You want to measure coping but your protocol's too long: consider the brief COPE

What Increases Smokers' Stress? Degree of Nicotine Dependence and Motivation to Quit Smoking in People After Myocardial Infarction

Background: Myocardial infarction (MI) represents one of the major causes of hospitalization in cardiology departments, while tobacco smoking remains a significant public health challenge in Europe. Therefore, there is a pressing need to study this phenomenon in order to undertake preventive actions and thereby reduce the number of people smoking tobacco and, consequently reducing the rate of morbidity and disease. This study aims to assess the factors that increase stress and examine the strategies for coping with stress, nicotine addiction, and the motivation to quit smoking among patients after myocardial infarction. Methods: We analyzed 100 post-MI patients using a sociodemographic questionnaire, the Schneider Smoking Cessation Motivation Test, the Fagerstrom Test for Nicotine Dependence, and the Mini-COPE questionnaire. Results: A sense of helplessness emerged as the primary stress trigger (p = 0.012), with job loss, workplace issues, illness, family death, and relationship problems (p < 0.001) as key stressors. Post-MI patients showed a high degree of smoking cessation motivation, this was enhanced by limited cigarette access and social support. Patients primarily used self-distraction and behavioral disengagement (p < 0.001) as coping mechanisms. A higher degree of nicotine tolerance (rho = -0.355; p < 0.00) and increased stress frequency (rho = -0.169; p = 0.093) correlated negatively with cessation motivation. Conclusions: Post-MI patients demonstrate significant stress-related helplessness, particularly within the professional, family, and relationship domains. The prevalence of coping mechanisms centred around avoidance suggests the need for targeted psychological interventions in this population.

Development and validation of a Coping Scale for pregnant women in Pakistan

This study developed and validated the Pregnancy Coping Scale (PCS) for women in Pakistan. Fifty-two items were generated from a literature review and interviews with 20 pregnant women. Six psychologists evaluated the content validity. Construct validity was evaluated with 230 pregnant women aged 18-40 recruited from government and private hospitals in Lahore, Pakistan. Principal component analysis produced 35 items across seven factors, with Cronbach's alphas ranging from 0.52 to 0.72. Convergent and discriminant validity were evaluated in a subsample of 140 participants who completed the Revised Prenatal Coping Inventory (Nu-PCI). A correlational analysis indicated convergence with four Nu-PCI subscales; the remaining subscales supported discriminant validity. The PCS demonstrated acceptable reliability and validity for assessing pregnancy coping in a collectivistic culture.

Validation of a machine learning model for indirect screening of suicidal ideation in the general population

Suicide is among the leading causes of death worldwide and a concerning public health problem, accounting for over 700,000 registered deaths worldwide. However, suicide deaths are preventable with timely and evidence-based interventions, which are often low-cost. Suicidal tendencies range from passive thoughts to ideation and actions, with ideation strongly predicting suicide. However, current screening methods yield limited accuracy, impeding effective prevention. The primary goal of this study was to validate a machine-learning-based model for screening suicidality using indirect questions, developed on data collected during the early COVID-19 pandemic and to differentiate suicide risk among subgroups like age and gender. The detection of suicidal ideation (SI) was based on habits, demographic features, strategies for coping with stress, and satisfaction with three important aspects of life. The model performed on par with the earlier study, surprisingly generalizing well even with different characteristics of the underlying population, not showing any significant effect of the machine learning drift. The sample of 1199 respondents reported an 18.6% prevalence of SI in the past month. The presented model for indirect suicidality screening has proven its validity in different circumstances and timeframes, emphasizing its potential as a tool for suicide prevention and intervention in the general population.

Intolerance of uncertainty and mental health in patients with IBD: the mediating role of maladaptive coping

The aim of this study was to investigate the relationship between intolerance of uncertainty (IU) and mental health in patients with Inflammatory Bowel Disease (IBD), and to explore the mediating role of coping styles. A questionnaire was administered to adult patients with IBD, which included general demographic information, the Intolerance of Uncertainty Scale, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9. The study ultimately included validated questionnaires from 163 IBD patients. Intolerance of uncertainty was significantly and positively correlated with anxiety (r = 0.738, p < 0.01) and depression (r = 0.683, p < 0.01). The mediating effect of adaptive coping style was not significant. The maladaptive coping style partially mediated the relationship between IU and anxiety, as well as between IU and depression, with the mediating effect size of 25.5% and 34.2%, respectively. Our findings emphasize the impact of the inability to tolerate uncertainty on the mental health of patients with IBD. It suggests that interventions can be implemented to enhance IBD patients' tolerance of uncertainty and to modify their maladaptive coping styles to promote mental health. This offers a valuable framework for psychological interventions for IBD patients.

The role of social role strain, psychological resources and perceiving diabetes as a priority with self-care in women with type 2 diabetes mellitus

BACKGROUND

The burden of Type 2 Diabetes Mellitus (T2DM) has increased globally and a significant number of Malaysian women are being affected by this disease. Self-care plays a vital role in improving glycemic control and preventing complications. However, women with diabetes face barriers to practising good self-care. This study aimed to determine factors associated with self-care in women with T2DM: social role strain, psychological resources (problem-focused coping and social support) and perception of diabetes as a priority.

METHODS

A cross-sectional study was conducted among women with T2DM between January and April 2023 in a public primary care clinic in Seremban, Malaysia. The study instrument consists of the Summary of Diabetes Self-care Activities (SDSCA), scale for Measuring Role Strain in Women with Diabetes, problem-focused coping from brief COPE, Multidimensional Scale of Perceived Social Support (MSPSS) and an item to assess the perception of diabetes as a priority.

RESULTS

A total of 346 women participated in the study (mean age = 60.67, SD = 10.12). Most were elderly (60.4%), Indian (48.3%), had low education (80.6%) and from lower income (70.8%). The mean score for self-care was 2.81 (SD 0.80) days, indicating a suboptimal level. Multiple linear regression analysis revealed that higher income (β = 0.82, [95% CI 0.04, 1.59], p = 0.039), problem-focused coping (β = 0.47,[95% CI 0.03, 0.06],p < 0.001), and perceiving diabetes as a priority (β = 0.04, [95% CI 0.004, 0.09], p = 0.031) were positively associated with self-care. Meanwhile, older age (β= -0.02, [95% CI -0.03, -0.01], p < 0.001), low education (β = -0.25, [95% CI -0.03, -0.01], p = 0.007) and social role strain (β = -0.02, [95% CI -0.03, -0.01], p = 0.003) were negatively associated.

CONCLUSIONS

Our findings highlighted that women with a higher social role strain, older age and low education have poor self-care. In contrast, those with higher income, utilising problem-focused coping and prioritising diabetes, exhibit better self-care. Interventions for women with T2DM should focus on assisting them to alleviate their social role strain and develop their coping skills. Additionally, involving family in the intervention would help women prioritise self-care.

Affected Other Prevalence and Profiles: Findings from a Cross-Sectional Australian Population-Representative Gambling Study

Gambling-related harm can extend to family members and friends but few population-representative studies have investigated affected other (AO) prevalence estimates and profiles in the general population. Using data from the 5000 adult respondents in the Fourth Social and Economic Impact Study of Gambling in Tasmania, this study aimed to: (1) identify prevalence estimates of AO status and professional help-seeking; (2) establish the socio-demographic and gambling profiles of AOs; (3) extend the growing literature examining negative mental health characteristics experienced by AOs, after accounting for socio-demographic characteristics and other potential sources of harm; and (4) explore the degree to which gender moderates these relationships. Results found that 1 in 20 adults (5.11%, 95% CI: 4.33, 6.01) reported past-year AO status but only 1 in 7 AOs (14.15%, 95% CI: 9.01, 21.52) had ever sought help in relation to another person's gambling (i.e., < 1% of all adults). AOs were significantly more likely than non-AOs to be younger, Australian-born, employed, and living in households with children. They were significantly more likely than non-AOs to report depression symptoms, anxiety symptoms, binge drinking, tobacco use, and drug use, even after controlling for socio-demographics and other potential sources of harm. Finally, they were more likely to report their own gambling participation, problems, and harm but only 2.20% (95% CI: 0.69, 6.78) had ever sought help for their own gambling. These findings suggest that a considerable proportion of AOs in the general population may benefit from support to improve their own mental health and address their own gambling harm.

Emotional Supportive Care Needs in Patients with Advanced Cancer and Their Associated Characteristics: A Multicenter Observational Cohort Study (eQuiPe Study)

Background: Patients with advanced cancer often have emotional problems such as inadequate coping, fear of new metastases, or the prospect of enduring physical suffering. Some will need professional emotional support to cope with these problems. Accurately identifying these patients requires a thorough understanding of their characteristics. Aim: To assess the need for emotional supportive care in patients with advanced cancer who have emotional problems, and their associated sociodemographic, disease-related, clinical, and psychosocial characteristics. Design: Prospective multicenter observational study on experienced quality of care and quality of life in patients with advanced cancer and their relatives. Setting/Participants: Baseline data were used of 892 patients with advanced cancer who had emotional problems. Results: In total, 92% of the patients with advanced cancer had emotional problems and 33% of these had emotional supportive care needs. Most patients without emotional supportive care needs had contact with an oncology nurse (70%), while a minority received additional psychosocial support. Our multivariable logistic regression analysis shows that fatigue (odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.82-3.86), pain (OR: 1.50, 95% CI: 1.07-2.12), and less social support (OR: 0.95, 95% CI: 0.91-0.99) were associated with having emotional supportive care needs. Conclusions: One-third of patients with advanced cancer who have emotional problems in the eQuiPe study report emotional supportive care needs. Oncologists and oncology nurses should be aware that emotional supportive care needs are more common in patients with advanced cancer who experience increased pain, fatigue, or decreased social support in addition to their emotional problems. The eQuiPe study is registered as NTR6584 in the Netherlands Trial Register.

