Relationship between coping flexibility and the risk of depression in Indian adults

Ineffective coping (00069): A Walker and Avant conceptual analysis

PURPOSE

To analyze the diagnostic concept of "ineffective coping" (00069) proposed by NANDA-I, using Walker and Avant's framework.

DATA SOURCES

The theoretical framework of Walker and Avant was used for the concept analysis. A search was performed in the Virtual Health Library portal using the keywords "ineffective coping" and "enfrentamento ineficaz."

DATA SYNTHESIS

According to the literature, ineffective coping is defined as an adoption of inadequate psychosocial and behavioral strategies in response to a set of contextual stressors that negatively affect well-being and lifestyle.

CONCLUSIONS

The concept created for ineffective coping has the potential to address the psychosocial elements associated with life experiences in the face of coping mechanisms.

IMPLICATIONS FOR NURSING PRACTICE

This analysis may contribute to the improvement of nursing care for patients experiencing difficult situations in their lives, as well as the challenges of nursing interventions that promote positive adaptation.

Prevalence of mental disorders in South Asia: A systematic review of reviews

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Moderating effect of coping flexibility over waiting patiently as a coping strategy for interpersonal stressors and depressive symptoms

Objective: The present study examined the moderating effect of coping flexibility on the association between the coping waiting patiently for interpersonal stressors and depression. Coping flexibility refers to devising and implementing suitable coping strategies according to the situation, coping was defined in this study as holding oneself back and not acting prematurely to address a stressful relationship. Participants: A total of 481 Japanese college students. Methods: Participants completed questionnaires to measure coping, coping flexibility, perceived stress, and depression using a longitudinal design. Results: Multiple regression analysis showed that an interaction between coping and coping flexibility was associated with depression. This result indicated that higher levels of coping was associated with lower depression 16 weeks later when coping flexibility was higher, but the association was not observed when coping flexibility was lower. Conclusions: Our findings contribute to elucidating the condition or process whereby the strategy of waiting patiently as a coping mechanism for interpersonal stressor reduces depression.

Coping Flexibility and Alcohol-Related Outcomes: Examining Coping Motives as Mediators

Background: Coping has been implicated in the etiology and treatment of problem drinking. Traditional, static measurement of coping styles (e.g., approach, avoidance, social support) may fail to capture how adaptive a given coping style may be. Coping flexibility is an emerging construct, associated with psychological health, and one that may shed light on coping's role in drinking risk. Coping flexibility includes (1) discontinuation of an ineffective coping strategy ("Discontinuation") and (2) production of an alternative strategy ("Implementation"). This study is the first to our knowledge to examine its association to drinking outcomes. Further, because coping deficits are theorized to lead to drinking through coping motives, we also examined mediated pathways from coping flexibility to alcohol outcomes via coping motives. Methods: College students (N = 528) completed an online assessment. Data were analyzed using path analysis. Control variables included sex and coping styles. Results: In path analytic models, Implementation was negatively associated with alcohol use and, indirectly via coping motives, negatively associated with alcohol consequences. The direct effect on alcohol use remained when controlling for coping styles and sex, but the mediational pathway was no longer significant. Conclusions: This study provides some evidence for the protective role of coping flexibility in alcohol use behavior, which may have implications for how best to address coping skills in alcohol interventions. The direct effect of Implementation on drinking suggests that there may be utility in teaching clients a flexible approach to coping in treatment. Replication, particularly with longitudinal designs, is needed.

Coping with Stress, Executive Functions, and Depressive Symptoms: Focusing on Flexible Responses to Stress

Coping flexibility is conceptually similar to both inhibition and set-shifting. Though they serve different functions, all three are robustly associated with depression. Coping flexibility is the ability to relinquish a coping strategy regarded as ineffective and to devise and implement an alternative one; the concept is based on stress and coping theory. Inhibition is the ability to suppress responses selectively according to a change in the situation, while set-shifting is the process of switching flexibly between task sets, mental sets, or response rules. Inhibition and set-shifting are both executive functions in cognitive mechanisms. We hypothesized that coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. In total, 200 Japanese university students (100 women and 100 men) completed questionnaires that measured coping flexibility and depression and performed the Stroop Color and Word Test and the Wisconsin Card Sorting Test, which measured inhibition and set-shifting. We found that greater coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. Our findings suggest that, although coping flexibility is conceptually similar to inhibition and set-shifting, its association with depression differs from theirs.

