indicates that the effects of OXTR on depressive symptoms may be largely mediated by the influence of OXTR on psychological resources.

Coping resources as explanatory factors of stress reactions during missile attacks: comparing Jewish and Arab adolescents in Israel

The aim of this study was to explore coping resources as explanatory factors in reducing emotional distress of adolescents in an acute stress situation. We compared two ethnic groups-Jewish and Arab-Bedouin Israelis-during intensive missile attacks in January 2009. Data were gathered from 138 Israeli-Jews and 84 Israeli-Arab Bedouins, 12-18 years old, who filled out self reported questionnaires among which state anxiety, state anger, and psychological distress (SPD) were measures of emotional distress, and sense of coherence (SOC) and hope index served as measures of coping resources. Findings indicated no differences between the two groups on state anxiety, SPD and hope levels. Arab Bedouins reported higher levels of state anger and lower levels of sense of coherence. The coping resources, however, explained the stress reactions differently among the two groups. While SOC made a major contribution in explaining stress reactions among Jewish adolescents, hope index explained stress reactions only for the Arab group. The findings are discussed against the background of the salutogenic theory and the cultural differences between the two ethnic groups.

Health literacy, self-reported status and health promoting behaviours for adolescents in Taiwan

AIM AND OBJECTIVE

The objective of this study was to analyse the associations between health literacy, health status and health-promoting behaviours among Taiwan adolescents.

BACKGROUND

Limited health literacy is associated with poor health outcomes such as low use of preventive services, poor self-reported health conditions and absence of health-promoting behaviours in adults. However, these factors have not been analysed in adolescents. The associations between health literacy and health outcome in adolescents provide helpful insights in conducting health education programmes for health professionals.

DESIGN

A cross-sectional survey.

METHODS

The survey analysed a purposive sample of 1601 senior/vocational high school students from six counties in Taiwan. Data for health literacy and health-promoting behaviours were collected by the Chinese version (short form) of the Test of Functional Health Literacy in Adolescents (c-sTOFHLAd) and health-promoting behaviour scale with subscales for the following health-promoting behaviours: nutrition, exercise, stress management, interpersonal relations, health responsibility and self-actualisation.

RESULTS

Adolescents with low health literacy were less likely to perceive good health status [adjusted odd ratio, (AOR) = 0·59, 95%CI = 0·41-0·86] and less likely to exhibit health-promoting behaviours (AOR = 0·58, 95%CI = 0·39-0·86) than those with high health literacy were, especially in nutrition (AOR = 0·62, 95%CI = 0·43-0·89) and interpersonal relations (AOR = 0·61, 95%CI = 0·43-0·87) subscales. Adolescents with high and low health literacy did not significantly differ in the following health-promoting behaviours: exercise, stress management, health responsibility and self-actualisation.

CONCLUSION

Health literacy is vital for promoting health in adolescents, especially in the domains of nutrition and interpersonal relations.

RELEVANCE TO CLINICAL PRACTICE

Health professionals should conduct health literacy assessments for adolescents prior to designing health education programmes for those with low health literacy to develop health literacy skills as to perform health promoting behaviours.

College Women's Feminist Identity: A Multidimensional Analysis with Implications for Coping with Sexism

This study examined components of women's feminist identity and possible relations to their reported coping responses to sexism. A sample of 169 undergraduate women (M = 19.4 y, SD = 1.2) from diverse ethnic backgrounds completed surveys assessing their experiences and gender-related views. The first set of analyses revealed that women's social gender identity, exposure to feminism, and gender-egalitarian attitudes independently contributed to feminist identification; moreover, non-stereotyping of feminists further predicted feminist self-identification. A second set of analyses tested the relative contribution of feminist identity components to women's cognitive appraisals of coping responses to sexual harassment. Seeking social support was predicted by self-identification as a feminist (for White European American women only). Confronting was predicted by social gender identity, non-stereotyping of feminists, and public identification as a feminist. Findings highlight possible components of women's feminist identity and their possible impact on coping responses to sexism.

Dispositional Versus Situational Coping: Are the Coping Strategies African Americans Use Different for General Versus Racism-Related Stressors?

When faced with difficulties and problems, people use a variety of cognitive and behavioral strategies to cope, and culture influences the strategies that are chosen. Unfortunately, little is known about how culture influences coping because most research is done with White samples. As coping is a key determinant of a person’s adaptation to stressful life events, it is imperative that researchers develop a nuanced understanding of African American coping that is specific enough to guide prevention and intervention efforts. Thus, the aim of this study was to (a) investigate how African Americans differ from one another in the way they cope and (b) examine whether the strategies they typically use to cope (dispositional coping) differ from those used to cope with racism (situation-specific coping). Results indicate that African Americans cope differently depending on the type of stressor—they use one set of strategies generally but rely on a different set to cope with racism. Results also revealed gender and acculturation differences in how African Americans cope.

Hostility and adiposity mediate disparities in insulin resistance among adolescents and young adults

OBJECTIVE

This study explores whether the relationship between lower socioeconomic status and insulin resistance in adolescents is mediated by both physiological and psychological factors associated with increased cardiometabolic risk.

STUDY DESIGN

School-based longitudinal cohort study of 1222 healthy, non-Hispanic black and white teens. Parent education (PE), youth-specific Cook-Medley hostility scale, waist circumference, height, weight, pubertal status, and fasting plasma insulin (FPI) were measured and FPI reassessed 1 year later. Regression analyses utilizing bootstrapping (n=2000) were used to estimate the direct and indirect effects of PE on FPI and assess the role of hostility and adiposity while adjusting for covariates.

