Positive Affect in the Midst of Distress: Implications for Role Functioning

Dissecting the depressed mood criterion in adult depression: The heterogeneity of mood disturbances in major depressive episodes

BACKGROUND

Mood disturbances have historically remained a core criterion in diagnosing major depressive episode. DSMs have illustrated this criterion with depressed, hopeless, discouraged, cheerless, and irritable mood, suggesting interchangeability. Extant research has examined individual forms of mood disturbance to depression severity. Less examined is the heterogeneity in mood disturbances and its implication to their association to depression presentations and outcomes.

METHOD

The current study used a nationally representative sample of U.S. adults with unipolar major depressive disorder to study the association between specific forms of mood disturbances to depression severity, chronicity, or symptoms, above and beyond other forms, as well as their relations to functional impairment, suicidal outcomes, and psychiatric comorbidity via generalized linear models.

RESULTS

Cheerless and hopeless mood were associated with depression severity. Hopeless and irritable mood were associated with depression chronicity. Different forms of mood disturbance showed differential relations to depressive symptoms. Cheerless, hopeless, and irritable mood were associated with depression-specific functional interference, incremental to depression severity. Cheerless, hopeless, and discouraged mood were associated with passive suicidal ideation. Hopeless mood was associated with active suicidal ideation. Hopeless and irritable mood were associated with both suicide plan and suicide attempt. Different forms of mood disturbance demonstrated differential associations to comorbid psychiatric conditions.

DISCUSSION

The relations between different forms of mood disturbances and various aspects of depression are nuanced. Theoretically, these relations highlight the potential utility in acknowledging the complexity and heterogeneity in mood disturbances. Clinically, our results suggest potential utility in routinely monitoring mood disturbances.

Life Satisfaction among the Poorest of the Poor: A Study in Urban Slum Communities in India

This study investigates the level and predictors of life satisfaction in people living in slums in Kolkata, India. Participants of six slum settlements (n = 164; 91% female) were interviewed and data on age, gender, poverty indicators and life satisfaction were collected. The results showed that the level of global life satisfaction in this sample of slum residents did not significantly differ from that of a representative sample of another large Indian city. In terms of life-domain satisfaction, the slum residents were most satisfied with their social relationships and least satisfied with their financial situation. Global life satisfaction was predicted by age, income and non-monetary poverty indicators (deprivation in terms of health, education and living standards) (R2 15.4%). The current study supports previous findings showing that people living in slums tend to report higher levels of life satisfaction than one might expect given the deprivation of objective circumstances of their lives. Furthermore, the results suggest that factors other than objective poverty make life more, or less, satisfying. The findings are discussed in terms of theory about psychological adaptation to poverty.

Does positive affect mediate the association of multimorbidity on depressive symptoms?

Objectives Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Positive affect is a major resource for coping with chronic conditions and for the prevention of depression. Long-term multimorbidity, however, may deplete positive affect. The purpose of this paper is to investigate the role of positive affect in the association between multimorbidity and depressive symptoms.Method We used four consecutive waves (2008, 2011, 2014, 2017) of the nationally representative German Ageing Survey (DEAS) with a total of 1,558 older adults aged 40 and over. To account for time-varying confounding, exposure-induced mediator-outcome confounding, and reciprocities, we applied the mediational g-formula with inverse-probability weighting techniques. We also tested for exposure-mediator interaction to adjust for differences in mediation across the duration of multimorbidity.Results We confirmed a positive longitudinal relation between multimorbidity and depressive symptoms, both of which were negatively associated with while positive affect. The model without interaction indicated a share mediated of ca. 18.3% on the total effect of multimorbidity on depressive symptoms. Addition of interaction led to substantial differences for multimorbidity duration and levels of positive affect. Associations for long-term multimorbidity (at least two survey waves) were more substantial, and the share mediated doubled (>40%). Additionally, the direct effect of multimorbidity on depressive symptoms diminished for short-term multimorbidity.Conclusion Strengthening positive affect could reduce depressive symptoms in those facing multimorbidity. This study also discusses methodological challenges in performing longitudinal mediation analysis. We advise researchers to consider the mediational g-formula and exposure-mediator interaction.