Moderation Effects of Coping Flexibility on the Association Between Depressive Symptoms and Suicidal Risk

Background: This study focused on poor coping flexibility, which involves the perseveration of a failed coping strategy, as a moderator of the association between depression and suicidal risk; no study has previously examined the association between coping flexibility and suicidal risk. Aims: This study examined whether individuals with lower coping flexibility would have a stronger suicidal risk when experiencing depression above a certain level. Method: Participants, who were 682 college students, answered questionnaires regarding coping flexibility, depressive symptoms, and suicidal risk. Results: Hierarchical multiple regression analyses showed that in individuals with greater depressive symptoms, lower coping flexibility was associated with higher suicidal risk, but this was not the case in individuals without depressive symptoms. Our hypothesis was supported. Limitations: Our findings cannot indicate the causal direction of the association between coping flexibility and depressive symptoms and suicidal risk. Conclusion: Our findings may be useful in understanding the association between depression and suicidal risk through coping flexibility and contribute to reductions in suicidal risk, as coping flexibility can be improved through training.

Risk factors for severity of depression in participants with chronic medical conditions in rural primary health care settings in India

Background

Depression and chronic medical disorders are strongly linked. There are limited studies addressing the correlates of the severity of depression in patients with co-morbid disorders in primary care settings. This study aimed to identify the socio-demographic and disease-specific risk factors associated with the severity of depression at baseline among patients participating in a randomized controlled trial (HOPE study).

Methods

Participants were part of a randomized controlled trial in 49 primary care health centers in rural India. We included adults (≥ 30 years) with at least mild Depression or Anxiety Disorder and at least one Cardiovascular disorder or Type 2 Diabetes mellitus. They were assessed for the severity of depression using the PHQ-9, severity of anxiety, social support, number of co-morbid chronic medical illnesses, anthropometric measurements, HbA1c, and lipid profile.

Results

Proportionately there were more women in the moderate category of depression than men. Ordinal logistic regression showed co-morbid anxiety and a lower level of education significantly increased the odds of more severe depression, while more social support was significantly negatively associated with depression severity in women. In men, anxiety was positively associated with greater depression severity; while reporting more social support was negatively associated with depression.

Limitations

This is a cross-sectional study and thus, no causal conclusions are possible.

Conclusions

Anxiety and poor social support in both genders and lower educational levels in women were associated with increased severity of depression. Early identification of risk factors and appropriate treatment at a primary care setting may help in reducing the morbidity and mortality associated with depression.

Flexibility in using self-regulatory strategies to manage self-control conflicts: The role of metacognitive knowledge, strategy repertoire, and feedback monitoring

For regulating emotion, it has been shown that people benefit from being flexible in their use of emotion regulation strategies. In the current study, we built on research focused on regulatory flexibility with respect to emotions to investigate flexibility in the use of self-regulatory strategies to resolve daily self-control conflicts. We investigated three components of flexibility: (1) metacognitive knowledge, (2) strategy repertoire, and (3) feedback monitoring. In a 10-day experience sampling study, 226 participants reported whether they had, within the past hour, experienced a self-control conflict of initiating an aversive activity, persisting in it, or inhibiting an unwanted impulse in response to a temptation. Results support the hypothesis that higher levels of all three components of flexibility are associated with higher levels of success in managing daily self-control conflicts, except for strategy repertoire and feedback monitoring in conflicts of persistence. Results also support the hypothesis that higher levels of trait self-control are associated with higher levels of metacognitive knowledge and feedback monitoring for conflicts of initiation, but not for conflicts of persistence and inhibition. We found no evidence of an association between trait self-control and strategy repertoire. These findings demonstrate the importance of flexible strategy use during daily self-control conflicts.

Testing of a Dual Process Model to Resolve the Socioeconomic Health Disparities: A Tale of Two Asian Countries

A wealth of past studies documented that individuals of lower socioeconomic status (SES) are more susceptible to both acute and chronic life stress than those of higher SES, but some recent evidence documents that not all individuals from the lower SES group experience immense stress. The present study was grounded in theories of coping and psychological adjustment, and a dual process model was formulated to address some resolved issues regarding socioeconomic disparities in health. For a robust test of the proposed dual process model, data were collected from two Asian countries—Hong Kong and Indonesia—with different socioeconomic heritage and conditions. Consistent with the predictions of our model, the present findings revealed that coping flexibility was a psychological mechanism underlying the positive association between social capital and health for the lower SES group, whereas active coping was a psychological mechanism underlying this positive association for the higher SES group. These patterns of results were largely replicable in both Asian samples, providing robust empirical support for the proposed dual process model.