Perceived social support and self-stigma as factors of COVID-19 booster vaccination behavior and intention via cognitive coping and emotion regulation among people infected with COVID-19 in Hong Kong

BACKGROUND

It is imperative to promote behavior/intention of taking up booster COVID-19 vaccination (BI-BV) among people who have ever contracted COVID-19 (PECC). The aims were to investigate the prevalence of BI-BV and its associations with perceived social support. Guided by the stress coping theory, we tested mediators between perceived social support and BI-BV via self-stigma, active coping, and maladaptive emotion regulation (rumination and catastrophizing).

METHODS

A random population-based telephone survey was conducted among adult PECC having completed the primary series of COVID-19 vaccination prior to the diagnosis; 230 participants were interviewed from June to August 2022 during the fifth (last) major outbreak in Hong Kong. The associations between the independent variables and BI-BV were tested by logistic regression analysis. A structural equation model (SEM) tested the indirect effects of the latent variables of self-stigma, active coping, and maladaptive emotion regulation between the latent variable of perceived social support and BI-BV.

RESULTS

The prevalence of BI-BV was 62.2%. It was associated with age, marital status, full-time employment, and chronic disease status. The logistic regression analysis found that BI-BV was positively associated with perceived social support (ORc = 1.31, 95% CI: 1.12- 1.54), active coping (ORc = 1.40, 95% CI: 1.10- 1.79), rumination (ORc = 1.75, 95% CI: 1.13- 2.70), and catastrophizing (ORc = 3.12, 95% CI: 1.49- 6.51) and negatively associated with self-stigma (ORc = 0.80, 95% CI: 0.72- 0.88). In the SEM analysis, the positive association between perceived social support and BI-BV was fully mediated: 1) via self-stigma (β = 0.07, 95% CI: 0.03- 0.14), 2) via active coping (β = 0.06, 95% CI: 0.02- 0.12), and 3) via self-stigma and then active coping (β = 0.01, 95% CI: 0.002- 0.04). Two of these indirect paths involved active coping. The indirect paths involving maladaptive emotion regulation were all non-significant.

CONCLUSIONS

Perceived social support was associated with BI-BV, and was mediated via self-stigma, active coping, and serially self-stigma then active coping but not emotion maladaptation. The data supported the stress cognitive coping model in explaining the association between perceived social support and BI-BV. Interventions promoting BI-BV may consider modifying the observed significant factors. Future longitudinal studies are warranted to confirm the findings.

Coping Strategies Among Healthcare Workers During the COVID-19 Pandemic: Emotional Responses, Challenges, and Adaptive Practices

Background and Objectives: The COVID-19 pandemic has posed unprecedented challenges to healthcare workers, leading to significant psychological distress, altered health-related behaviors, and reliance on various coping mechanisms. Understanding these impacts is critical for developing targeted interventions to support healthcare professionals. This study aimed to evaluate the psychological stressors, emotional responses, changes in healthy behaviors, and coping mechanisms employed by healthcare workers during the COVID-19 pandemic. The study further examined differences across demographic and professional groups and explored correlations between stressors, coping strategies, and emotional outcomes. Materials and Methods: A cross-sectional survey was conducted among 338 healthcare workers, including physicians and nurses, in urban and rural healthcare settings during the pandemic. Data were collected using validated instruments to measure emotional responses (anxiety and anger), lifestyle behaviors (dietary habits, sleep patterns, physical activity, and smoking), and coping strategies. Statistical analyses included descriptive, inferential, and correlation techniques to assess relationships between variables. Results: Fear of infecting family members (M = 3.36, SD = 0.86) and concerns about inadequate protective equipment (M = 2.80, SD = 0.95) were the most significant stressors, strongly associated with heightened anxiety and anger. Changes in healthy behaviors were observed: 69.2% maintained a healthy meal schedule, 56.5% reported disrupted sleep patterns, and only 39.6% engaged in regular physical activity. Among smokers (27.5%), 31.1% increased smoking as a maladaptive coping strategy, while 21.1% reduced smoking. Nurses predominantly relied on emotion-focused strategies, such as religious coping and venting, whereas physicians favored problem-focused strategies like planning and active coping. Social support emerged as a protective factor, mitigating stress and facilitating adaptive coping. Conclusions: The study revealed significant psychological and behavioral impacts on healthcare workers during the COVID-19 pandemic. Key stressors included the fear of infecting family members, concerns about inadequate protective measures, and the prolonged uncertainty of the pandemic, which contributed to heightened levels of anxiety and anger. Changes in healthy behaviors, such as disrupted sleep patterns, decreased physical activity, and increased reliance on maladaptive coping mechanisms, further underscored the multifaceted challenges faced by healthcare professionals. Although the acute phase of the pandemic has passed, the long-term consequences on the mental health and well-being of healthcare workers remain critical concerns. Further research is essential to develop effective strategies for monitoring, preventing, and addressing psychological distress among healthcare professionals, ensuring their preparedness for future public health crises.

Determining the influence of an intervention of stress management on medical students' levels of psychophysiological stress: the protocol of the PROMESS-Stress clinical trial

BACKGROUND

Medical students face highly competitive stressful situations throughout their curriculum, which can lead to elevated stress levels and a major decline in quality of life, well-being, learning abilities, and health. It is crucial to assist medical students in coping with these stressful situations during their curriculum.

METHODS

The PROMESS-Stress clinical trial aims to support future healthcare professionals by enhancing their abilities to manage stressful situations. The support will be provided through a 3-session stress management program. Each session will include an individual meeting between a PROMESS-Stress expert and a medical student. To reduce stress levels and enhance coping mechanisms, these sessions will focus on establishing personalized advice and goals. The present protocol is designed to assess the influence of this program on forty-five undergraduate medical students (4th and 5th-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of psychological and physiological stress variables will be conducted before and during the intervention. At the end of the 3rd session the student's levels of satisfaction will be assessed. The primary outcome will be changes in scores on the Perceived Stress Scale (PSS), while secondary outcomes will provide a detailed characterization of the intervention's effects on stress coping behaviors, psychological and physiological stress variables. Exploratory outcomes will provide information regarding the student's level of satisfaction and will determine the moderators of the program's efficacy. Data will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained by the Institutional Review Board (IRB: 2023-07-04-02) and all the procedures will be performed in adherence to the Helsinki declaration. Results from this study will be presented at scientific conferences and in peer-reviewed scientific journals.

DISCUSSION

Results will provide valuable insights into the program's efficacy in reducing stress and improving coping abilities. If its efficacy is proven, PROMESS-Stress could become an integral and sustainable part of medical education, fostering a healthier and more resilient future for healthcare professionals. This manuscript follows the SPIRIT guidelines (Additional files 1 & 6).

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06295133; retrospectively registered.

Illness perception, coping and psychological distress among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) in China

OBJECTIVES

The study examined the effects of illness perception on mental health among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and the moderating role of coping style in this effect.

METHODS

The current study has collected the data of MAFLD patients at baseline and 8 months after. In both baseline and follow-up surveys, structural questionnaires were adopted to assess participants' illness perception (BIPQ), coping strategies (Brief COPE) and psychological distress (GHQ-12). A cross-lagged panel model was constructed to examine the associations between illness perception and psychological distress over 8 months. The moderating role of coping in the relationship between illness perception and psychological distress was addressed.

RESULTS

A total of 155 participants diagnosed with MAFLD were enrolled in the baseline survey, of which 71 patients engaged in the 8-month follow-up. The results showed that severe illness perceptions (perceiving MAFLD with more negative consequence, more negative emotions, lower coherence, and less treatment control) were associated with increased psychological distress 8 months later (β = 0.171, p < 0.05). Though approach coping showed an overall positive effect (β = 0.169, p < 0.05), people using it as a dominant strategy tend to be more subjected to the impacts of negative illness perceptions.

CONCLUSION

Threatening perceptions about MAFLD were associated with more psychological distress over time, and coping style has moderated the effects of illness perceptions. Healthcare providers should be aware of the impacts of negative illness perceptions, particularly when developing coping skill training programs to promote well-being and recovery.

