Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis

BACKGROUND

Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed.

AIMS

The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents.

METHODS

Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators.

RESULTS

The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17).

CONCLUSIONS

These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

Embracing Emotional Pain: A Case Study of Adolescent Suicidality and Spirituality

BACKGROUND

Suicidality continues to be the second leading cause of adolescent death. Nurses are in a prime position to address the emotional pain associated with adolescent suicidality but report skepticism and discomfort. Moreover, spirituality is identified as a protective factor against suicidality, yet a gap exists related to exploring spirituality within the context of the emotional pain associated with adolescent suicidality. Building awareness of adolescents' spirituality and emotional pain associated with suicidality is essential to address nurse skepticism and discomfort.

AIMS

The purpose of this study was to explore young adults' experiences of suicide attempt(s) during adolescence in the context of spirituality using a case study application of participant narratives to Minton and Antonen's B.L.E.S.S. acronym.

METHOD

A multiple-case study design was used to provide an alternative perspective for understanding adolescent suicidality from a spiritual context. Reed's theory of self-transcendence and the B.L.E.S.S. acronym guided the analysis and interpretation. Convenience online sampling resulted in six adult participants who provided email narratives of their adolescent experiences. Email data collection was guided by Fritz and Vandermause. Analysis of participant narratives followed the protocol of Baxter and Jack.

RESULTS

Participant's narratives revealed self-transcendence that paralleled the five truths about emotional pain and spirituality inherent in the B.L.E.S.S. acronym.

CONCLUSION

This case study provides nurses a guide for counteracting the barriers of skepticism and stigma to promote help-seeking behavior associated with adolescent suicidality. Further research is needed for the application of the B.L.E.S.S. acronym with other population samples.

Spirituality, Trait Gratitude, and Post-Traumatic Growth in Iranian Veterans with PTSD: The Mediating Role of Ego Resilience

In Iran, spirituality is one of the most critical factors affecting veterans' health. The present study aimed to determine the mediating role of ego resilience in the relationship between spirituality and trait gratitude with post-traumatic growth in Iranian veterans with PTSD. In the present descriptive and correlational study, 300 veterans with PTSD were hospitalized and treated at Isar Psychiatric Hospital in Ardabil in 2021 and were selected as the sample. Data were collected using Tedeschi and Calhoun's Traumatic Developmental Questionnaire, Parsian and Dunning, Mc Cullough et al.'s Trait Gratitude Questionnaire, and Block et al.'s Ego Resilience Questionnaire. Based on the obtained results and various fit indices, the direct and indirect relationships between spirituality, trait gratitude, ego resilience, and post-traumatic growth in veterans with post-traumatic stress disorder were confirmed (p < 0.01). Also, spirituality and trait gratitude through ego resilience indirectly affected the post-traumatic growth of veterans with PTSD (P < 0.05). Thus, targeting these three components through psychological therapies may effectively increase post-traumatic growth in veterans experiencing trauma.

Hope, optimism, gratitude, and wellbeing among health professional minority college students

Objectives: To (1) describe the level of hope, optimism, and gratitude in a sample of minority health professional college students. (2) To examine the association between hope, optimism, and gratitude with wellbeing domains.

PARTICIPANTS

One hundred and thirty-two (n = 132) college students from the Nursing, Medicine, and Allied Health programs.

METHODS

Cross-sectional survey study assessed wellbeing across the five domains of positive emotion, engagement, relationships, meaning, and accomplishment.

RESULTS

Mean and Standard Deviation on hope, optimism, and gratitude were 50.2 ± 5.6; 21.7 ± 4.34; and 36.3 ± 5.35, respectively. Hope, optimism, and gratitude were positively associated with domains of wellbeing, controlling for gender and age.

CONCLUSION

Students maintained a positive outlook in life. Hopeful, op6timistic, and grateful students experienced positive emotion, were more engaged in their daily activities, had more supportive relationships, had a better sense of direction in life, and more often accomplished their goals. Interpretations and future directions are discussed.

Temporal relationships between changes in depression and suicidal ideation: A mediation analysis in a randomized double-blinded clinical trial

OBJECTIVES

There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition.

DESIGN

This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation.

METHOD

Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0-2-7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model.

RESULTS

The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0-2 and Δ 2-7) via the early improvement of depressive symptoms (Δ 0-2).

CONCLUSIONS

The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.

Risk factors for suicide attempts among U.S. military veterans: A 7-year population-based, longitudinal cohort study

BACKGROUND

Population-based data on risk factors for suicide attempts among veterans remains limited.

METHODS

A national probability sample of 2307 veterans was followed over the course of four timepoints spanning seven years to examine how a range of baseline risk factors predict incident suicide attempt. Suicide attempt data were aggregated into a single follow-up timepoint.