Positive Emotions Experienced on Days of Stress are Associated with Less Same Day and Next Day Negative Emotion

Positive emotions help us during times of stress. They serve to replenish resources and provide relief from stressful experiences. Positive emotions may be particularly beneficial during times of stress by dampening negative emotional reactivity and quickening recovery from stressful events. In this study, we used a daily diary design to examine how positive emotions experienced on days with minor stressful events are associated with same day and next day stressor-related negative emotions. We combined data from the National Study of Daily Experiences II (NSDE II) and the Midlife in the United States survey (MIDUS II), resulting in 1,588 participants who answered questions about daily stressors and emotion across 8 consecutive days. On days when people experienced a stressor and had higher than their average level of positive emotion, they experienced less of a same day increase in negative emotion. Additionally, they experienced less subsequent negative emotion the following day and were less likely to experience a stressor the next day. Results held when adjusting for trait measures of positive and negative emotion. These results suggest that daily positive emotions experienced on days of stress help regulate our negative emotion during times of stress.

Positive and Negative Affects in Living Kidney Donors

OBJECTIVE

This study aimed to identify the factors influencing the positive and negative affects and the health-related quality of life (HRQOL) of living kidney donors.

METHODS

With the use of a cross-sectional study design and a structured questionnaire, information on the basic characteristics, positive affect, negative affect, and HRQOL of 41 living kidney donors were compared.

RESULTS

The negative affect in living kidney donors was similar to that of the general population, but the positive affect was slightly lower. The physical HRQOL of living kidney donors was slightly higher than that of the general population, and the mental HRQOL was similar. Female donors showed a greater positive affect than male donors. The donors who were siblings of the recipients showed a more negative affect. Donors without chronic disease and with good perceived physical health showed improved positive affect, negative affect, and mental HRQOL. Furthermore, living kidney donors with better positive and negative affects showed improved physical and mental HRQOLs.

CONCLUSIONS

Clinical health providers should evaluate and determine the positive affect, negative affect, and quality of life of living kidney donors, especially in men, siblings of the recipients, those with chronic disease, and those with poorer perceived physical health. Moreover, psychosocial interventions should be provided to improve these factors.

Resilience Resources Moderate the Association of Adverse Childhood Experiences with Adulthood Inflammation

BACKGROUND

Exposure to adverse childhood experiences (ACE) has been associated with elevated circulating inflammatory markers in adulthood. Despite the robust effect of ACE on later health outcomes, not all individuals exposed to ACE suffer from poor health.

PURPOSE

The goal of this study was to evaluate whether current resilience resources may attenuate the impact of ACE on inflammatory markers among individuals with elevated C-reactive protein (CRP) levels.

METHODS

Participants (N = 174) completed one-time self-report questionnaires assessing ACE exposure within the first 18 years of life and current resilience resources, and provided blood samples for interleukin-6 (IL-6) and CRP.

RESULTS

Individuals who were exposed to multiple ACE had greater IL-6 than participants with lesser ACE exposure. However, current resilience resources significantly moderated this effect. Among individuals who reported multiple ACE, higher resilience resources were associated with lower IL-6 levels.

CONCLUSION

These data suggest that resilience resources might attenuate the association between ACE and later health outcomes.

Well-Being of Nursing Students: Role of Affect Regulation, Self-Esteem, Family Cohesion and Social Support

Background:

Nursing is a profession often characterized with high level of stress, physical and mental demands at work, which then can bring personal and social strains in nurses’ life. It is important to identify the factors, which can lead to nurses’ better subjective well-being.

Objective:

This study explores the relationship between subjective well-being (life satisfaction, happiness) and set of personal (self-esteem, affect regulation strategies) and social variables (family cohesion, social support).