Perceived coercion amongst healthcare workers during the COVID-19 pandemic

Direct and prolonged exposure to stress and uncertainty among healthcare workers (HCWs) during the COVID-19 pandemic likely had a significant negative impact on their mental health and general wellbeing. Although the contributors to such distress remain to be fully understood, the construct of perceived coercion appears to be relevant. Among HCWs, perceived coercion is conceptualised as appraisals about lack of control/'freedom to choose' and pressure to perform patient-care duties in the context of unprecedented threat of contagion from patients. To improve our understanding of perceived coercion amongst HCWs, we developed a 10-item scale-the Pandemic-specific Perceived Coercion Scale for Healthcare Workers (PPCS-HCW) scale-designed to be adaptable and applicable for use in future mass-contagion emergencies. A preliminary (exploratory) factor analysis (N = 546) showed that relevant items coalesced around three factors-'internal pressure', 'external pressure' and 'perceived coercion', that partly overlap with previous conceptualisations of perceived coercion. The exploratory conceptual and psychometric structure was confirmed in a separate sample of HCWs from the UK and Norway (N = 483). On average, across the three PPCS-HCW scale factors, HCWs showed low levels of perceived coercion (M = 0.22 (95% CI [0.11, 0.33] on a - 3 to + 3 scale). However, cluster analysis identified three groups: low (- 1.09 (95% CI [- 1.20, - 0.99]), moderate (0.17 (95% CI [0.08, 0.25]) and high scoring (1.57 (95% CI [1.47, 1.67]) PPCS-HCW clusters. High scoring participants showed higher levels of psychological distress, avoidance coping and compassion fatigue. In summary, our findings suggest that perceived coercion is a relevant construct in understanding the adverse psychological impact of large-scale contagion emergencies on HCWs.

Navigating the medical journey: Insights into medical students' psychological wellbeing, coping, and personality

BACKGROUND AND AIMS

In recent years, increased awareness of the psychological wellbeing of healthcare professionals and students has become a pressing public health issue affecting care delivery. Medical students undergo rigorous training programs that can affect their psychological wellbeing. Despite increased awareness of mental health issues among medical students, research often focuses on negative aspects, overlooking potential positive contributors to wellbeing. This study aims to explore both negative and positive factors influencing medical students' psychological wellbeing, considering coping strategies and personality traits to inform targeted support measures for diverse student needs.

METHODS

A mixed-methods approach was employed to investigate medical students' psychological wellbeing, coping strategies, and personality traits. Quantitative data was gathered via self-report questionnaires and analysed using regression models. Additionally, qualitative insights were obtained from semi-structured interviews and analysed thematically to capture students' perceptions and experiences.

RESULTS

The analysis revealed moderate to high levels of stress, anxiety, and depression among medical students, along with decreased life satisfaction. Regression analysis showed that problem-focused coping positively impacted medical students' psychological wellbeing, whereas emotion-focused and avoidance coping showed less favourable effects. Notably, problem-focused coping partially mediated the relationship between stress and depression. Furthermore, personality traits, particularly agreeableness and conscientiousness, played a pivotal role in shaping medical students' coping strategies and mental health outcomes. Based on thematic analysis, codes gave rise to three overarching themes and corresponding subthemes.

CONCLUSIONS

The study underscores the significance of addressing both positive and negative factors impacting medical students' wellbeing and highlights the need for tailored support considering individual personality traits that influence coping strategies and mental health. It also identifies challenges within medical education, emphasising the necessity for stress management programs, mental health support, and curricula promoting problem-solving skills. Prioritising medical students' wellbeing may not only foster good mental health among future professionals but may also enhance future healthcare quality.

Coping and Positive Body Image in Young Women with Breast Cancer: The Buffering Role of Social Support

Background/Objectives: Considering the unique body image challenges faced by young women with breast cancer, this study aims to deepen our understanding of how coping strategies and perceived social support contribute to fostering positive body image in this population. This is an important issue as body image is capable of influencing women's self-esteem and psychological adaptation to breast cancer. Methods: A sample of 157 young women with breast cancer (M age = 41.43; SD = 6.05; Min 26 years, Max 50 years), 43% of whom had undergone breast reconstruction, completed an online survey. The survey included measures of coping strategies, positive body image, and perceived social support. Results: No significant differences in coping strategies, perceived social support, or positive body image were observed based on reconstruction status. Moderation analyses revealed that both avoidant and problem-focused coping were significantly associated with positive body image at moderate and high levels of perceived social support, but not at low levels of perceived social support. Perceived social support moderated the relationship between coping strategies and positive body image in women with breast cancer. Conclusions: These findings highlight the importance of social support in enhancing the effectiveness of both avoidant and problem-focused coping strategies in promoting positive body image. Future interventions should prioritize strengthening social support networks to optimize psychological outcomes in this population.

A Socio-Demographic Analysis of Compassion Fatigue among Mental Health Practitioners

MHPs are exposed to the emotional and psychological suffering of their clients on a daily basis, which can take a toll on their own well-being. This study examines the significance of various socio-demographic factors-such as marital status, years of experience, work sector, socio-economic status, and type of MHP-on compassion fatigue, resilience, and coping strategies of MHPs in India. Burnout was found to be higher among single MHPs, while MHPs living with their loved ones demonstrated higher levels of compassion satisfaction and resilience. MPhil & doctoral-level practitioners reported higher levels of secondary traumatic stress, while master's-level practitioners exhibited higher levels of avoidant coping. Job satisfaction was positively correlated with compassion satisfaction and resilience and negatively correlated with burnout and secondary traumatic stress. No significant differences were found based on years of experience or working hours per day. The findings highlight the complex interplay of sociodemographic variables among MHPs.

Stress and coping in Australian male farmers

INTRODUCTION

Farmers face high levels of stress, often related to unique farming industry stressors. Coping strategies in dealing with stress, can be less (avoidant) or more (approach) effective. No previous research has investigated coping strategies across a range of farming-specific stressors.

OBJECTIVE

To determine levels of stress in various categories and the relationship between these stressors and coping strategies used.

DESIGN

Cross-sectional survey, using self-report questionnaire. Independent variables included five stressor categories, and two types of coping.

PARTICIPANTS

One hundred and twenty-five rural male farmers, over 18 years of age, across Australia.

MAIN OUTCOME MEASURES

Demographic data were collected in addition to responses regarding stress and coping. The Australian Family Farming Stressor Scale, comprising five stressor categories, measured the stressors unique to Australian farming. The Brief COPE (B-COPE) measured approach and avoidant coping strategies.

RESULTS

A total of 125 responses to the survey were analysed, with ages ranging from 19 to 84. While varying levels of stress were found in all stressor categories, Daily Stressors rated highest, followed by Financial Stressors. Higher levels of avoidant coping were utilised for Family Stressors, whereas higher levels of approach coping were utilised for farm-related stressors.

CONCLUSIONS

Findings indicate that the rating of stressors may be determined by current affairs, such as Daily Stressors rating highest. This could be due to the lack of available workforce during the COVID-19 pandemic. Furthermore, coping strategy findings could better inform clinical practice in assisting farmers in utilising their approach coping skills across all stressors.

Sensory processing patterns and their relationships to coping and occupational engagement in mental health service users

INTRODUCTION

Mental health service users often have sensory processing difficulties hampering their ability to cope with mental health problems and occupational engagement. However, there is little knowledge of sensory processing and its relation to these factors. Hence, this current study aims to investigate sensory processing patterns in relation to coping and occupational engagement for the target group.

METHODS

This cross-sectional study involved 97 mental health service users. Sociodemographic information and self-rated questionnaires were administered; Adolescent/Adult Sensory Profile (AASP), Coping Orientation to Problems Experienced Inventory scale (short version) (Brief-COPE), and Profiles of Occupational Engagement among people with Severe mental illness (POES). Statistical analysis included descriptive statistics and multiple linear regression models.

CONSUMER AND COMMUNITY INVOLVEMENT

This study sits within an RCT project where parts were designed collaboratively with research-educated service users.

RESULTS

The result showed strong relationships between sensory processing patterns and occupational engagement. Low levels of occupational engagement were related to high levels of sensory sensitivity, sensation avoiding, and low registration. Whereas, high levels of occupational engagement were related to high levels of sensation-seeking. Concerning coping styles, high levels of emotion-focused coping were related to high levels of low registration, while high levels of avoidant coping styles were related to high levels of sensation-seeking.

CONCLUSION

The findings indicate that occupational engagement and coping styles are related to outcomes of the sensory profile and thus affect how a person with severe mental health problems interprets and reacts to sensory stimuli in daily life.

Religious Coping in Parents of Children with Down Syndrome: A Systematic Review of the Literature

Having a child with Down syndrome (DS) is stressful for families. Social, physical, economic and emotional difficulties are the most challenging stressors for parents of children with DS. Therefore, parents who have children with DS have used various types of coping strategies. This systematic review investigates religious coping in parents of children with DS to synthesize what is known of the literature regarding religious coping among parents of children with DS. Pubmed and Scopus databases were searched with no restriction on language and the year of publication. Additionally, manual searches of the retrieved articles' references were performed. Forty-four original studies published between 2000 and 2023 were included in the review. No study on the subject was found in either Pubmed or Scopus before 2000. Most studies were conducted in USA 7 (15.9%), Egypt 7 (15.9%), and Türkiye 6 (13.6%). In the studies, the total number of participants was 4266, range between 8 and 530 (median 55.5). The ethnic origins of the participants were very diverse and the studies included participants from many cultures around the world. Based on the studies, we identified seven themes that represented the main stressors encountered by parents/caregivers of children with DS: "information deficits," "child caregiving burdens," "familial difficulties," "financial difficulties," "challenges related to social and professional support," "society's misconceptions," and "worries about the future." The most commonly (n = 12, [27.2%]) used coping scale was coping orientation to problems experienced. Religious coping was the coping strategy most frequently used by participants in 36 (81.8%) studies. Religion, spirituality, and belief in Allah (God) were of central importance for most participants in most of the studies. Most parents reported that belief in Allah (God) encouraged them to accept the diagnosis of DS and feel better and become stronger; provided improvements in the lives of families and the necessary resources to face their difficulties; played a fundamental role in adaptation with the conditions of their children with DS; brought them peace of mind and a sense of hope; and motivated them to keep on moving forward. In conclusion, religion plays an important role in the lives of most parents of children with DS. Religious coping has been used by parents of children with DS in many cultures around the world, regardless of religion, race, or ethnicity. Belief in Allah (God), belief in fate and belief in the afterlife, provided physical, mental and psychosocial relief for most parents of children with DS.