Examination of the Coping Flexibility Hypothesis Using the Coping Flexibility Scale-Revised

Coping flexibility, as defined by the dual-process theory, refers to one’s ability to relinquish a coping strategy recognized as ineffective—abandonment—and to devise and implement an alternative and more effective strategy—re-coping. The coping flexibility hypothesis (CFH) dictates that richer coping flexibility produces more adaptive outcomes caused by stress responses, such as reduced psychological and physical dysfunction. We tested the reliability and validity of the Coping Flexibility Scale-Revised (CFS-R) and the CFH using the CFS-R, which was developed to measure coping flexibility. In total, we performed three studies involving 6,752 participants. Study 1 provided the psychometric properties of the CFS-R and tested this factorial structure by a confirmatory factor analysis. Study 2 estimated the validity of the CFS-R by examining the associations between its three subscales and variables that were conceptually similar to them. Study 3 tested the CFH using a longitudinal design after controlling for the effects of typical coping strategies and other types of coping flexibility. Overall, the CFH was supported by the use of the CFS-R, and the findings in Studies 2 and 3 showed that it had acceptable validity and reliability. Our findings implied that abandonment and re-coping can predict reduced depressive symptoms more than other types of theoretical framings for coping flexibility. Additionally, a meta-analysis of the Cronbach’s alphas for all samples in this study (k = 9, N = 6,752) showed that they were 0.87 (95% CI [0.87, 0.88]) for abandonment, 0.92 (95% CI [0.91, 0.92]) for re-coping, and 0.86 (95% CI [0.85, 0.87]) for meta-coping.

Effects of waiting patiently as coping strategy for an interpersonal stressor on depressive symptoms

Background: Coping behavior is known to moderate the effect of stressors on depressive symptoms. Increased reassessing coping, that is, waiting patiently for an appropriate opportunity to handle a stressful relationship, as coping strategy for interpersonal stressors is associated with lower depressive symptoms. Objectives: We hypothesized that higher reassessing coping would be associated with lower depressive symptoms in individuals with higher coping flexibility. Coping flexibility is the ability to discontinue a coping strategy that produces undesirable outcomes by monitoring and evaluating stressful situations and the effects of coping strategies. Methods: Two studies involving approximately 1,800 college students were conducted, one using a cross-sectional design (n = 281) and another a longitudinal design (n = 1,468). Results: In both studies, hierarchical multiple regression analyses showed that the interaction between reassessing coping and coping flexibility scores was predictive of a significant depressive symptom score. This indicates that higher levels of reassessing coping are associated with lower levels of depressive symptoms when coping flexibility is higher, whereas reassessing coping is not associated with depressive symptoms when coping flexibility is lower. Conclusions: These results were consistent with our hypothesis in both studies.

Quantitative and Qualitative Evaluations of the Enhanced Logo-autobiography Program for Korean-American Women

This study extends Bernstein et al.'s (2016) investigation of the effects of the Enhanced Logo-autobiography Program on Korean-American women's depressive symptoms, coping strategies, purpose in life, and posttraumatic growth by analyzing quantitative and qualitative data. This study's participants significantly improved on quantitative measures of depression, coping strategies, purpose in life, and post-traumatic growth at eight weeks post-intervention and follow-up. The qualitative content analysis revealed 17 themes with five essential themes. The program's activity to promote purpose in life through posttraumatic growth facilitated participants' recovery from traumatic experiences. Standardized guidelines are needed to conduct this program in Korean community centers.

Effects of coping flexibility on cardiovascular reactivity to task difficulty

OBJECTIVE

Coping flexibility refers to an individual's ability to effectively modify his or her coping behavior to better fit the nature of each stressful situation they encounter. More flexible coping is believed to produce more adaptive psychological functioning and physical health.

METHODS

We examined the relationship between coping flexibility and cardiovascular reactivity (CVR) to psychological stress. Challenging tasks of two difficulty levels were presented to 24 men and 24 women aged 18 to 24years. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure were measured.

RESULTS

Change scores (from baseline to reactivity) for SBP and HR responses in the difficult task were higher than those in the easy task and were negatively correlated with coping flexibility during the difficult task but not the easy one.

CONCLUSIONS

The findings suggest that more flexible coping is associated with reduced CVR to a difficult task.