Method:

411 participants were nursing part-time students, 79% females (M=25 years). They reported life satisfaction, happiness, strategies used by the Measure of Affect Regulation Styles classified into 6 scales: Behavioral, Cognitive, Situation-directed, Affect-directed, Disengagement and Avoidance, Rosenberg Self-Esteem Scale, Family cohesion scale and shortened and adapted version of the Interpersonal Support Evaluation List belonging subscale, their gender, age and socioeconomic status.

Results:

Well-being variables were best predicted positively by behavioral and affect-focused strategies, social support, family cohesion and self-esteem. Both sets of personal and social variables showed similar predictive power.

Conclusion:

The findings of our study showed the importance of personal as well as social variables in predicting well-being among nursing students. Providing strong social support and good family cohesion, as well as using effective regulation strategies and having higher self-esteem would help in improving their life satisfaction and happiness.

Use of Smartphones to Prospectively Evaluate Predictors and Outcomes of Caregiver Responses to Pain in Youth with Chronic Disease

This study examined outcomes and predictors of different types of responses to child pain used by caregivers of youth with chronic disease. Sixty-six children and adolescents (ages 7-18) with juvenile idiopathic arthritis answered questions about pain, pain interference in activities, and mood on a smartphone three times per day for one month, while a caregiver contemporaneously answered questions about their own mood and use of protecting, monitoring, minimizing, or distracting responses to their child's pain. Multilevel models were used to evaluate (a) how a child's pain and pain interference changes after a caregiver uses different types of pain responses; (b) the extent to which caregiver responses to pain vary across days; and (c) whether variability in caregiver responses to pain is predicted by changes in child pain characteristics, child mood, and/or caregiver mood. Results showed that children's pain intensity and pain interference increased following moments when caregivers used more protective responses, whereas children's pain interference decreased following times when caregivers responded with minimizing responses. Caregiver pain responses varied considerably across days, with caregivers responding with more protecting and monitoring responses and fewer minimizing responses at moments when their child reported high levels of pain unpleasantness and pain interference. Caregivers also were found to respond with fewer protective responses at moments when they themselves were in a more positive mood. Implications for clinical recommendations and future studies are discussed.

Coping strategies of nurses in the care of patients with head and neck neoplasms

Abstract OBJECTIVE To understand and describe the experience of the development of coping strategies during the professional life of nurses providing care to patients with facial image alteration. METHOD Descriptive qualitative study with a hermeneutic-dialectic framework conducted in the head and neck ward of a reference hospital in Rio de Janeiro, with the participation of eight nurses and data produced through semi-structured interviews conducted between June and August 2013. RESULTS Three major impressions were found: initial estrangement and complexity, consisting in the care given to patients with facial image alteration; a threshold between estrangement and coping, corresponding to the emergence of coping strategies during care; and image-likeness as a (re)cognition of the individual with facial image alteration in the development and consolidation of coping strategies during care. CONCLUSION Among other contributions, the identification and understanding of coping strategies may contribute to better qualify nursing education and care.

Validation of the Scale of Positive and Negative Experience in a South African student sample

This study investigated the validity of the Scale of Positive and Negative Experience in a South Africa context using a sample of 992 university students. Item fit and unidimensionality of the Positive and Negative Experience subscales were examined using a process of Rasch analysis. Reliability of the subscales was evaluated, and correlations between the Scale of Positive and Negative Experience, the Mental Health Continuum – Short Form, and the Satisfaction with Life Scale were examined. In general, the Scale of Positive and Negative Experience exhibited good Rasch fit and reliability. However, there were two items, one from each Positive and Negative Experience subscales, respectively, that exhibited some problems with Rasch fit. While the substantive effect of these problematic items on reliability was marginal, their identification as problematic corroborated analysis in another study, enjoining, if not their removal, certainly a direction for future research. Overall, the findings serve to both support the notion that in its present form, the Scale of Positive and Negative Experience is a psychometrically sound instrument to measure positive and negative experiences as a facet of well-being among South African university students and to indicate directions for further research on the scale.