Effects of personal cancer history and genomic risk information on mothers' psychological adaptation to inherited breast/ovarian cancer syndrome

This study aimed to understand long-term coping responses of mothers (N = 287) receiving genetic counseling and testing (GCT) for hereditary breast/ovarian cancer (HBOC) syndrome. Psychological characteristics, including cancer-specific distress (Impact of Events Scale-Revised, α = .85) and coping (Brief COPE, α = .93) were assessed via structured personal communication, along with epidemiologic items assessing personal and family history of cancer. Genetic risk was determined by BRCA1/2 carriage. A principal component analysis was conducted on the coping measure to reduce its summary score to active coping (α = .91) with nine approach-oriented strategies responsive to stress. A multivariable regression model examined the main and interacting effects of clinical and psychological characteristics on maternal coping. Personal cancer history (F = 4.99, df = 1, p = .026), BRCA test result (F = 22.20, df = 1, p < .001), and cancer-specific distress (F = 17.80, df = 1, p < .001) were associated with greater engagement in active coping strategies. When controlling for cancer-specific distress, the interaction between personal cancer history and genetic test results was significant, such that women previously unaffected by cancer who received positive BRCA results reported the greatest levels of active coping (F = 7.92, p < .001). These findings indicate that previous cancer history, genetic risk, and psychological distress independently and jointly impact how women adapt to the threat of cancer over time.

Destructive Self-Leadership? Self-Leadership, Maladaptive Coping, and Stress in College Students

Prior research has examined self-leadership as a proactive self-regulatory approach for the management of stress and anxiety in college students. However, little is known about the possible negative effects of self-regulatory approaches such as self-leadership. Using the transactional model of stress and coping and the interaction model of stress, anxiety, and coping as theoretical frameworks, this study investigates a parallel multiple mediation model of the relationship between self-leadership and state anxiety as mediated by adaptive coping behaviours and maladaptive coping behaviours in a sample of 143 undergraduate students. Results suggest that self-leadership, paradoxically, is positively related to both adaptive coping behaviours and maladaptive coping behaviours in students. Moreover, the magnitude and significance of the indirect effects of self-leadership on state anxiety through maladaptive coping behaviours are greater than the indirect effects of self-leadership through adaptive coping behaviours. This study is therefore the first to identify possible detrimental effects of self-leadership on individual outcomes, that is, destructive self-leadership. Implications, both theoretical and practical, are discussed along with limitations and directions for future research.

Illness perceptions in cochlear implant users - a longitudinal study

PURPOSE

'Illness perceptions' refers to the thoughts and ideas a person has about an illness. According to Leventhal's Self-Regulatory Model (SRM), changing the threatening illness perceptions of cochlear implant (CI) recipients can be a further step in optimizing hearing outcomes with the CI. The aims of the present study were to assess users' illness perceptions and to determine whether perceptions change during six months of CI rehabilitation.

METHODS

One hundred and thirty-eight participants completed the Brief Illness Perception Questionnaire (Brief IPQ), assessing their illness perceptions on nine scales. Data were collected at a German CI center at first CI fitting and six-month follow-up. After first fitting, participants underwent intensive rehabilitation including auditory training, medical, audiological and psychological treatments.

RESULTS

At both assessments, participants tended to view their hearing impairment as a severe threat. On the Brief IPQ, the 'consequences' assessment improved during CI rehabilitation, which can be explained by the CI-induced hearing improvement. However, 'understanding' and 'identity' assessments worsened. This could be because CI recipients only come to realize the full complexity of their hearing impairment during rehabilitation. The other scales and the total score remained unaffected.

CONCLUSIONS

Current practice in CI rehabilitation seems to be insufficient to improve threatening illness perceptions (except for perceived consequences). This may be because standard information often fails to reach the patients. The development and empirical validation of an intervention program to address individual illness perceptions in CI recipients could be helpful in this context. Further research will be needed to confirm the results.

Strategies for Coping With Complicated Grief in Relatives of Patients Who Are Critically Ill: An Observational Single-Center Cohort Study

BACKGROUND

Relatives of patients who are critically ill who die are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood.

RESEARCH QUESTION

How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms?

STUDY DESIGN AND METHODS

In this observational single-center cohort study, relatives of patients who are critically ill who died while in the ICU were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief Coping Orientation to Problems Experienced questionnaire, to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score.

RESULTS

Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ± SD ICG sum score was 41.6 ± 10.9. Eighty-four relatives (94.4%) had an ICG score ≥ 25. Multivariable analysis revealed that being a partner significantly affected the ICG sum score (coefficient, 4.9; 95% CI, 1.8 to 8.0; P = .003), as did the coping strategies of self-distraction (coefficient, 4.4; 95% CI, 2.5 to 6.3; P < .001), acceptance (coefficient, -4.4; 95% CI, -6.3 to -2.5; P < .001), and self-blame (coefficient, 3.8; 95% CI, 1.4 to 6.3; P = .002).

INTERPRETATION

Almost all relatives of deceased patients who are critically ill exhibit symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

Psychological Distress, Resources, and Coping Strategies Among Evacuees and Non-Evacuees From an Armed Conflict Zone: A Network Analysis

This study focuses on two groups: evacuees from Israel's southern and northern frontline communities following the October 7th Hamas attack, and individuals from regions not directly threatened. Using network analysis, we identified key associations and central nodes related to stress indicators (i.e., exposure to traumatic life events, physical health-related quality of life, anxiety, and depression) as well as personal resources (i.e., self-mastery and meaning in life), and coping strategies. The study included 221 evacuees and 145 non-evacuees (controls), recruited via iPanel, Israel's leading online research panel. Participants completed standardised self-report questionnaires. Evacuees exhibited higher levels of anxiety, depression, and traumatic life events, than did controls. Additionally, evacuees showed higher levels of problem-focused coping and a greater sense of meaning in life, along with lower physical health-related quality of life. Network analysis revealed that both groups had four sub-networks: 'personal state', 'psychological distress', 'resources', and 'coping'. However, the sub-networks' composition varied. Both groups shared similar sub-networks for 'coping' and 'personal state', but differed in 'psychological distress' and 'resources'. For the controls, dysfunctional coping strategies were part of 'psychological distress', whereas for evacuees, they were included in 'resources'. Additionally, meaning in life was more central among the controls, influencing the interaction between coping mechanisms, personal states, and psychological distress. For evacuees, physical health-related quality of life was more closely associated with the absence of negative factors-(i.e., anxiety, depression, traumatic experiences, and lower self-mastery)-rather than the presence of adaptive coping strategies and meaning in life. These differences highlight the vulnerability of evacuees and the central role of personal resources. Targeted interventions that foster resources such as self-mastery and meaning in life are vital for coping with the psychological distress associated with forced displacement.

Effect of Coping Strategies on Perceived Stress and Hair Cortisol Levels During the COVID-19 Pandemic According to Sex

The COVID-19 crisis generated subjective and physiological stress, with important interindividual differences. Studies have shown that coping strategies and sex modulate subjective stress, although their effects on stress hormones have been overlooked. In addition, it remains unknown whether sex and coping interact to predict these stress metrics during long-term stressful events. To examine the impact of coping strategies, sex, and their interaction on subjective and physiological indicators of stress during the year following the arrival of the COVID-19 virus. Coping strategies were assessed using the Brief COPE questionnaire in May 2020. Stress symptoms were assessed as a subjective indicator of stress every 3 months (June 2020 to March 2021) with the Perceived Stress Scale questionnaire in 155 participants (49 men). Of these individuals, 111 provided a 6-cm hair sample in June 2020 to estimate cortisol levels as a physiological indicator of stress before and during the first lockdown. A factor analysis identified three clusters of coping strategies: positive-oriented, avoidance-oriented, and social support. For subjective stress, a linear-mixed model showed that women reported more stress than men. Positive-oriented and avoidance-oriented strategies were associated with less and more stress, respectively. An interaction between sex and coping strategies indicated a positive relationship between social support and perceived stress levels in men. However, among men and women who used this strategy infrequently, women reported higher stress levels than men. For physiological stress, a regression revealed that women had greater cortisol secretion in response to the pandemic. These findings suggest that coping and sex modulate subjective stress, whereas sex influences physiological stress.

