Exploring the Role of Coping Strategies on the Impact of Client Suicide: A Structural Equation Modeling Approach

Client suicide refers to cases where a mental health practitioner is exposed, affected, or bereaved by a client's suicide and is known to have a profound impact on MHPs. The current study investigated the role of coping styles in understanding short- and long-term impact of client suicide. An international sample of 213 mental health practitioners who experienced a client suicide completed a survey on coping strategies (i.e., Brief-COPE) and the impact of traumatic events (i.e., impact of event scale-revised, long-term emotional impact scale and professional practice impact scale). Results indicate coping strategies explain 51% of the short-term, 64% of the long-term emotional and 55% of the long-term professional differences in impact of client suicide. Moreover, while an Avoidant coping style predicted more impact of client suicide, Positive coping and Humor predicted less impact of client suicide. Social Support coping did not predict impact of client suicide. Implications for both research and clinical practice are discussed.

The Relationship Between the Humor Styles of Nurses and Psychological Well-Being During the COVID-19 Pandemic Period

BACKGROUND

The previous studies have revealed that the psychological state of nurses, who work in the front line, is negatively affected by the situations that created high pressure such as epidemics and disasters in the past.

OBJECTIVES

The aim of the study was to determine some characteristics that affect nurses' humor styles and psychological well-being during the COVID-19 pandemic period, and to determine the relationship between humor styles and psychological well-being.

METHOD

The research was conducted in a cross-sectional study. The sample of the study consists of 260 nurses from a city in eastern Turkey. The data have been collected by using a personal information form, the Humor Styles Scale, and the Psychological Well-Being Scale in the study. Frequency, arithmetic mean, minimum and maximum, correlation analysis t test in the independent groups, 1-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test have been used in the analysis of the data. This study aligns with the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

RESULTS

It is determined that the mean age of the nurses is 28.35 ± 6.19 years, and the age range is between 20 and 47 years. It is determined that there is a statistically significant positive relationship between "self-improving humor" and "participatory humor," which are among the harmonious/positive humor styles of the nurses, and the total Psychological Well-Being Scale score (P < .05). It is determined that there is a statistically significant negative relationship between "aggressive humor," which is one of the inharmonious/negative humor styles, and the total Psychological Well-Being Scale score (P < .05).

DISCUSSION

The results support that nurses' use of self-enhancing and participatory humor contributes to psychological well-being.

Do humour styles moderate the association between hopelessness and suicide ideation? A comparison of student and community samples

Research has found that humour styles can moderate the relationship between various facets of mental health and well-being. Most of these studies have used college student samples, however, and the generalizability of these findings has not been firmly established. This study examined how humour styles moderate the relationship between hopelessness and suicide ideation in both student and community samples. Community participants from the U.S. and Canada (n = 554) and student participants from a Canadian university (n = 208) completed several self-report measures including the Humor Styles Questionnaire. Analyses revealed differences in humour styles between the samples, as well as differences in humour styles between men and women. Regression analyses showed that self-defeating humour moderated the relationship between hopelessness and suicide ideation for student participants but not for community participants. Conversely, self-enhancing humour moderated the relationship between hopelessness and suicide ideation for community participants but not for student participants. These results suggest that high levels of self-defeating humour and self-enhancing humour may be uniquely maladaptive for these respective samples. These and other findings point to the necessity of recruiting diverse samples to better understand the beneficial and detrimental associations between humour styles and mental health. The potential to use measures of humour style as a tool to help identify at-risk individuals and to inform the development of intervention programs is discussed.

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.

Understanding the Association Between Humor and Emotional Distress: The Role of Light and Dark Humor in Predicting Depression, Anxiety, and Stress

Despite increasing interest in the relationship between humor and psychological distress, investigations have failed to focus on specific categories of humor and negative mental conditions. A sample of 686 Italian participants (187 men and 499 women), aged between 20 and 76 years, completed an online survey, data from which was used to investigate the relationship between eight comic styles, depression, anxiety, and stress. Findings from the multiple linear regression demonstrate benign humor as a protective factor of all three variables considered, while irony was positively associated with anxiety and stress. Wit was a protective factor associated with anxiety, while sarcasm was positively related to depression. No significant correlations emerged between the other variables considered. These findings highlight how specific categories are linked to varying dimensions of emotional distress, which are discussed with reference to the extant literature.

The Moderating Role of University Students' Humor Styles on the Association between General Mental Health and Subjective Well-Being

This study investigated the associations among humor styles, general mental health (GMH), and subjective well-being (SWB) in a non-clinical sample of 662 university students (Mage = 21.35, SD = 4.14; 66.3% females) attending Greek public universities, via an online survey. In addition, it investigated possible moderating effects of humor styles in the association between GMH and SWB as well as gender differences. Positive correlations emerged between GMH and SWB, as well as among GMH, SWB, and benign humor styles. Malignant humor styles had a negative correlation with both GMH and SWB. The use of aggressive and self-defeating humor moderated the association between GMH and SWB in that at low levels of these humor styles the link between GMH and SWB was stronger. Finally, males scored higher on self-enhancing and aggressive humor than females. The findings expand previous research and are discussed in terms of their implications.