Perceptions of guided imagery for stress management in pregnant African American women

Maternal stress during pregnancy has been associated with numerous adverse pregnancy, birth, and health outcomes. Pregnant African American women have been reported to have higher levels of stress compared to other ethnic or racial groups underscoring the need for effective interventions to reduce stress in this population. The purpose of this study was to gain an in-depth understanding of the perceptions of guided imagery (GI) as a technique for stress management in a cohort of pregnant African American women who participated in a GI intervention as part of a larger mixed methods randomized controlled trial. The 12week intervention was a professionally recorded compact disc with four tracks developed and sequenced to reduce stress and associated symptoms. The findings from this descriptive phenomenologic study were derived from daily logs and interviews from 36 participants randomized to the GI group. Participants described the stressful nature of their lives. Results demonstrated pregnant African American women perceived the intervention as beneficial in reducing stress and the associated symptoms. The emergent themes suggested the intervention offered a respite from their stressful lives, reduced the negative emotional responses to stress and enhanced well-being, benefited other areas of their daily life, and provided an opportunity to connect with their baby. The study results support the perceived efficacy of GI as a stress coping intervention. GI is an economic as well as easy to implement, access and use technique that has potential stress coping benefits as perceived by pregnant African American women.

A web-based psychoeducational program for informal caregivers of patients with Alzheimer's disease: a pilot randomized controlled trial

Background

Although several face-to-face programs are dedicated to informal caregivers of persons with dementia, they are not always accessible to overburdened or isolated caregivers. Based on a face-to-face intervention program, we adapted and designed a Web-based fully automated psychoeducational program (called Diapason) inspired by a cognitive approach.

Objective

This study aimed to evaluate through a pilot unblinded randomized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer’s disease (PWAD) based on a mixed methods research design.

Methods

We recruited and randomized offline 49 informal caregivers of a PWAD in a day care center in Paris, France. They either received the Web-based intervention and usual care for 3 months (experimental group, n=25) or only usual care (control group, n=24). Caregivers’ perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression (secondary outcomes) were measured during 3 face-to-face on-site visits: at baseline, at the end of the program (month 3), and after follow-up (month 6). Additionally, semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis.

Results

Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups (P=.98). The experimental group significantly improved their knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25 participants allocated to the experimental group, 17 (71%) finished the protocol and entirely viewed at least 10 of 12 online sessions. On average, participants used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD 270.74). The results of the satisfaction questionnaire showed that most participants considered the program to be useful (95%, 19/20), clear (100%, 20/20), and comprehensive (85%, 17/20). Significant correlations were found between relationship and caregivers’ program opinion (P=.01). Thus, positive opinions were provided by husbands and sons (3/3), whereas qualified opinions were primarily reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral opinions (1/3). Caregivers expected more dynamic content and further interaction with staff and peers.

Conclusions

In this study, quantitative results were inconclusive owing to small sample size. Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers. Caregivers did not rule out their interest in this kind of intervention provided that it met their needs. More dynamic, personalized, and social interventions are desirable. Our recruitment issues pointed out the necessity of in-depth studies about caregivers’ help-seeking behaviors and readiness factors.

Trial Registration

Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286 (Archived by WebCite at http://www.webcitation/6KxHaRspL).

Shared pleasure in early mother-infant interaction: predicting lower levels of emotional and behavioral problems in the child and protecting against the influence of parental psychopathology

Shared pleasure (SP) was analyzed in fifty-eight 2-month-old infants and their mothers in face-to-face interaction (T1, at 2 months). The association of SP with child's emotional and behavioral outcome at 2 years (T2) was examined. SP as a possible protecting factor in the presence of parental psychopathology also was studied. Mean duration of SP moments (SP-MD) was related to subsequent socioemotional outcome of the child: Infants of dyads with longer SP-MD showed fewer internalizing and externalizing problems 2 years later. In hierarchical linear regressions, SP-MD uniquely and significantly contributed to internalizing problems after adjusting for infant and maternal factors and mother's interactive behavior. SP protected the child against the influence of parental psychopathology. Father's mental health problems during the follow-up increased the child's risk for higher externalizing and internalizing problems, but only among children with short SP-MD at T1. Internalizing symptoms at T2 increased when moving from the category "no mental health problems" to "mental health problems in one parent" and further to "mental health problems in both parents," but this increase was found only among those with short SP-MD at T1. SP in parent-child interaction is an important feature that fosters positive psychological development and moderates the health effects of other risks such as parental psychopathology.