Coping in the Danish general population: psychometric properties of the Danish version of the Brief Approach/Avoidance Coping Questionnaire

OBJECTIVE

To enable measurement of coping in the general Danish population the aims of this study are to 1) describe the translation and cultural adaption of the Danish Brief Approach/Avoidance Coping Questionnaire (BACQ) and 2) investigate the psychometric properties of the Danish BACQ.

DESIGN

The BACQ was translated and adapted into Danish, and the psychometric properties tested in two samples of adult Danish citizens: Sample A = 167, used for exploratory factor analysis (EFA), and Sample B = 330 persons, used for confirmatory factor analysis (CFA). Internal consistency was evaluated by Cronbach's Alpha, item-to-rest correlation, and scale-to-scale Pearson correlation.

RESULTS

The EFA suggested reasonable fits for both a three-factor and four-factor model, confirmed by the CFA with acceptable goodness-of-fit indices for both models. Using the four-factor-model would require a re-evaluation of the scale. The three-factor model had admissible internal consistency with an overall Cronbach's alpha of 0.66. Individuals with low self-rated health, extreme concern about current health and poor physical fitness, respectively, had lower Approach and higher Diversion and Resignation scores.

CONCLUSION

The psychometric properties showed that the Danish BACQ could be used as a three-factor model. With some limitations, the Danish version had acceptable construct validity, internal consistency, and content validity.

Positive dementia caregiving in 30 days (PDC30): Study protocol of a randomized controlled trial of a self-guided automated online training program

The Benefit-Finding Intervention, a face-to-face psychoeducation program with a focus on the positive meanings of caregiving, has been found to reduce depressive symptoms and burden in dementia caregivers. The program was revamped into a computer-delivered web-based program to enable 24/7 access without location restriction. This study evaluates the efficacy of this new online program called Positive Dementia Caregiving in 30 Days (PDC30). A 2-arm (PDC30 vs. waitlist control) parallel-group randomized controlled trial will be conducted. Target sample is 200 mildly depressed dementia family caregivers with internet access and fluency in English, who will be recruited globally through a YouTube video promoted on social media and through service agencies. The primary outcome is depressive symptoms whereas secondary outcomes are anxiety symptoms, burden, and positive gains, all collected at baseline and 1, 2, and 3 months. The treatment x time (both linear and quadratic) interaction effects will be examined using mixed-effect regression. Additionally, possible therapeutic mechanisms via strengthened self-efficacy in controlling upsetting thoughts and positive reappraisal coping will be examined in a mediation path model. If positive treatment effects are found, the potential public health benefits, given the ease of access, universal availability, and flexible approach, of this online intervention are considerable.

Personality Typing and Body Dissatisfaction in Korean Young Adults: Which Personality Type Is More Dissatisfied With Their Body Image?

OBJECTIVE

Previous studies showed that personality traits, which influences self-perception, anger expression and coping mechanisms, are associated with body dissatisfaction in various ways. However, few studies investigated the role of personality traits on body dissatisfaction in Korea. The aim of this study was to identify specific personality characteristics associated with body dissatisfaction and categorize participants into subgroups of potential clinical significance.

METHODS

In total, 345 adults in Korea completed the Body Dysmorphic Disorder Examination Self-Report, HEXACO Personality-Inventory-Revised, paranoia, borderline features, antisocial features of the Personality Assessment Inventory, the Ways of Coping Checklist, and the State-Trait Anger Expression Inventory. Cluster analysis was performed to categorize participants.

RESULTS

It showed that major contributing factors of body dissatisfaction among young adults were identity problems, anger in, and resentment. Cluster analysis resulted in three personality types, cluster 1 exhibited introverted and lack of ability to cope with stress and control anger, cluster 2 was characterized by honesty, humility, extraversion, amiability, and conscientiousness, and cluster 3 displayed socially aversive behavior, highly emotional traits, and passive coping skills. Cluster 2 was associated with lower body dissatisfaction compared to cluster 1 and 3.

CONCLUSION

This study indicates the pivotal role of personality traits in understanding and addressing body dissatisfaction. Identification of specific personality types offers insights for tailored treatment strategies, suggesting potential implications for treatment outcomes and prognosis. Clinicians should also be aware of the body dissatisfaction when seeing patients with introverted, socially aversive, emotional personality traits or who lack ability to manage stress and anger.

Predictors of Individual and Interpersonal Adjustment Among Non-offending Partners of Individuals With Histories of Sexual Offenses

Recent research indicates that the consequences of sexual offenses extend beyond target victims, including to non-offending partners of individuals with sexual offense histories. However, little research has focused on non-offending partners' wellbeing and relationships with persons with sexual offense histories leading up to and following acts of sexual aggression. Non-offending partners may be secondary victims of their partners' offenses in managing psychological difficulties (e.g., guilt, shame), social stigma and isolation, fear for their safety, or difficulties in their romantic relationships resulting from their partners' sexual offenses, often with minimal supports. The current study examined key correlates of individual and interpersonal adjustment among 207 non-offending partners of individuals with histories of sexual offenses who were residing in Canada (n = 36) or the United States (n = 171). Findings indicate that positive changes due to the offense (i.e., improved finances), self-esteem, interpersonal adjustment, instrumental support, lower levels of acceptance, and humor positively predicted individual adjustment. Interpersonal adjustment was predicted by trust, intimacy, partner's stress communication, and problem-focused and emotion-focused common dyadic coping. Findings highlight the need for services for non-offending partners, including interventions that address self-esteem and practical difficulties resulting from the offense, and couples therapy to address trust issues, intimacy concerns, and shared coping with stressors related to the offense.

Effectiveness of Empower-Grief for Relatives of Palliative Care Patients: Protocol for an Exploratory Randomized Controlled Trial

Background

Grief reactions of relatives of palliative care patients are seldom addressed. Most interventions focus on Prolonged Grief Disorder (PGD) and not on its prevention. This is particularly relevant in palliative care, in which death is the result of a difficult period of a terminal illness, making caregivers particularly vulnerable to psychological distress. The purpose of the present exploratory trial is to test the efficacy of a selective intervention (Empower-Grief) for the initial problematic grief reactions and to study potential predictors of adherence and efficacy.

Method

This is an exploratory Randomized Controlled Trial (RCT) studying Empower-Grief compared with Treatment as Usual (TAU). Participants will be relatives or caregivers of palliative and oncological patients with initial indicators of risk of developing PGD and will be randomly allocated to Empower-Grief and TAU. Participants will be assessed prior, at the end and six months after the intervention. The primary outcome considered will be symptoms of PGD. The assessment includes measures of anxiety and depression, coping, attachment, psychological flexibility, posttraumatic growth, social support and therapeutic alliance.

Results

The trial is ongoing. Forty-four participants will be invited to participate.

Conclusion

This study addresses the need for the development of empirically grounded and feasible interventions aimed at dealing with initial problematic reactions in grief, exploring potential predictors and possible venues for personalizing intervention and understanding the mechanism through which these interventions operate.

Factor Structure of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) in Chinese Nursing Students

Background/Objectives: Coping strategies are influenced by sociocultural factors, and an understanding of how the Brief-COPE functions within the Chinese student population is important for its validity and reliability. This study aimed to explore the factor structure of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) in Chinese nursing students. Methods: A cross-sectional study design was adopted. A total of 284 college nursing students, aged 18 years or older, were recruited from a medical university in China using convenience sampling. Exploratory factor analysis (EFA) was conducted to identify the underlying domain structure of the Brief-COPE within those students. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: The Brief-COPE demonstrated robust validity, revealing eight distinct factors: positive reframing coping, avoidant and passive coping, seeking social support, self-blame and emotional distress coping, denial and deflective coping, spirituality and humor coping, avoidance and emotional release coping, and adaptive acceptance with distraction. The scale exhibited good internal consistency, as indicated by a Cronbach's alpha of 0.759. Conclusions: The Brief-COPE is a valid tool for assessing coping strategies in Chinese nursing students. Nursing educators could benefit from training aimed at enhancing the use of appropriate strategies. Also, culturally tailored interventions, such as peer support groups and mentorship programs, could further promote coping skills and improve the emotional well-being of these students.

Perceived stress and coping strategies used by undergraduate dental students: An observational study

Studies around the world have reported that dental students experience higher stress compared to medical students. Prolonged and high perceived stress can be of a significant concern as it affects the personal, psychological, and professional well-being of the student, affecting quality of life. The aim of the study was to describe the perceived stress and coping strategies that undergraduate students at dental schools of Lahore, Pakistan employ. This observational study was conducted in year 2023 to report perceived stress and coping strategies among 720 undergraduate dental students of Lahore using modified Dental Environment Stress (DES) and brief Coping Orientation to Problems Experienced (COPE) questionnaires. Categorical variables such as sex, year of study (year 1 till 4), and responses to DES stress domains, stress-related items, COPE domains, and COPE-related items were computed into frequencies and percentages. Mean item scores of stress domains, stress-related items, COPE domains, and COPE-related items were presented with standard deviations (SD). Groups wise comparisons were done using Mann Whitney U and Kruskal Wallis H tests. P value < 0.05 was considered statistically significant. The majority of the undergraduate dental students perceived moderate amount of stress. Item "overload feeling due to huge syllabus" had the highest mean stress score (3.49±0.76) and "language barrier" had the lowest mean stress score (1.75±0.92). Female students had higher mean stress scores than the male students in all of the DES domains. Mean stress scores were higher in year 4 students for "workload", "self-efficacy beliefs", "faculty and administration", "clinical training", and "social stresses" compared to other years. "Religion" was the highest- and "denial" was the lowest-ranked coping strategies. Female students employed "active coping", "positive reframing", "religion", "venting", "self-blame", "denial", and "behavioral disengagement" coping strategies more than males. Moreover, final year dental students used "instrumental support", "humor", "self-blame", "denial", and "behavioral disengagement" coping strategies more than year 1 and 2 students. Sex and year of study can influence the degree of perceived stress and choice of coping strategies employed to overcome stressful situations. For the emotional, psychological, and professional well-being of undergraduate students, institutions must provide a nurturing and positive learning environment implementing strategies for stress prevention and management.