"Beyond laughter": a systematic review to understand how interventions utilise comedy for individuals experiencing mental health problems

Introduction

There is evidence for the impact of comedy and humour for mental health and wellbeing. Existing systematic reviews have concluded laughter has a positive impact on wellbeing, however other potential benefits of comedy interventions have remained under explored. The aim of the current study was to synthesise current evidence for comedy/humour interventions and evaluate mechanisms through which comedy interventions may impact upon the recovery of those experiencing psychological distress, using the Connectedness, Hope, Identity, Meaning and Purpose and Empowerment (CHIME) framework.

Methods

Five electronic databases were searched for studies exploring the impact of interventions using comedy on wellbeing and mental health recovery, from earliest record until January 2023. Grey literature was obtained via contacting experts in comedy interventions for mental health and supplemented by an internet search for comedy interventions. To be eligible for inclusion, studies had to include primary data, published in English or German, and explore a population of adults, with self-reported distress or a self-reported/diagnosed mental health condition. Studies included only explored interventions which utilised comedy as the main intervention and aimed to induce 'simulated' laughter, in response to a stimulus. 17 studies were included in the review.

Results

Studies were found to have positive impact on mental health symptoms and several mechanisms of the CHIME framework for recovery, including connectedness, hope, identity and empowerment. Potential theorised mechanisms for change included confidence in new skills, promotion of social skills, opportunities for social interaction, laughter, vulnerability, and cognitive flexibility. The current review found that comedy/humour interventions are beneficial for mental health recovery and wellbeing and found preliminary evidence for a range of mechanisms through which comedy may have positive impact.

Discussion

Further research should focus on qualitative exploration of the mechanisms by which comedy interventions may have impact on wellbeing and mental health recovery for specific populations and within different settings. It is concluded that there is a need for transdisciplinary collaboration in research on comedy interventions, which brings together the expertise of comedians delivering/developing interventions, those with lived experience of mental health issues and researchers from both health sciences and humanities disciplines.

Self-efficacy beliefs in managing positive emotions: Associations with positive affect, negative affect, and life satisfaction across gender and ages

Two studies were carried out on a Spanish population to explore the extent to which different self-efficacy beliefs in managing positive emotions are associated with common indicators of wellbeing, such as positive and negative affect or life satisfaction. The first study was conducted on 483 participants and attested to the factorial structure of three different self-efficacy beliefs: (a) perceived self-efficacy in expressing positive emotions; (b) perceived self-efficacy in retrieving memories of positive emotional experiences; and (c) perceived self-efficacy in using humor. The second study was carried out on 1,087 individuals between 19 and 80 years of age, and it provided evidence of the factorial invariance of the scales across age and gender. Furthermore, this latter study showed the association of self-efficacy in managing positive affect (SEMPA) with high chronic positive and low negative affect, and with high life satisfaction, controlling for gender and age. In younger participants, stronger associations were found between perceived self-efficacy in using humor and life satisfaction compared to older subjects. These findings may guide the design of interventions aimed at enhancing the potential benefits that could be drawn from the proper management of positive emotions.

Humour Against Binge Drinking During the COVID-19 Pandemic: A Cartoon-Based Anti-Alcohol Health Campaign Targeting Women-Who-Have-Sex-With-Women

This study focuses on the role of humour in health and well-being of women-who-have-sex-with-women (WSW) during COVID-19. This group has been shown to be vulnerable to alcohol abuse, especially as self-medication coping with social consequences of the COVID-19 pandemic. We investigated the potential usefulness of WSW-inclusive (i.e., depicting a female-female romantic couple) versus hetero-normative (i.e., depicting a male-female romantic couple) humorous cartoons in an anti-alcohol health campaign against excessive drinking among WSW. One-hundred-and-twenty-seven self-categorized WSW of diverse genders (woman, non-binary) and sexual orientations (e.g., lesbian, bisexual, pansexual, queer, heterosexual) participated in a 2 × 2 factorial between-participants design. Data were collected during the first months of the COVID-19 pandemic in The Netherlands. Humorous cartoons explicitly referring to lockdown measures systematically varied the humour subject (punchline about excessive drinking versus staying sober) and the couple (male-female, female-female) that were depicted. Although the (very brief) health message did not influence binge drinking determinants, the humorous health campaign depicting a female-female couple was perceived as more inclusive and evoked more amusement and less anger than when the cartoons depicted a male-female couple. High WSW identifiers were less amused about the health campaign text (but not the cartoons), less likely to share campaign materials offline (but not online), and had more positive binge drinking attitudes but lower binge drinking intentions than low identifiers. Implications are discussed.