RESULTS

Sixty-two veterans (3.1%) reported attempting suicide during the 7-year period. The strongest risk factors for suicide attempts were higher baseline levels of loneliness, lower baseline levels of adaptive psychosocial traits (e.g., dispositional gratitude), baseline thoughts of self-harm, and greater post-baseline trauma exposures (12.3%-41.3% of explained variance). Veterans with multiple co-occurring risk factors were at greatest risk for attempts; of veterans with 0, 1, 2, 3, and all 4 of these factors, the predicted probability of suicide attempt was 2.0%, 5.3%, 13.5%, 30.4%, and 55.0%, respectively.

CONCLUSIONS

Baseline loneliness, dispositional gratitude, thoughts of self-harm, and new-onset traumas emerged as the strongest risk factors for suicide attempts among veterans, underscoring the potential importance of targeting these factors in prevention efforts. Veterans with multiple co-occurring risk factors have substantially greater risk for suicide attempts, suggesting that examination of multiple coinciding vulnerability factors may help improve suicide risk prediction models.

Is Gratitude Associated With Suicidal Ideation in Veterans With Mental Illness and Student Veterans With PTSD Symptoms?

ABSTRACT

The present study is aimed to identify the effect of gratitude as an adaptive regulating mechanism from suicidal ideation (SI) for veterans with mental illness (study 1) and student veterans with posttraumatic stress disorder (PTSD) symptoms (study 2) in the United States. Descriptive statistics and regression analyses were used to examine sociodemographic characteristics and relationships between gratitude and SI. Our study 1 consisted of 156 veterans with mental illness. The mean age for study 1 was 37.85. Our study 2 consisted of 232 student veterans with PTSD symptoms. The mean age for study 2 was 28.43. Higher gratitude scores in study 1 and study 2 were significantly associated with lower SI scores after adjusting for demographics and depression. This study partially supports the association between gratitude and SI in veterans with mental illness. Based on the results from this study, gratitude interventions may be effective in reducing SI when working with veterans with mental illness.

Gratitude and suicide risk among college students: Substantiating the protective benefits of being thankful

Gratitude, or thankfulness for positive aspects of life, is related to psychosocial well-being and decreased psychopathology, and may reduce suicide risk. We explored four potential hypotheses purported to explain the beneficial outcomes of gratitude (schematic, positive affect, broaden-and-build, and coping), hypothesizing that hopelessness (schematic), depression (positive affect), social support (broaden-and-build), and substance use (coping) would mediate the gratitude-suicide linkage. Participants: 913 undergraduate students from a mid-size, southeastern U.S. university. Methods: Respondents completed online self-report questionnaires including the Suicidal Behaviors Questionnaire-Revised, Gratitude Questionnaire, Beck Hopelessness Scale, Beck Depression Inventory, Duke Social Support Index, Alcohol Use Disorders Identification Test, and Drug Abuse Screening Test. Results: Supporting theory and hypotheses, gratitude was related to less suicide risk via beneficial associations with hopelessness, depression, social support, and substance misuse. Conclusions: The linkage between gratitude and suicide risk appears to be predicated on the beneficial association of gratitude to negative mood and interpersonal functioning.

A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence

Resilience is the psychological capability to recover from difficulties quickly. Healthcare professionals are especially vulnerable to job-related stress and burnout. Unitary Caring Science is the framework for Watson's Human Caring Theory, providing a philosophy of practice in healthcare. With the high rates of clinician burnout and psychological issues, it will be significant to unify the human caring theory with research-informed psychological and neuroscience evidence to develop clinicians' resilience-building strategies. The purpose of this article is to introduce a Unitary Caring Science Resilience Model and explain the science behind the core strategies based on Unitary Caring Science philosophy and the psychological and neuroscience research. This model includes six strategies: Embracing loving-kindness for self and others; Nurturing interpersonal and intersubjective connections/relations; Deepening a creative use of self and sense of belonging; Balancing self-learning, self-awareness, and an evolved self-consciousness; Valuing forgiveness and releasing negativity; Inspiring and maintaining faith-hope. The caring-theory guided resilience-building strategies are proven to alleviate the depletion of clinicians' energy and emotions. Healthcare practices are challenging but rewarding. Clinicians can be emotionally, psychologically, and physically exhausted if they always consider themselves 'giving' and 'doing' institutional tasks without a sense of purpose or fulfillment. The practice can be rewarding if it becomes more aligned with clinicians' value to serve humanity. Through the unitary caring science resilience strategies, clinicians can build resilience as an antidote to clinician burnout and depletion.

Relationship of Self-Compassion, Hope, and Emotional Control to Perceived Burdensomeness, Thwarted Belongingness, and Suicidal Ideation

Background: Cultivating positive feelings of self in relationships with others can affect perceptions of belongingness and burdensomeness. Aims: The present study examines the relationships of self-compassion, hope, and emotional control to thwarted belongingness, perceived burdensomeness, and suicidal ideation. Method: Participants were 481 college students who completed scales measuring self-compassion, hope, emotional control, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Results: Correlation and parallel mediation analysis results show relationships between self-compassion, hope, and emotional control with perceived burdensomeness, thwarted belongingness, and suicidal ideation. Limitations: The study is limited by its cross-sectional design, sample demographics, and inability to distinguish between individuals with suicidal ideation and those who attempt suicide. Conclusion: The results show that the relationships of self-compassion, hope, and emotional control to perceived burdensomeness, thwarted belongingness, and suicidal ideation are worth further investigation.