Occupational injuries, mental workload and coping strategies among the nursing workforce in the Eastern Region of Ghana: a multi-centre study

BACKGROUND

The nursing profession plays a crucial role in the quality of healthcare services. While nurses face occupational injury challenges globally, mental workload, which is often overlooked, plays a significant role in these injuries. Understanding nurses' coping strategies can help develop effective interventions. The study examined the influence of mental workload on occupational injuries and coping strategies among nurses.

METHODS

A multi-centre cross-sectional study was conducted in selected hospitals in the Eastern Region of Ghana. Using a stratified sampling technique, 317 nursing staff from 6 hospitals participated in the study. A researcher-developed occupational injury questionnaire, NASA Task Load Index and Brief COPE scale were used to measure occupational injury, mental workload and coping strategies among nurses. Descriptive statistics, Pearson moment-product correlations, and regression analysis were used to analyse the data at a statistical significance of 0.05.

RESULTS

Needle pricks, injuries from sharps, exposure to blood and other body fluids, and back pain and injury from patient handling tasks were shared among participants in the past year. The study also revealed a high level of mental workload among participants. A significant correlation was observed between mental workload and various occupational injuries. The participants adopted different coping strategies in dealing with the mental workload, with active coping and instrumental support being the most used coping strategies.

CONCLUSION

The findings underscore the importance of addressing mental workload in nursing to reduce occupational injuries. To achieve this, nurses must be provided with appropriate coping strategies and support to minimise mental stress.

IMPLICATION

Providing accessible and effective coping strategies tailored to nurses' needs can significantly improve their well-being and job performance. Healthcare administrators and policymakers should consider these results when designing interventions to support the nursing workforce.

Paranoia and unusual sensory experiences in Parkinson's disease

OBJECTIVES

There has been limited exploration into the nature and development of psychotic experiences (PEs) in Parkinson's disease (PD). We aimed to comprehensively assess the frequency, severity, and associated distress of paranoia and unusual sensory experiences (USEs) in PD, and to assess what variables are significantly associated with these experiences, focussing on psychological processes central to understanding PEs in non-PD groups.

METHOD

A questionnaire battery was completed by 369 individuals with PD with a mean age of 66 years and mean time since diagnosis of 5 years. Recruitment was via Parkinson's UK, social media, and local community groups. For a subset of measures, comparisons were made to age-matched controls using pre-existing data.

RESULTS

182 (49%) participants reported USEs, including almost half of those not taking dopaminergic medication. For 83 (23%), the experience was distressing. Paranoia across the sample was significantly lower than in age-matched controls. However, specific paranoid concerns around abandonment (16%) and spousal betrayal (10%) were reported by some. Depression, anxiety, loneliness, and stigma and desire for support with PEs were high across the sample. Almost all psychological variables were significantly associated with PEs in structural equation models.

CONCLUSION

PEs in PD are common, even in those not taking dopaminergic medication. For a small subset, these experiences are distressing and not resolved by existing treatment. Cognitive-affective variables like depression and anxiety could play a maintaining role in PEs in PD thus providing easy avenues for trialling intervention.

The influence of locus of control, coping strategies and time perspective on post-traumatic growth in survivors with primary breast cancer

BACKGROUND

Breast cancer, a potential traumatic stressor, may be accompanied by positive changes, such as post-traumatic growth (PTG), which may allow patients to overcome this stressful event more easily. Our aim was to identify factors associated with PTG in breast cancer survivors (BCSs).

METHODS

We conducted a cross-sectional study in Seintinelles volunteers who answered online questionnaires. PTG was measured using the Post-Traumatic Growth Inventory (PTGI). Data on sociodemographic, health-related factors and lifestyle habits, fear of cancer recurrence, health locus of control, coping strategies, and time perspective were collected.

RESULTS

The study included 821 BCSs aged 26 to 79 years, one to 16 years after cancer diagnosis. Mean of PTG scores were: relating to others 20.27 ± 6.61; new possibilities 14.00 ± 5.44; personal strength 12.24 ± 4.32; spiritual change 2.95 ± 2.54; appreciation of life 10.59 ± 3.00 and total PTG 60.05 ± 18.11. Several factors were associated with PTG: health-related factors (satisfaction with one's own health, longer time since diagnosis), lifestyle habits (increasing physical activity level and stopping or reducing alcohol consumption after diagnosis), elements of locus of control (powerful others), coping strategies (positive thinking, seeking social support) and time perspective (present hedonistic), which were significantly positively associated with PTG. Chance locus of control and coping avoidance were inversely related to several PTG domains, even several years after diagnosis.

CONCLUSIONS

PTG may be increased in BCSs by acting on its modifiable factors. This includes adopting healthy behaviours, such as increasing physical activity and stopping/reducing alcohol consumption, and developing locus of control elements, such as powerful others, and coping strategies, such as positive thinking and seeking social support, through targeted interventions. Further studies, especially longitudinal studies, are needed to confirm the observed associations between health behaviours, health locus of control, time perspective, and PTG scores. Other measures, such as post-traumatic stress, should be considered because of possible inferences with PTG.

Moderating Effects of Coping Styles on the Relationship Between Nursing Stress and Mental Health Among NICU Nurses

OBJECTIVE

To examine whether coping styles moderate the relationship between nursing stress and mental health in NICU nurses.

DESIGN

Cross-sectional observational study.

SETTING

Four Level 3 and 4 NICUs in New South Wales, Australia.

PARTICIPANTS

A total of 123 NICU nurses.

METHODS

Participants completed self-report questionnaire measures of nursing stress (Nursing Stress Scale), dispositional stress coping styles (Brief Coping Orientation to Problems Experienced Inventory [Brief COPE]), and mental health (Mental Health Inventory-21). I conducted exploratory factor analysis of the Brief COPE to show that it comprises four factors: support-oriented coping, problem-oriented coping, emotion-oriented coping, and denial-oriented coping. I used hierarchical multiple regressions with interactions and simple slopes analyses to conduct moderation analyses.

RESULTS

I found that the interaction between nursing stress and problem-oriented coping style (i.e., positive reframing, planning, religion, and active coping) was significant and explained further variance in psychological distress (ΔR2 = .05, p = .013), emotional well-being (ΔR2 = .03, p = .027), and hopelessness (ΔR2 = .06, p = .005). The moderation effects on mental health were significantly different at high versus low levels of problem-oriented coping for psychological distress (t = 2.55, p = .011), emotional well-being (t = 2.26, p = .024), and hopelessness (t = 2.89, p = .004). The other coping styles did not have significant moderator effects.

CONCLUSION

Problem-oriented coping buffered the ill effects of nursing stress on positive and negative dimensions of mental health in NICU nurses. Accordingly, cognitive behavioral therapy may be the most effective counseling modality for NICU nurses. Understanding how and why problem-oriented coping might not be effective in certain clinical situations that are controllable and theoretically solvable should inform further mixed methods research in NICU nurses.

The Role of Student Coping Strategies on Success in the Command Actions Course: A Special Operations Selection Course of the Brazilian Army

INTRODUCTION

Army Command Action units in Brazil are recognized for their operational effectiveness, operating in hostile scenarios. However, these operations are extremely stressful, requiring specific stress-coping skills. The objective of this study was to identify the profile of stress-coping strategies of military personnel enrolled in the Command Actions Course (CAC) and their relationship with completion of the course.

MATERIALS AND METHODS

A prospective cohort study was carried out with 87 military personnel from the CAC class of 2022. Data were collected on personal characteristics, coping strategies, and stress levels, among other variables. Specific instruments were used to assess coping (Brief-COPE), stress (DASS-21), social support (MOSS), and sociodemographic variables (own instrument) to evaluate the relationship between coping with stress and course completion. Descriptive analyses were performed (central tendency and dispersion measures), and overall survival analysis was performed using the log-rank test for comparison (P < .05). Cox regression was used for multiple analyses considering a statistical significance of 5%.

RESULTS

A total of 31% of the participants completed the course. The profile of graduates is mainly composed of young people with higher education, single status, and White. Certain coping strategies such as Active Coping (hazard ratio (HR) = 1.48; 95% CI, 1.25-1.75) as well as high stress levels (HR = 1.07; 95% CI, 1.02-1.11) were associated with disengagement, while the Humor-based coping strategy reduced the chance of disengagement by 15% (HR = 0.85; 95% CI, 0.74-0.98).