Just a Joke? Adolescents' Preferences for Humor in Media Entertainment and Real-Life Aggression

Humorous media entertainment frequently punctuates the everyday lives of adolescents. Theorists have suggested that this exposure may impact behavior, particularly real-life aggression. Specifically, exposure to prosocial (coping) humor in media entertainment is posited to decrease aggression, whereas the reverse has been argued for exposure to antisocial (disparaging and slapstick) humor. Despite these suppositions, little empirical evidence about this relationship exists. To fill this gap, this study employed a cohort-sequential design using latent growth curve models to estimate the (co-)development of adolescents' preferences for television shows featuring disparaging, slapstick, and coping humor and aggression from age 10 to 17. Results showed that at the onset of adolescence, especially boys had a higher preference for shows with disparaging and slapstick humor than with coping humor. However, over the course of adolescence, boys' and girls' preferences for shows with coping humor increased, while especially girls' preferences for shows with disparaging and slapstick humor decreased. These preferences were unrelated to adolescents' aggression. Our findings provide an important addition to the ongoing media effects debate. Taken together, they offer room for optimism and point toward an increased focus on the potential positive rather than the negative sides of humor in the lives of young people.

The roles of mental illness disclosure and disclosure strategies on well-being among college students

ObjectivesTo examine how the degree of mental illness disclosure and disclosure strategies are associated with psychological and physical well-being among college students. Participants: Participants were 181 undergraduate students from two American universities who self-identified as having been diagnosed with mental illness. Method: Participants completed an online survey, which included measures of mental illness disclosure and a range of outcome measures (e.g., life satisfaction, self-report somatic complaints). Results: The degree of mental illness disclosure was positively related to well-being outcomes. After controlling for the effect of the degree of self-disclosure, a direct disclosure strategy was positively associated with well-being outcomes, whereas disclosure strategies involving entrapment, humor, and indirect medium were related to poorer well-being outcomes. Conclusions: Results suggest that the degree of mental illness disclosure and the manner in which individuals disclose their mental illness to others may have implications to the well-being of individuals living with mental illness.

The Robust Italian Validation of the Coping Humor Scale (RI-CHS) for Adult Health Care Workers

The Coping Humor Scale (CHS) is a seven-item tool widely used to assess the use of humor in coping with stressful situations. The beneficial effect of humor in buffering the impact of negative experiences has been investigated in several contexts and populations; for this reason, the CHS has been used in many languages, but its solid validation in Italian is still missing. Our study aimed at building a robust instrument to measure coping humor strategies among Italian health care workers, a category which has been particularly exposed to stressful situations in the last two years. The CHS translated into Italian was administered to a sample of 735 health care workers during the first wave of the COVID-19 pandemic in Italy. Confirmatory factor analysis and Rasch analysis were performed. As a result, a six-item Robust Italian Coping Humor Scale (RI-CHS) was validated and ready to use for future studies on Italian health care workers’ samples. This study gives evidence that our six-item solution works as a ruler (i.e., an instrument that meets the conditions of fundamental measurement in the context of the human sciences) to measure the degree to which Italian health care workers rely on humor to cope with stress.

Nurses' experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study

In the event of a contagious disease outbreak that reaches the level of a pandemic, the responsibility of providing care for patients increases for front-line nurses. However, being in a nursing role exposes professionals to a range of risks, including but not limited to contagion and mental health impacts. This qualitative study aimed to explore in-depth nurses' experiences of providing care in the time of the COVID-19 global pandemic. The study followed the COREQ guidelines. Purposive sampling was applied to recruit participants. Semi-structured face-to-face interviews were used to collect the data from 16 nurses across five hospitals in Taiwan in 2020. Contents were analysed using Colaizzi's seven-step method. The essential structure that was identified was 'Providing care cautiously and being alert to the changing environment', which reflects the progress of Taiwanese nurses in providing care during the global COVID-19 pandemic. The essence of the phenomenon is presented through three themes: (i) facing the emerging challenge, (ii) struggling with uncertainty, fear, stigma, and workload, and (iii) adapting to changes in the environment: learning and innovation. The findings identified multi-dimensional impacts of nursing experiences during the COVID-19 pandemic, and the study yielded evidence and practices that can be used to guide and support adequate interventions to support nursing professionals. By understanding the various aspects of nurses' experiences, policymakers and administrators can better address nursing care providers' professional and mental health needs during a pandemic.

Evaluation of a Humor Training for Patients with Chronic Pain: A Randomized Clinical Trial

Background

Humor and laughter are positively associated with psychological as well as with physical well-being. As there is little research examining to what extent patients suffering from chronic pain could benefit from a humor intervention, the goal of this study was to develop a pain-specific humor training and to evaluate its feasibility and effectiveness as component of regular, multimodal pain therapy.

Patients and Methods

Patients from inpatient treatment groups for chronic pain in a German hospital were randomly assigned to the training group (final n = 62) and the control group (final n = 65). The training consisted of four sessions that were implemented in the usual therapy throughout two weeks. Outcomes were divided into primary (perceived current pain intensity and depression) and secondary ones (quality of life impairment by pain, cheerfulness, and self-enhancing humor) and were assessed prior to and after intervention.