RESULTS

Lower PE predicted higher FPI (B=-1.52, P=.003), as did hostility (B=.19, P=.002) and adiposity (waist circumference B=.44, P<.001, BMI B=.98, P<.001). The effect of PE on FPI was mediated by both hostility and adiposity. When adiposity and hostility were accounted for, the effect of PE on FPI decreased by 32% (B=-1.04, P=.04); the total indirect estimate was -.485 (95% CI, -.652, -.041). Hostility accounted for 36% of the meditational effect.

CONCLUSIONS

Lower PE influences insulin resistance through adiposity and hostility. Thus, interventions to reduce health disparities associated with insulin resistance should consider both physiological and psychological approaches.

Socioeconomic differences in obesity among Mexican adolescents

OBJECTIVE

We investigate socioeconomic disparities in adolescent obesity in Mexico. Three questions are addressed. First, what is the social patterning of obesity among Mexican adolescents? Second, what are the separate and joint associations of maternal and paternal education with adolescent obesity net of household wealth? Third, are there differences in socioeconomic status (SES) gradients among Mexican boys and girls, rural residents and non-rural residents?

METHODS

Using data from the Mexican National Health Survey 2000 we examined the slope and direction of the association between SES and adolescent obesity. We also estimated models for sub-populations to examine differences in the social gradients in obesity by sex and non-rural residence.

RESULTS

We find that household economic status (asset ownership and housing quality) is positively associated with adolescent obesity. High paternal education is related to lower obesity risk, whereas the association between maternal education and obesity is positive, but not always significant.

CONCLUSION

The household wealth components of SES appear to predispose Mexican adolescents to higher obesity risk. The effects of parental education are more complex. These findings have important policy implications in Mexico and the United States.

Socioeconomic Status and Coronary Heart Disease Risk: The Role of Social Cognitive Factors

The aim of this study is to examine existing research on social cognitive factors that may, in part, mediate the relationship between socioeconomic status (SES) and coronary heart disease (CHD). We focus on how social status is 'carried' in the mental systems of individuals, and how these systems differentially affect CHD risk and associated behaviors. To this end, literatures documenting the association of various social cognitive factors (e.g., social comparison, perceived discrimination, and self-efficacy) with cardiovascular disease are reviewed as are literatures regarding the relationship of these factors to SES. Possible mechanisms through which social cognitions may affect health are addressed. In addition, directions for future research are discussed, and a model identifying the possible associations between social cognitive factors, SES, and coronary disease is provided.

Conceptualization and measurement of coping during adolescence: a review of the literature

PURPOSE

The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.

DESIGN

A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.

METHODS

A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables.

FINDINGS

Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination.

CONCLUSIONS

Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being.

CLINICAL RELEVANCE

Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.

The protective functions of relationships, social support and self-esteem in the life satisfaction of children of migrant workers in Shanghai, China

BACKGROUND

At present, China has approximately 20 million migrant school-aged children accompanying their parents in relocating to the cities. However, very little is known about them. Using a resilience framework, the present study attempted to examine the psychosocial factors affecting their life satisfaction in Shanghai, China.

METHODS

A total of 625 migrant children were recruited from 10 schools in Shanghai through a cross-sectional survey design using multi-stage cluster sampling method. The questionnaire included measures of life satisfaction, self-esteem, social support, relationships at school and the parent-child and peer relationships.

RESULTS

Hierarchical regression analysis was performed to explore the relative effects of different relationship domains, self-esteem and social support on the life satisfaction of migrant children. The results suggested that parent-child and peer relationships significantly influenced the life satisfaction of children of migrant workers. Relationships in school did not exert such effect. Both social support and self-esteem had significant effects on the life satisfaction of migrant children.

CONCLUSIONS

Relationship factors, social support and self-esteem are critical factors affecting the life satisfaction of migrant children. The findings and implications were discussed in relation to developmental and migration-related issues and the social contexts of the lives of children of migrant workers in Shanghai, China.

Maternal psychological control and child internalizing symptoms: vulnerability and protective factors across bioregulatory and ecological domains

BACKGROUND

We examined ecological (family socioeconomic status (SES)) and bioregulatory (sleep duration, sleep efficiency) moderators of the link between maternal psychological control and children's vulnerability to internalizing symptoms.

METHOD

A large socioeconomically diverse sample of third graders (N = 141) and their mothers participated. Sleep was examined via actigraphy for one week. Psychological control and internalizing symptoms (depressive symptoms, anxiety symptoms, pre-sleep arousal) were examined through children's reports.

RESULTS

For children with poorer sleep, lower SES, or a combination of the two, maternal psychological control was positively related to depressive symptoms; this association was not evident for children with both better sleep and higher SES. Further, maternal psychological control, sleep efficiency, and SES interacted to predict both anxiety symptoms and pre-sleep arousal. Children were protected from the negative effects of psychological control when they were from higher SES families and had higher sleep efficiency; for all other groups of children, psychological control was associated with anxiety symptoms. A similar but less robust pattern of results was found for pre-sleep arousal.

CONCLUSIONS

Findings highlight the importance of children's bioregulatory processes within the socioeconomic context for an enhanced understanding of children's vulnerability to internalizing problems in the context of maternal psychological control.

Family stressors and child obesity

Child obesity is a public health priority with numerous and complex causes. This study focuses on factors within the family, namely stressful experiences, which may be associated with child obesity. We examine data from the Child Development Supplement of the Panel Study of Income Dynamics for children in two age groups: 5-11 and 12-17 years old. Results from an ordered probit regression model of child weight categorizations (healthy weight, overweight, obese) indicate positive associations between a range of family stressors (lack of cognitive stimulation and emotional support in the household among younger children, and mental and physical health problems and financial strain in the household among older children) and child overweight and obesity. We discuss how public policies that reduce family stressors may, in turn, help reduce child obesity.