CONCLUSIONS

This study highlights the importance of investigation using coping strategies in the military context as a useful tool in coping with stress in the CAC.

A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia

BACKGROUND

Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners-together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis.

OBJECTIVE

This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial.

METHODS

All study procedures will be conducted on the web (via phone and health care system-supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial.

RESULTS

This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024.

CONCLUSIONS

We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60382.

Psychological distress and the COVID-19 pandemic: the role of personality and coping strategies

Personality traits and coping strategies significantly predict predisposition to psychopathology. This study aimed to examine the predictive role of coping strategies in psychological distress during the COVID-19 pandemic in a sample of Portuguese individuals, considering personality and sociodemographic variables. Data were collected using Google Forms from 2402 individuals (86.8% women; mean age ± SD = 36.80 ± 11.80) between March and June 2020, found primarily through Facebook. The evaluation instruments included the Brief Symptom Inventory (BSI), NEO Five-Factor Inventory, and Brief-COPE. Younger adults, females, single individuals, and those with lower education experienced higher distress. Neuroticism was strongly associated with all dimensions of psychological distress and the overall BSI. Maladaptive coping strategies (self-distraction, denial, self-blame, behavioral disengagement) were positively correlated with distress, whereas agreeableness and positive reframing were negatively correlated. Regression analysis showed that gender, age, education, and psychiatric diagnosis predicted 12% of distress; adding neuroticism increased prediction to 34% and coping strategies to 37%, with self-blame among coping strategies being the strongest predictor. Personality traits and coping strategies were significant predictors of psychological distress during the COVID-19 pandemic. These findings emphasize the need for interventions that target neuroticism and maladaptive coping strategies to improve mental health outcomes during public crises.

Associations between violent and sexual childhood trauma and maladaptive coping in patients with functional seizures

OBJECTIVE

Functional seizures (FS) are a highly debilitating symptom of functional neurological disorder (FND). FS requires a multi-disciplinary approach to treatment because the patient's initial presentation is to neurology, emergency medicine, or primary care and treatment consists of psychotherapy. People with FS commonly experience severe childhood trauma, particularly sexual trauma. The authors aimed to investigate associations between reported trauma and maladaptive coping mechanisms in the FS population.

METHODS

This retrospective, observational study reports on 137 patients enrolled in the FS Clinic at the University of Colorado between March 2020 - March 2021. Multiple linear regression was used to reveal associations between self-reported childhood sexual and violent trauma and maladaptive coping mechanisms of self-blame and disengagement on the Brief COPE. A quantile regression was generated for each of these outcomes.

RESULTS

Results showed that violent and sexual trauma were experienced by 47.5% and 61.6% of the population sample, respectively. Of those exposed to violent trauma, 27.2% perceived it as extremely severe while 43.4% of those exposed to sexual trauma perceived it as extremely severe. Quantile regressions for self-blame and disengagement showed significance for the 25th percentile of those who experienced violent trauma. Self-blame was significantly associated with the 50th and 75th percentile of those exposed to sexual trauma.

CONCLUSIONS

This evidence supports the value of identifying trauma experienced by individuals with FS as it is associated with specific coping mechanisms that may affect treatment. Identifying prior trauma and resulting coping mechanisms can potentially assist in individualizing care for people with FS.

Impact of the COVID-19 pandemic on the mental health of Nursing students: A systematic review and meta-analysis

BACKGROUND

There is an increased prevalence of mental health problems in various population groups as a result of the COVID-19 pandemic and its consequences, especially regarding anxiety, stress, depression, fear, and sleep disturbances, require to be investigated longitudinally.

OBJECTIVE

This study aimed to determine the impact that the COVID-19 pandemic had on the mental health of Nursing students, as well as to examine other associated factors such as anxiety, fear, sleep disturbances, and coping strategies.

METHOD

This systematic review and meta-analysis were designed following the PRISMA guidelines and were registered in PROSPERO with code CRD42024541904. PubMed, Web of Science, CINAHL, and Scopus electronic databases were utilized. Keywords indexed in the MeSH thesaurus were used (COVID-19, nurs* student and mental health), following the Condition Context Population (CoCoPop) strategy. A total of 3866 studies were obtained of which 36 were selected for inclusion in the review. The Joanna Briggs Institute critical appraisal tool was used to assess the methodological quality of the selected studies, all of which were cross-sectional, finally including those with a cutoff point equal to or greater than 4 out of 8.

RESULTS

The prevalence of total anxiety was found to be 33.6% in the meta-analysis. For depression, the prevalence was 37.92%, and for stress, it was 52.46%. The results of this study show increased levels of stress, anxiety, depression, fear, and sleep disturbances among Nursing students that coincide with the different waves of the pandemic, changes in the study methodology, and the increase or decrease in reports of cases of infection. A relationship is observed between variations in these variables and the implementation of protective measures and vaccinations in different countries.

CONCLUSION

As the pandemic progressed, hygiene and prevention measures became more effective, and the lethality of the virus decreased. The prevalence of the negative psychological effects also decreased from the onset in 2020 until the end of 2022. Due to the impact of the pandemic on global health, preventive measures should include personal, family, emotional, economic, educational, professional, and mental health approaches.

Influence of Coping, Esteem, and Resilience on Caregiver Distress in Pancreatic Cancer Patient-Caregiver Dyads

Background/Objectives: Through survey and analysis of pancreas cancer patient-caregiver dyads, we aimed to identify patient and caregiver characteristics that influence and determine the impact of caregiver coping strategies, self-esteem, and resilience on caregiver distress. Methods: This was a cross-sectional, observational study including pancreatic cancer patients and their caregivers. Demographics of patients and caregivers were collected. Caregivers completed validated instruments (National Comprehensive Cancer Network (NCCN) Distress Thermometer, Caregiver Reaction Assessment (CRA), Perceived Stress Scale 4 (PSS-4), Patient Reported Outcomes Measurement Information System-Anxiety/Depression Short Form (PROMIS-Anxiety/Depression), Brief Resilience Scale (BRS), Zarit Caregiver Burden Interview (CBI-12), and Brief Coping Orientation to Problems Experienced (COPE)) investigating anxiety, depression, perceived stress, caregiver burden, use of approach and avoidant coping, resilience, and self-esteem. Descriptive statistics, univariate, and multiple linear regression models were used to analyze the data. Results: One hundred and fourteen patient-caregiver dyads were included in this study. The majority of patients were male (55%), 65% of caregivers were female, and 64% of patients were receiving palliative intent treatment. Younger caregiver age, more personal care tasks, higher patient distress, and caregiving for a parent were characteristics related to caregiver avoidant coping. Fewer caregiving activities and early clinical stage were associated with caregiver approach coping. High caregivers' self-esteem was significantly associated with fewer personal care tasks to perform and with caregivers of patients with higher levels of education. Avoidant coping and low resilience were both significantly correlated to distress, anxiety, depression, caregiver burden, and perceived stress. Additionally, low self-esteem was associated with a high perceived caregiver burden. Conclusions: Overall, caregiver factors such as age, relationship with the patient, and number of care tasks and activities influence caregivers coping and self-esteem. Additionally, patient education and clinical stage impacted caregiver coping and self-esteem. Developing interventions to address caregiver coping, self-esteem, and resilience will prove beneficial in improving caregiver distress, anxiety, depression, burden, and perceived stress.

Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study

BACKGROUND

The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care.

OBJECTIVE

This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes.

METHODS

A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness.

RESULTS

The findings indicated an evolving trajectory in students' mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=-2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=-2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=-5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=-7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=-8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=-10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03).

CONCLUSIONS

In this study, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students' mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/29561.

Australian Women in the Perinatal Period During COVID-19: The Influence of Self-Compassion and Emotional Regulation on Anxiety, Depression, and Social Anxiety

Objectives: This study examined how self-compassion and emotional regulation strategies have influenced perinatal anxiety, depression, and social anxiety during COVID-19. Methods: A probabilistic sample, determined by convenience criteria of 265 Australian perinatal women completed an online survey containing measures of depression, anxiety, social anxiety, COVID-19 experiences, self-compassion, and emotional regulation strategies. Results: As hypothesised, correlation analyses showed that self-compassion and adaptive emotional regulation strategies were negatively related to anxiety, depression and social anxiety, and maladaptive strategies were positively related. Contrary to predictions, COVID-19-related experiences showed little relationship with mental health outcomes. Parallel mediation analyses showed that self-compassion negatively predicted depression and anxiety and was partially mediated by specific emotional regulation strategies. For social anxiety, self-compassion was fully mediated by emotional regulation strategies. Different emotional regulation strategies were significant mediators of the relationship between self-compassion and each mental health outcome. Conclusions: The findings suggest that reinforcing self-compassion and addressing certain emotional regulation deficits is important in alleviating mental health symptoms among perinatal women.

Coping, meaning in life, and quality of life during ongoing conflict: insights from Israeli populations

BACKGROUND

Conducted in May 2024, this study examines the well-being of Israeli evacuees and non-evacuees from conflict zones. We assess health-related quality of life (HRQoL), meaning in life (MIL), coping strategies, psychological symptoms, and self-mastery. Aims include exploring effects of trauma and socio-demographics on HRQoL and MIL, analyzing mediating roles of psychological symptoms and coping, and evaluating if evacuation status moderates these relationships during ongoing conflict.