Results

Results showed improvements in all outcomes for both groups. For primary outcomes, a trend for a greater reduction in current pain intensity was found for the training group compared to the control group (p = 0.060, η²_p = 0.02), as well as, for secondary outcomes, a trend for greater reduction of quality of life impairment by pain (p = 0.079, η²_p = 0.02) and a trend for greater increase in self-enhancing humor (p = 0.086, η²_p = 0.02). Depression and cheerfulness remained unaffected. Feedback indicated feasibility of the training within multimodal therapy, showing overall acceptance as well as providing specific suggestions for improvement.

Conclusion

As the first study evaluating a specific humor training for patients with chronic pain within a randomized controlled trial, its results are promising regarding an additional contribution that humor interventions can make towards multimodal pain therapy.

How Do We Perceive a Humorous Manager? Manager Humor, Impression Management, and Employee Willingness to Work With the Manager

Humor is a form of communication that is intended to be entertaining and produce positive affective and cognitive responses from receivers. Nonetheless, humor in the workplace is a complicated matter. It has been recognized as a valuable tool for managers because it can activate various favorable outcomes and alter employees' perception of the manager's warmth and competence (impression management), but not always to the benefit of the manager. In our studies, the use of humor showed changed attitudes toward a manager's warmth and competence, and eventually influenced the employee's behavioral intentions. In Study 1, we tested the use of managerial humor in two emails. The humorous manager was perceived as warm, but not competent. Impression management mediated the employee's willingness to work with the manager. In Study 2, we tested the use of managerial humor with one introductory email. In this study, we also monitored the gender of both the manager and the employee. Once again, the humorous manager was perceived as warm and humor mediated employees' behavioral intentions. As for competence, gender moderated the results, such that male employees perceived humorous female managers as more competent, while female employees perceived humorous male managers as less competent. Practical implications are presented.

How does the use of humour in the UK ambulance service affect a clinician's well-being?

Introduction:

Paramedics and ambulance staff face many different stresses in today’s UK ambulance service, with many having reported an effect on their well-being and mental health. Humour is widely used by staff as a coping mechanism, but little is known about this topic. This literature review aims to find out how humour is used and how it can affect clinicians’ well-being.

Methods:

A total of nine medical databases were searched for relevant literature – Cochrane, Scopus, CINAHL Complete, Science Direct, Medline Complete, Complementary Index, Academic Search Complete, Emerald Insight and Supplemental Index. Articles were included if they were published in 2005 or after, if they were a UK-based original study and if they studied humour in relation to paramedics’ well-being.

Results:

After limiters were applied, a total of 26 articles were found. Only four articles met all the inclusion and exclusion criteria. Two of the articles studied humour directly, whereas two found humour as a result of studying the resilience and strategies used to cope with the stresses of ambulance work. Four key themes were identified: different types of humour, the source and boundaries of humour, offloading and camaraderie.

Conclusion:

This review of the literature found that many in the ambulance community view their use and expression of humour as a positive coping strategy that helps them to relieve the stresses of the job. Further research is needed to investigate any negative effects that humour has on a clinician’s well-being and larger studies are needed to give a better representation of the ambulance community.

Turnover among medical clowns early in their career

In recent years, several investigations of the medical clowning profession have appeared in the literature. However, few studies have focused on factors associated with turnover among medical clowns early in their careers. The current study examined whether individual differences in humor disposition predicted turnover behavior. Participants were 111 medical clowns in a three-phase longitudinal study. Humor disposition was measured in the first week of their training, clowns' job satisfaction two months later, and turnover six months after that. Results showed that humor appreciation decreased actual turnover through the mediating role of job satisfaction, whereas individual differences in humor creation directly decreased turnover. In addition, previous traumatic experiences moderated the associations between humor appreciation and turnover. Overall, our research findings support the notion that humor disposition can help predict which clowns remain in the hospital.

Humorous Coping With Unrequited Love: Is Perspective Change Important?