Optimism and gratitude on suicide risk in Spanish adults: Evidence for doubling up or doubling down?

OBJECTIVE

The present study examines the role of optimism and gratitude as predictors of suicide risk, namely depressive symptoms and suicide ideation. Beyond their expected predictive role, optimism and gratitude were also hypothesized to interact together to predict both suicide risk outcomes.

METHODS

A sample of 1,013 Spanish adults (521 females) participated in this study. The average age was 39.63 years old (standard deviation = 16.19; range 16-82).

RESULTS

Results indicated that the optimism × gratitude interaction term significantly augmented the prediction of both depressive symptoms and suicide ideation. Specifically, pessimists presented with a higher risk of suicide, but the effect was weaker among those individuals with higher levels of gratitude. Alternatively, optimists with high gratitude showed the highest amount of protection from suicide risk.

CONCLUSIONS

Our findings are the first to show how optimism and gratitude might interact as a positive psychological variable to confer greater personal resources in protecting individuals against suicide risk.

What character strengths are protective factors for suicidal ideation?: A cross-sectional study in Japan

One factor that has been studied as a protective factor for suicide is character strength and there are many studies that examined the relationship between gratitude and suicide. The problem of character strength research on suicide prevention is that the link between various character strengths and suicide has not been comprehensively examined. We explored which character strength is associated with suicidal ideation. The study is a cross-sectional, self-administered questionnaire survey. Participants were 2,000 Internet users in Japan aged 20 years or older. The online survey covered suicidal ideation, character strengths and demographic details. A hierarchical multiple regression analysis was performed with the suicidal ideation as the dependent variable and character strengths as the independent variable. A significant regression equation was found (F (22, 1977) = 64.65, P < 0.001), with an R² of 0.42. 'Engagement' (B = -0.38, P < 0.001), 'Love' (B = -0.33, P = 0.001), and 'Risk-taking' (B = 0.40, P < 0.001) were significant predictors of suicidal ideation. The positive trait of being able to actively engage with people and build a loving relationship could be a protective factor for suicide.

The Brief COPE: Factor Structure and Associations With Self- and Other-Directed Aggression Among Emerging Adults

The Brief COPE has seen frequent use across populations despite lack of confirmatory factor-analytic examination. We further examine Brief COPE validity with respect to self- and other-directed aggression because emerging adulthood represents a distinct developmental time period in which stress, poor coping, and aggression intersect. Drawing on archival data (n = 576) from a larger investigation of college student health, this cross-sectional survey study tested (1) four competing Brief COPE factor structures, (2) Brief COPE factor associations with aggression, and (3) stress by coping interactions predicting aggression outcomes. Prominent findings included (1) poor-to-marginal confirmatory factor-analytic support for a four-factor structure; (2) positive bivariate associations of avoidant coping with elevated stress, depression, suicide, self-injury, and aggression; (3) positive bivariate associations between adaptive coping strategies with stress and aggression; and (4) an interaction where avoidant coping has a stronger association with other-directed aggression for those low in stress. The interaction findings were significant for males only and applied specifically to hostility. Findings are contextualized within future Brief COPE research as well as emerging adulthood theory.

Rumination's effect on suicide ideation through grit and gratitude: A path analysis study

The current study documents the relationship between suicide ideation, grit and gratitude, and rumination subtypes of brooding and reflection. The relationship between rumination and suicide ideation has been well documented and previous research has demonstrated that grit and gratitude are protective factors against suicide. We hypothesized that both subtypes of rumination would have an indirect effect on suicide ideation through levels of grit and gratitude. Results of a conditional indirect effects path analysis indicated that brooding was indirectly related to suicide ideation through gratitude. Brooding interacted with grit such that it only predicted suicide ideation at low levels of grit. Reflection interacted with gratitude to predict levels of grit. Results suggest that brooding may impact suicide risk and resilience through its effect on gratitude, indicating important cognitive-behavioral targets for suicide prevention strategies. These results extend the literature about the relationship between well known risk factors for suicide and protective factors.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.

Psychometric Characteristics of the Wish to Be Dead Scale (WDS) in Iranian Psychiatric Outpatients

The Wish to be Dead Scale (WDS) was administered to a convenience sample of 200 Iranian psychiatric outpatients. Using a Principal Component Analysis, two factors were identified, labeled Lack of purpose in life (F1), and Lack of interest in living (F2). The WDS had good reliability and significant positive correlations with scores on the Beck Suicide Ideation Scale and with other measures of mental ill-health. This study provides evidence of the usefulness of the WDS for assessing psychiatric patients.