Positive psychological determinants of treatment adherence among primary care patients

Background

Patient adherence to medical treatment recommendations can affect disease prognosis, and may be beneficially or deleteriously influenced by psychological factors.

Aim

We examined the relationships between both adaptive and maladaptive psychological factors and treatment adherence among a sample of primary care patients.

Methods

One hundred and one rural, primary care patients completed the Life Orientation Test-Revised, Trait Hope Scale, Future Orientation Scale, NEO-FFI Personality Inventory (measuring positive and negative affect), and Medical Outcomes Study General Adherence Scale.

Findings

In independent models, positive affect, optimism, hope, and future orientation were beneficially associated with treatment adherence, whereas pessimism and negative affect were negatively related to adherence. In multivariate models, only negative affect, optimism and hope remained significant and, in a comparative model, trait hope was most robustly associated with treatment adherence.

Implications

Therapeutically, addressing negative emotions and expectancies, while simultaneously bolstering motivational and goal-directed attributes, may improve adherence to treatment regimens.

Regoaling: a conceptual model of how parents of children with serious illness change medical care goals

BACKGROUND

Parents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child's quality of life. We call this process of transitioning from one set of goals to another regoaling.

DISCUSSION

Regoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care.

SUMMARY

The psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process.

Testing predictive models of positive and negative affect with psychosocial, acculturation, and coping variables in a multiethnic undergraduate sample

Despite the prevalence and popularity of research on positive and negative affect within the field of psychology, there is currently little research on affect involving the examination of cultural variables and with participants of diverse cultural and ethnic backgrounds. To the authors' knowledge, currently no empirical studies have comprehensively examined predictive models of positive and negative affect based specifically on multiple psychosocial, acculturation, and coping variables as predictors with any sample populations. Therefore, the purpose of the present study was to test the predictive power of perceived stress, social support, bidirectional acculturation (i.e., Canadian acculturation and heritage acculturation), religious coping and cultural coping (i.e., collective, avoidance, and engagement coping) in explaining positive and negative affect in a multiethnic sample of 301 undergraduate students in Canada. Two hierarchal multiple regressions were conducted, one for each affect as the dependent variable, with the above described predictors. The results supported the hypotheses and showed the two overall models to be significant in predicting affect of both kinds. Specifically, a higher level of positive affect was predicted by a lower level of perceived stress, less use of religious coping, and more use of engagement coping in dealing with stress by the participants. Higher level of negative affect, however, was predicted by a higher level of perceived stress and more use of avoidance coping in responding to stress. The current findings highlight the value and relevance of empirically examining the stress-coping-adaptation experiences of diverse populations from an affective conceptual framework, particularly with the inclusion of positive affect. Implications and recommendations for advancing future research and theoretical works in this area are considered and presented.

Illness appraisals and depression in the first year after HIV diagnosis

Illness appraisals provide important context to help understand the way individuals cope with chronic illness. In the present study, a qualitative approach to the analysis of HIV diagnosis experience narratives in a sample of 100 people newly diagnosed with HIV revealed five groups that differed in their initial illness appraisals: HIV as Chronic Illness, Concern about Dying, Stigmatization, Threat to Identity, and Other Threats Overshadow HIV. When compared on quantitatively measured depressive mood, the groups differed on level and trajectory over the course of the first year post-diagnosis. Although the experience of living with HIV has changed significantly with the advent of effective Antiretroviral Therapies (ART), there were a number of similarities between the appraisals of this group of participants who were diagnosed post ART and groups who were diagnosed before ART became widely available. Posttest counselors and other HIV service providers should take individual differences in illness appraisals into account in order to help newly HIV-positive clients manage their healthcare and cope adaptively with their diagnosis.