A large number of studies suggest that humor is associated with mental well-being and effective as a means of coping. However, it is less well-understood which mechanisms are effective for this particular function of humor. The present study examines whether processes of change of perspective, which are often regarded as constitutive for humor, could be an effective coping-factor when facing unrequited love as a specific psychological burden. In a questionnaire study, N = 148 persons aged 18-65 years (w = 96) with actual or past experiences of unrequited love reported on their subjective burden due to this experience, their self-esteem and satisfaction with life, two scales for humor (Multidimensional Sense of Humor Scale: MSHS, and a self-constructed scale: Humorous Change of Perspective, HCOP) and a coping scale which measure change of perspective in the confrontation with goal blockages (Flexible Goal Adjustment, FGA). Results indicated that the burden of unrequited love [operationalized objectively as actuality of experience (dichotomous) or subjectively as burden experienced] and both indicators of well-being were negatively associated. Multiple regression analyses showed that humor was a significant moderator of this relationship in nearly all combinations of operationalizations of humor and indicators of well-being: Higher levels of humor are associated with better well-being even when the perceived burden was high. In addition, the study examined whether the coping effect of humor can be partly or mainly attributed to the individual's capacity to perspective change as captured by FGA. When including this scale as a covariate in the regression models, the moderation effect for MSHS did not persist; however, for HCOP the moderation effect remained unchanged: the moderator effect of humorous change of perspective proved to be independent of FGA. Taken together the results suggest that perspective-changing skills play a significant role in the coping effect of humor in dealing with psychological burdens. However, depending on which humor facet is measured, the entailed perspective change may or may not appear to go beyond what the individual's FGA can account for. This suggests that the coping effect caused by humorous change of perspective includes aspects that are also discussed for other coping resources as well as its own, humor-specific aspects. Potential avenues for future studies are discussed both with respect to the necessity for replication and extension of the present study and to the determination of other potential alleviativing effects of other facets of humor.

"The Referee Plays to Be Insulted!": An Exploratory Qualitative Study on the Spanish Football Referees' Experiences of Aggression, Violence, and Coping

Referees are essential participants in the sport of football. They are responsible for enforcing the rules and achieving the necessary impartiality for the matches. Referees are often target of hostile reactions from fans, players, and coaches. However, few studies have focused on these experiences and the strategies they use to manage them. In order to fill this gap, a qualitative interview-based study was developed to explore the experiences of a group of football referees (four males and four females) on aggression, violence, and coping. A thematic analysis was developed combining inductive and deductive processes. Results indicated that the most frequent aggressions experienced were verbal abuse. Most of the aggressions from spectators were of a sexist nature. When aggressions were considered normal by referees, symbolic violence emerged. Racist aggressions were directed to the two Moroccan participants. Problem and emotional-focused coping strategies were identified. The two most common referee responses to coaches’ and players’ verbal abuse were penalties and send-off calls. Smiling and not considering insults as a personal matter were two emotional-focused coping strategies used toward spectator aggressions. Implications for the referees’ job and well-being as well as the quality of football competitions were highlighted to reduce aggressions and violence and to help referees to cope with hostile behaviors.

Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students

Background: The concern over the high level of stress experienced by students of the caring professions has led to increased attention being paid to the promotion of their resilience. Most earlier studies have focused on the resilience of medical and nursing students. There has been little exploration of the resilience and associated factors of students of other health-care disciplines. The aim of this study was to gather data from students of pre-registration health-care disciplines to identify the factors that influence their resilience. Method: Valid questionnaires were used to assess respondents’ resilience, self-efficacy, mindfulness, coping and trait positive and negative affect. The data were analyzed using descriptive statistics and univariate and general linear regression. Results: A total of 1320 university students from nursing, medical laboratory science, radiography and optometry were recruited. The results showed that the subjects’ resilience scores were lower than those of students in Western countries. We found self-efficacy and denial to be the common predictors for students of all disciplines. Conclusion: The resilience of students in the four disciplines was predicted by a combination of predictors. Faculties of universities and clinical mentors should collaborate in building resilience in their health-care students and support them to grow both personally and professionally during their careers.

Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease (COVID-19) outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers' exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers' stress levels, and the Brief COPE Scale and Coping Humor Scale were used to assess participants' avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that (1) levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 (i.e., who came into contact with COVID-19 patients or worked in wards dedicated to COVID-19) in comparison to less-exposed workers; (2) participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and (3) healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study.

Character Strengths Predict an Increase in Mental Health and Subjective Well-Being Over a One-Month Period During the COVID-19 Pandemic Lockdown

This study examines whether character strengths predict resilience (operationalized as stable or higher mental health and subjective well-being despite an adverse event) over a period of approximately 1 month during the COVID-19 pandemic lockdown in Spain. Using a longitudinal design, participants (N = 348 adults) completed online measures of sociodemographic data, information regarding their situation in relation to the COVID-19, character strengths, general mental health, life satisfaction, positive affect and negative affect. All variables were measured at Time 1 and Time 2, except for sociodemographic and most COVID-related information (Time 1 only). Time 1 data collection was conducted between March 21, 2020 and April 2, 2020, i.e., approximately the second week of lockdown in Spain. Time 2 data collection was conducted between April 24, 2020 and May 18, 2020, after the Spanish government announced its intention to progressively release the lockdown. A principal component analysis of character strengths was conducted. Five character strength factors were extracted: fortitude, goodness, intellectual, interpersonal, and restraint. Factor structures at Times 1 and 2 were highly consistent. All character strength factors at Time 1 correlated positively with life satisfaction and positive affect, and negatively with negative affect and mental health at T2 (higher scores in the mental health measure indicate poorer mental health). Fortitude strengths showed the highest correlations. We conducted a series of regression analyses with strength factors at Time 1 as predictors, and mental health, life satisfaction, and positive and negative affect as dependent variables, controlling for their baseline levels. To test the directionality of the relationship between strengths and the dependent variables, all analyses were reversed. All character strength factors predicted an increase in mental health. They also predicted positive affect, with the exception of strengths of restraint. Fortitude, intellectual, and interpersonal strengths predicted an increase in life satisfaction. Finally, fortitude strengths, interpersonal strengths, and strengths of restraint, predicted a decrease in negative affect. None of the reversed analyses yielded significant effects. Limitations, implications, and possible character strengths-based interventions aimed at promoting mental health in the COVID-19 pandemic are discussed.