METHODS

In May 2024, seven months post-October 7th attacks, we conducted a cross-sectional study with 366 participants (221 evacuated, 145 non-evacuated) via a survey company. We assessed HRQoL (SF-12), MIL (MLQ), psychological symptoms (PHQ-4), self-related and other-related coping strategies (Brief COPE), and self-mastery (Self-Mastery Scale) through self-reported measures. Path and moderated mediation analyses evaluated relationships among socio-demographics, psychological symptoms, coping variables, HRQoL, and MIL.

RESULTS

Except for self-mastery, northern and southern evacuees showed no significant differences and were combined into one group. Path analysis revealed significant associations between traumatic life events, HRQoL, and MIL. Traumatic events were negatively associated with the physical component summary (PCS) of HRQoL and positively with anxiety, depression, and coping (self and others- problem-solving). Depression negatively related to PCS, mental component summary (MCS), and MIL, while coping (self and others) was positively associated with MIL. Moderated mediation analysis showed evacuated participants had higher dysfunctional coping, whereas non-evacuated participants demonstrated a stronger positive relationship between anxiety and the search for meaning.

CONCLUSION

Despite regional differences, evacuees exhibited similar psychological responses, likely due to the shared experience of displacement. Traumatic events negatively impacted their HRQoL and MIL. Adaptive coping strategies-self-related and problem-focused coping through helping others-played significant roles in mitigating these effects. The theoretical frameworks of Conservation of Resources (COR) theory, Taylor's "tend and befriend" model, and Frankl's existential framework provided a basis for explaining these findings.

Building relational well-being: empowering street-connected young people to transition from precarity to security through youth associations

Street-connected young people (SCYP) in Tanzania face intersecting challenges, including economic vulnerability, social marginalisation and limited access to supportive networks. This study examines the impact of the Youth Association (YA) model, implemented by Railway Children Africa, and does so through the lens of the relational well-being approach, which emphasises the interplay of material, relational and subjective dimensions of well-being, as well as personal, societal and environmental drivers of well-being. Using a mixed methods design, this study tracked 116 SCYP in Mwanza and Dar es Salaam, Tanzania, through four stages of the YA model. Quantitative data revealed gains: 71% transitioned into stable housing, 84% reported increased pride and self-worth and 58% initiated income-generating projects. Qualitative insights provided deeper context, capturing participants' reflections on how peer networks and leadership opportunities, and vocational training fostered self-confidence, economic independence and community integration. Participants' recommendations included expanding educational opportunities, enhancing health services and addressing logistical barriers to increase the model's accessibility and impact. This study demonstrates the transformative potential of relationally driven interventions for vulnerable young people. By leveraging existing networks and prioritising relational support, the YA model offers an effective pathway for SCYP to transition from precarity to stability. The findings underscore the importance of participatory approaches and call for further research into the invisible networks of care supporting SCYP, ensuring that future interventions are responsive to their lived experiences and evolving needs.

The Basic Psychological Need Satisfaction and Frustration Scale: Some Satisfying and Frustrating Findings

As a tool for operationalizing basic psychological needs theory (an aspect of self-determination theory), the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS) has become the primary self-report measure. Here, with a sample of 807 Canadian military members, we confirm the BPNSFS six content factor structure and, in supporting that structure, demonstrate the differential association of satisfaction and frustration scales with psychological functioning variables that are external to the factor analysis. Although the specific content interpretation of the BPNSFS can be debated, we support the continued use of the BPNSFS as a psychometrically sound instrument.

Fear of progression, coping strategies, and associated factors among a sample of Malaysian women with breast cancer

Fear of progression (FoP) is a stressful psychosocial condition that affects health and quality of life. Breast cancer is recognized as the most prevalent cancer among women globally. This study aims to determine the prevalence of FoP, coping strategies, and associated factors among Malaysian female breast cancer survivors. A cross-sectional survey was conducted among 242 female breast cancer patients recruited from the south of Malaysia using simple random sampling method. The questionnaire captured sociodemographic characteristics, clinical factors, coping strategies and FoP level. Factors associated with FoP were investigated using multiple logistic regression analysis. The mean age was 55.1 (± 10.9) years. Majority of them were Malays, attained secondary ducation and above, married, unemployed, and in advanced cancer stages. Most patients had low FoP levels, with a smaller proportion having moderate-to-high FoP levels (10.7%). Higher education (AOR = 5.10, P = 0.050), being employed (AOR = 3.85, P = 0.020), advanced can cer stage (AOR = 4.23, P = 0.030), and adoption of avoidant coping strategy (AOR = 1.19, P = 0.009), were associated with higher FoP level. The level of FoP is low among Malaysian females with breast cancer. Higher levels of FoP were associated with higher educational levels, employment status, advanced cancer stage, and utilization of avoidant coping strategies. The fundamental cognitive process mainly affects FoP, rather than disease-related factors.

Are the ways women cope with stressors related to their health behaviors over time?

OBJECTIVE

Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.

METHODS

Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.

RESULTS

Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.

CONCLUSIONS

Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

Resilience Among Caregivers of People With Multiple Sclerosis: Exploring the Influence of Personality Traits, Coping, and Caregiver Burden

BACKGROUND

Resilience has been recognized as a vital protective factor in coping with stress and adversity. Multiple sclerosis (MS) caregiving is a complex and demanding role, often characterized by challenges.

METHODS

Caregivers of people with MS were recruited through health care professionals affiliated with the Jacobs MS Center for Treatment and Research in Buffalo, New York. Resilience was assessed by the Connor-Davidson Resilience Scale (CD-RISC-25) and the Health-Resilience-Stress Questionnaire (HRSQ). We examined the influence of personality traits (NEO Five-Factor Inventory-3), coping strategies (Brief Coping Orientation to Problems Experienced Inventory), quality of life (Adult Carer Quality of Life Questionnaire), and caregiver burden (Zarit Burden Interview) on resilience.

RESULTS

In our study of 98 caregivers (70.4% men; average age, 60 years), 91.8% were partners of people with MS. Out of a maximum score of 100, CD-RISC-25 scores were an average (SD) of 75.5 (14.4) and HRSQ scores were an average of 74.8 (12.9). Quality of life was positively associated with both resilience measures (r = 0.60 for CD-RISC-25; r = 0.70 for HRSQ), whereas higher resilience was linked to lower caregiver burden (r = -0.40 for CD-RISC-25; r = -0.49 for HRSQ). CD-RISC-25 showed higher resilience negatively correlated with neuroticism (r = -0.65) and positively with extroversion (r = 0.57) and conscientiousness (r = 0.59). HRSQ also showed strong negative correlation with neuroticism (r = -0.76) and positive correlations with extroversion (r = 0.60), conscientiousness (r = 0.53), and agreeableness (r = 0.24).

CONCLUSIONS

Caregivers for people with MS showed relatively high resilience levels, positively correlating with quality of life and reduced caregiver burden. Furthermore, resilience correlated inversely with neuroticism and positively with extroversion and conscientiousness. Future research should target personalized interventions, particularly for caregivers with low resilience.

Investigation of the Relationship Between Intolerance of Uncertainty, Metacognitions, Maladaptive Coping, and Fear of Cancer Recurrence via Moderated Mediation Model

OBJECTIVE

In recent years, many studies have investigated the triggers, perpetuating factors, and outcomes of Fear of Cancer Recurrence (FCR), highlighting its complexity with multiple dimensions that encompass both antecedents and consequences. In this sense, the cognitive approach to FCR has explored variables such as metacognition, maladaptive coping strategies, and intolerance of uncertainty (IU). On the other hand, the findings of a restricted number of studies investigating the relationship between FCR and stated variables appear to be inconsistent. The objective of this study was thus to examine the relationship that existed among these variables in breast cancer survivors by moderated mediation model.

METHODS

In this cross-sectional study, 130 breast cancer survivors completed the Fear of Cancer Recurrence Inventory (FCRI), the Intolerance of Uncertainty Scale Short Form (IUS-12), Metacognitions Questionnaire-30 (MCQ-30), and Brief COPE Scale (BCS) Short Form. The mediated moderation analysis was conducted using Process Macro.

RESULTS

There was a significant positive correlation found between FCR and IU (r = 0.87, p < 0.001), and between FCR and negative metacognitions (r = 0.72, p < 0.001). A weak to moderate positive correlation was identified between IU and maladaptive coping strategies (r = 0.19, p < 0.05), and between negative metacognitions and maladaptive coping strategies (r = 0.31, p < 0.001). The relationship between FCR and maladaptive coping strategies was nonsignificant (r = 0.16, p > 0.05). As a result of hierarchical regression analysis, controlling for demographic and clinical variables, IU, positive metacognitions, and negative metacognitions significantly explained 45%, 2%, and 1% of the variance in FCR, respectively.

CONCLUSION

The results of the current study contribute to the literature in terms of supporting the views that cognitive models of worrying could be used to understand the FCR mechanism and address the IU been which has limitedly studied in the FCR literature. The current study's findings have also contributed to the clinical field by highlighting the importance of incorporating breast cancer survivors' metacognitions and IU in FCR intervention programs.