Coping with caregiving: Humor styles and health outcomes among parents of children with disabilities

BACKGROUND

Parents of children with developmental disabilities experience greater stress and worse mental and physical health outcomes than parents of typically developing children. The use of various humor styles to cope with stressors has been associated with mental and, to a lesser extent, physical health outcomes in other populations, but has not been previously examined among parents of children with disabilities.

AIMS

To examine relations of adaptive vs. maladaptive humor styles with depression, daily affect, mental and physical functioning, somatic symptoms, and health behaviors, and to examine whether social support or positive reappraisal mediate relations of humor with health outcomes.

METHOD

80 parents of children with disabilities completed online surveys at T1. 40 parents completed T2 surveys 4 months later.

RESULTS

As predicted, the adaptive humor styles - self-enhancing and affiliative - were associated with enhanced mental health outcomes, and these relations were mediated by social support and, to a lesser extent, positive reappraisal. Self-defeating humor was associated with worse mental health, greater symptoms, and worse health behavior; these relations were mediated by social support.

CONCLUSION

Adaptive humor use may facilitate caregivers' ability to garner support from others and reframe stressors, which ultimately may contribute to mental and physical resilience to stress.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Play Experiences of Children With a High Level of Physical Disability

Importance: This research provides practitioners with an understanding of play from the perspective of children with a high level of physical disability.

Objective: To explore the experience of play for children who have a high level of physical disability as a result of cerebral palsy.

Design: Interpretative phenomenological analysis. Children participated in three interviews each to discuss their experience of play. Visual methods, such as use of video and drawings, enabled a greater depth of discussion.

Setting: Participants’ homes.

Participants: Six children ages 6–11 yr with a high level of physical disability, recruited via snowball sampling and charities working with children with cerebral palsy.

Results: We found that making choices and controlling play were important for the children, that they often experienced play differently than their peers, and that they connected with others in play through humor and communication skills.

Conclusions and Relevance: Occupational therapy practitioners can respond to the findings by understanding the embodied unit, recognizing vista play, enabling expression of each child’s imagined self, supporting negotiation of identity and disability, recognizing participation in play through watching, enabling opportunities for belonging, enabling development of component skills for play, and supporting strategies for connection.

What This Article Adds: This article provides occupational therapy practitioners and other professionals with an understanding of play from the perspective of children who have a high level of physical disability.

The effects of three positive psychology interventions using online diaries: A randomized-placebo controlled trial

Three positive psychology interventions (coping humor, three funny things, three good things) were compared with a placebo control condition (early memories) in a randomized placebo-controlled online trial. A total of 182 healthy participants participated in a one week web-based diary study and completed evaluation measures at pre, post, and one month follow-up. They were recruited via e-mail and have been primarily students. Primary outcomes have been happiness and depressive symptoms, secondary outcomes coping humor, cheerfulness (and its subscales), and subjective perceived change. The intention-to-treat analysis (ITT) using linear mixed models could not replicate the positive effects of past research. When compared to the control condition, only the coping humor intervention influenced primary outcomes (r = 0.24-0.29). Three funny things and three good things had no effects at all. Secondary outcomes showed only isolated effects, so that no uniform effect pattern was found for the interventions. Reasons for the small effects, such as motivation and psychosocial status of the participants, as well as recommendations for future studies are discussed.

Humorous cognitive reappraisal: More benign humour and less "dark" humour is affiliated with more adaptive cognitive reappraisal strategies

The capacity to find humorous perspectives in aversive situations may outline a helpful strategy in the context of cognitive reappraisal. Yet, research suggested that some people produce more adaptive humour than others. At the same time, not all forms of cognitive reinterpretation seem to be unequivocally beneficial. The present study aimed to investigate specific cognitive reappraisal strategies that individuals employ in humorous reappraisal of adverse events. In a sample of 95 participants, the use of cognitive reappraisal sub-strategies was assessed in a behavioural test in which participants were required to generate a series of humorous reappraisals of self-relevant, threatening events. These reappraisal sub-strategies (three positive reinterpretation strategies, three de-emphasising strategies) were then related to the habitual use of different kinds of humour as well as the broader DSM-5 personality trait domains and well-being in terms of depressive experiences, assessed by self-report questionnaires. While no robust relationships were found for reappraisal strategies based on de-emphasising, sub-strategies within the positive reinterpretation category showed specific and contrasting associations with the examined traits. Findings indicated that the ability to produce humour is only linked to a favourable pattern of reappraisal strategies when manifested in benign forms of humour. Specific relations also emerged for the broader personality traits. The study suggests that some characteristics that advance the use of benign humour also benefit adaptive emotion regulation. The opposite seems to be true for malicious, or "dark" humour. The introduced behavioural approach to the analysis of humorous cognitive reappraisal may prove useful also in future related research.

Resilience as a Mediator Between Workplace Humour and Well-being at Work: An Enquiry on the Healthcare Professionals

Humour is considered as a crucial job resource for healthcare professionals. It has been further credited for several positive outcomes such as resilience and well-being. This study investigated: (a) the mediating role of resilience between adaptive humours styles (self-enhancing and affiliative) and well-being at work and (b) the moderating role of self-esteem in the indirect relationship between the adaptive humour styles and well-being at work via resilience. The study was conducted on a sample of 354 healthcare professionals. The findings of the study indicate a significant association between the adaptive humour styles and well-being at work with resilience as a mediator. Furthermore, self-esteem was found to significantly moderate the indirect relationship between self-enhancing humour and well-being at work via resilience.

Self-Efficacy in Retrieving Positive Emotional Experience and Using Humor

Abstract. Recent research has pointed to the benefits of positive emotions and their appropriate modulation in buffering the impact of negative experience, and in promoting well-being. Two studies examined the psychometric properties of a new scale that was designed to assess perceived self-efficacy in using memories of positive emotional experiences and humor to face challenges and to cope with stressful experiences. In the first study, we examined the factor structure and internal validity of two scales in youths from the United States (N = 1,277), Italy (N = 363), and Spain (N = 223). In the second study, we examined correlations of the two scales with positive affect, as well as other indicators of well-being and adjustment in the three countries (US: N = 499; Italian and Spanish samples of Study 1). The results of the exploratory and confirmatory factor analyses supported two distinct factors and showed acceptable partial invariance of the scales across countries. Correlations supported the scales’ construct and discriminant validity. Overall, the findings corroborated the psychometric properties of the two scales and the view of retrieval of positive emotional experiences and humor as distinct self-regulatory strategies.

Laughing away the pain: A narrative review of humour, sense of humour and pain

BACKGROUND AND OBJECTIVE

The link between humour and sense of humour with pain has been a topic of research for decades. The purpose of the present article was to review the different studies that have been conducted to date on the association between humour and sense of humour with pain.

DATABASES AND DATA TREATMENT

The literature search was conducted using the PubMed, Science Direct and ProQuest databases. Forty-one studies were reviewed, and the results are summarized and structured into three sections: experimental pain, chronic pain and pain in children.

RESULTS

For experimental pain, the findings support the idea that humorous distractions, such as watching a comedy clip, increase pain tolerance, although most of the studies indicate that other non-humorous distractions produce similar effects. Regarding chronic pain, humour has been studied as a way of coping with pain and the emotional distress produced by chronic pain conditions. The results of correlational studies show significant associations between the use of humour and main variables such as anxiety and catastrophizing. Finally, concerning pain in children, similar findings to those described for the previous sections have been reported, with a notable presence of studies on clinic clown interventions, which promote emotional well-being among children and their parents, although their effectiveness in pain reduction is controversial.

CONCLUSIONS

The study of the link between humour and pain is still on an early stage, and overcoming the limitations of previous studies is required to strengthen the promising results that have been observed up to date.

SIGNIFICANCE

This review summarizes all main findings regarding humour, sense of humour and pain up until the first half of 2018 and offers a list of aspects to be considered in further studies regarding the link of humour and pain to contribute to a more systematic research.

The Happiness, Hardiness, and Humor Styles of Students with a Bachelor's Degree in Sport Sciences

Happiness, psychological hardiness, and humor (“the 3Hs”) are useful ways of assessing resilience to stress in positive psychology. The literature analyzing their confluence regarding sports is scarce. This study aims to analyze the participants’ 3H levels and the relationships between those levels and specific variables. The Psychological Hardiness Scale (Psikolojik Dayaniklilik Olcegi, PDO), the Oxford Happiness Questionnaire Short Form (OHQ-SF), and the Humor Styles Questionnaire (HSQ) were used. Students in pedagogical formation training during the 2016–2017 fall semester have participated in the study (N = 211). Significant differences were found regarding the levels of psychological hardiness in relation to gender, type of sport, and years of participation, and, in humor types regarding the variables of gender, age, residence and perceived income. There were significant differences in all instruments regarding gender. Negative relationships were found between the “aggressive humor” and “challenge” and “self-commitment” sub-dimensions of PDO, while the relationships were positive between “self-enhancing humor” and PDO and OHQ-SF, and between “affiliative humor” style and PDO and OHQ-SF. This study enhances the positive socio-psychological account in the literature by incorporating the issues of 3H and provides an understanding of particularities that may help improve the practice of relevant experts and individuals.

Age-varying associations between coping and depressive symptoms throughout adolescence and emerging adulthood

The objective of the current study was to apply the novel technique of time-varying effect modeling to examine age-varying associations between specific coping strategies and depressive symptoms across adolescence and emerging adulthood (ages 14–24). The participants were drawn from a community sample and followed across 4 years of high school and once 5 years postgraduation (N = 1,251, 53% female, 58% non-Hispanic White). Coping and depressive symptom questionnaires were administered across all data collection time points. Time-varying effect modeling used all available data (N = 5,651 measurement occasions) and adjusted for gender. Venting emotions and denial were associated with more depressive symptoms at a similar magnitude across adolescence and emerging adulthood. A positive association between problem solving oriented strategies (planning, active coping) and depressive symptoms was not observed until age 17.5, after which the magnitude of the association strengthened. More frequent instrumental and emotional support seeking were linked to fewer depressive symptoms between ages 18.8 and 23.6. More frequent use of humor was associated with greater depressive symptoms from ages 14.0 to 14.6, but with fewer depressive symptoms from ages 16.8 to 18.8. The findings illuminate when and how associations between specific coping strategies and depressive symptoms may emerge and change across developmental age, generating both theoretical and clinical implications.

Development of a coping with stress scale for a non-western population of children and adolescents

BACKGROUND AND OBJECTIVES

In the related literature numerous instruments have been developed to measure children and adolescents' coping with stress. Considering the cultural differences in individuals' choice for coping strategies, along with the limitations of the existing measures of coping for children and adolescents (e.g., being derived from coping measures developed for adults; unrepresentative samples with limited age range, etc.), the current study aimed to construct a self-report coping scale for a non-western population of children and adolescents.

DESIGN AND METHODS

The study design included both qualitative and quantitative methodology. Three consecutive studies were conducted for the development and validation of the Children and Adolescents' Coping with Stress Scale (CACSS), a self-report measure assessing coping strategies of children and adolescents aged from 9 to 18 in response to self-identified stressors.

RESULTS

Exploratory and confirmatory factor analyses resulted in a 61-item CACSS with 10 factors. The scale appears to have a clear factor structure; sufficient temporal stability; and good convergent, discriminant, and construct validity.

CONCLUSIONS

By addressing limitations of existing coping scales, CACSS is believed to contribute to the literature as a developmentally appropriate and multidimensional tool.

Humor Use Moderates the Relation of Stressful Life Events With Psychological Distress

Three studies examined humor and adjustment to stressful events. In Study 1, patients with fibromyalgia syndrome ( N = 22) reported on mental and physical adjustment, social interaction, and reappraisal of their illness. Dispositional humor was associated with reduced distress and fewer physical symptoms. Study 2 ( N = 109) examined undergraduates’ reports of stressful events. Dispositional, self-enhancing, affiliative, and self-defeating humor showed direct effects on distress, which were mediated by social interaction and reappraisal. Moreover, dispositional and aggressive humor showed stress-buffering effects. Study 3 ( N = 105) examined undergraduates’ adjustment to the September 11, 2001, attacks at 1 and 3 months postattack. At T1, affiliative humor showed a stress-buffering effect on distress. Social interaction mediated the relation of self-enhancing humor with reduced T1 distress, and mediated relations of aggressive and self-defeating humor with greater distress. Relations of T1 dispositional and self-defeating humor to changes in T2 distress were mediated by reappraisal.

Personal resilience and coping Part II: Identifying resilience and coping among U.S. military service members and veterans with implications for work

BACKGROUND

U.S. military personnel face challenging situations including frequent deployments, family separations, and exposure to war. Identifying coping strategies used by the most resilient service members and veterans could positively influence military resiliency training programs.

OBJECTIVE

The purposes of this paper are to investigate the relationship between coping and resilience among U.S. military active service members and veterans, to identify the coping strategies used by those considered most resilient, and to discuss coping and resilience as they relate to the workplace.

METHODS

U.S. military active service members and veterans (N = 191) completed a demographic survey and two self-report questionnaires: The 14-Item Resilience Scale [1] and the Brief COPE [2].

RESULTS

Active duty service members had higher resilience scores than veterans (p < 0.05), but both fell into the moderate range. Coping strategies were not significantly different between the two groups (p > 0.05). Active service members' resilience was predicted by their use of positive reframing and less use of self-blame as coping strategies, accounting for 52.3% of the variance (R2 = 0.523, F(2, 60) = 32.92, p = 0.000). Veterans' resilience was predicted by longer time-in-service, greater use of humor, and less use of self-blame as coping strategies, explaining 44.8% of the variance (R2 = 0.448, F(3, 116) = 31.408, p = 0.000).

CONCLUSIONS

This research identifies the positive coping strategies, and least-used negative coping strategies, of the U.S. service members and veterans in our study population with higher resilience scores. Incorporating this information into military- or veteran-based resilience training is likely to increase training effectiveness.