Beyond coping: The role of supportive relationships and meaning making in youth well-being

INTRODUCTION

The purpose of this study was to identify coping strategies, resources, and strengths that predict well-being in a community-based sample of youth with varying levels of adversity.

DESIGN

Grounded in the resilience portfolio model, we used a mixed methods approach with data from a cross-sectional sample of 231 youth ages 8-17.

MATERIALS AND METHODS

Data were collected using a survey, participant-generated timeline activity, and brief interview. Measures included assessments of coping and appraisal, resilience resources and assets, and subjective well-being and depression.

RESULTS

Active and passive coping strategies predicted subjective well-being and depression. Controlling for demographics and coping, meaning making strengths and supportive relationships were significant predictors of subjective well-being and lower depression, and decreased the impact of adversity on these outcomes.

DISCUSSION

The results of this study provide support for the resilience portfolio model in a community-based sample of youth, with relationships as predicted for subjective well-being and symptoms of depression. For both outcomes, family relationships held the strongest associations with positive well-being and lower symptoms of depression. Supportive relationships with peers, meaning making strengths, interpersonal strengths, less passive coping, and fewer adverse life events were also associated with better outcomes.

CONCLUSIONS

These findings underscore the need to assess youth resources and strengths and to design interventions that target these protective factors for all youth, regardless of exposure to adversity.

CLINICAL RELEVANCE

A theory-informed understanding of resources and strengths that predict youth well-being is essential to inform strengths-based interventions for pediatric research and practice. The resilience portfolio model is a useful framework for understanding predictors of youth well-being.

Assessment of Youth Coping and Appraisals Through a Timelining Activity: Validation and Utility of a Tool for Pediatric Research and Practice

INTRODUCTION

Many tools to assess coping in youth fail to engage youth meaningfully in the assessment process. This study aimed to evaluate a brief timeline activity as an interactive way to assess appraisal and coping in pediatric research and practice.

METHOD

We used a mixed method convergent design to collect and analyze survey and interview data from 231 youths aged 8-17 years in a community-based setting.

RESULTS

The youth engaged readily in the timeline activity and found the activity easy to understand. Relationships among appraisal, coping, subjective well-being and depression were in the hypothesized directions, suggesting the tool supports a valid assessment of appraisals and coping in this age group.

DISCUSSION

The timelining activity is well-accepted by youth and supports reflexivity, prompting youth to share insights on strengths and resilience. The tool may augment existing practices for assessing and intervening in youth mental health in research and practice.

Loneliness is Associated With Lower Coping Self-Efficacy Among Older Adults

To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, sex, body mass index, chronic disease composite score, social support, coping self-efficacy, and depression symptoms. Loneliness was reported in 32.1% of participants and negatively associated with coping self-efficacy (OR = 0.68, 95% CI: 0.50-0.93) while controlling for age, race, sex, chronic disease composite score, and body mass index. Our findings suggest that coping self-efficacy may be a target for intervention involving loneliness in future research; however, the causal relationship between coping self-efficacy and loneliness should be explored further.

Participant-generated timelines as a novel strategy for assessing youth resilience factors: A mixed-methods, community-based study

PURPOSE

The purpose of this study was to explore youth perceptions of resilience through participant-generated timelines as a potential new strategy for nursing research and practice.

DESIGN AND METHODS

We used a concurrent triangulation design to collect and analyze qualitative and quantitative data from a statewide, community-based sample of 448 youth ages 8 to 17 years. We collected three sources of data during two waves of data collection in 2019 and 2021: a participant-generated timeline, a brief structured interview, and a PROMIS pediatric global health measure.

RESULTS

The timeline activity was easy to administer and well accepted by youth in a community setting. Youth reporting an adverse experience or mental health challenge in the previous year had unique patterns of variability in the timelines, and more frequently reported certain resilience factors, including family support and regulatory, interpersonal, and meaning-making assets. Pandemic-related differences were noted between the two cohorts.

CONCLUSIONS

The timeline drawing activity reflects and extends findings from a standard measure of global health. This activity benefits both the participant and the clinician or researcher by helping youth to communicate how they make sense of the world, honoring different ways of knowing and prompting recollection of coping appraisals and resilience factors.

PRACTICE IMPLICATIONS

Participant-generated timelines are a developmentally appropriate and interactive strategy for assessing youth perceptions of their internal strengths. In conjunction with traditional assessments, this strategy may support the identification of malleable targets for intervention in practice with youth who have experienced adversity or mental health challenges.

HIGHER COPING SELF-EFFICACY ASSOCIATED WITH LOW SELF-PERCEIVED LONELINESS IN OLDER ADULTS WITH CHRONIC DISEASE

Loneliness is an emotional state involving social network perceptions and linked to worse health outcomes. Coping self-efficacy evaluates confidence in ability to manage problems effectively using problem-solving, emotional regulation and social coping. The purpose of this cross-sectional study (N=151 community dwelling adults ages ≥ 65) was to evaluate associations between loneliness and coping self-efficacy. All participants had at least one chronic condition and were cognitively intact. In this sample, 32.08% were lonely (score ≥ 5 on UCLA 3-item loneliness scale (range 3-9). Higher coping self-efficacy was significantly associated with low loneliness after adjustment for age, sex, race/ethnicity, social support, depressive symptoms, body mass index, and a chronic disease-function score (β= -0.03, p=0.014). Causality could not be assessed; higher loneliness may lead to lower self-efficacy or lower self-efficacy may lead to higher loneliness. Nonetheless, loneliness and self-efficacy are both modifiable with great potential for improvement, possibly bettering health outcomes.

Loneliness among cancer caregivers: The current state of the science

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Background: A cancer diagnosis can profoundly affect both patients and their caregivers. Providing care to a loved one with cancer places demands on caregivers that may result in changes to caregivers’ daily routines and disruptions to their social relationships, which may contribute to feelings of loneliness. Though caregivers’ psychosocial challenges have been extensively examined, loneliness—a determinant of health—has not been well-studied in this population. In this narrative review, we described the current state of the science related to loneliness among cancer caregivers, methods to assess loneliness, and recommended strategies to mitigate loneliness in cancer caregivers. Methods: We used evidence from peer-reviewed articles listed in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Articles were reviewed for the following inclusion criteria: (1) published in English, (2) caregivers of cancer patients, (3) loneliness as a study variable, and (4) peer-reviewed with no restriction on timeframe of publication. Caregivers were defined as relatives, friends, or partners who provide most of the care for someone with cancer. Results: Eighteen studies met inclusion criteria and were included in the analysis. Caregivers’ experiences of loneliness can contribute to negative effects on a caregiver’s social, emotional, and physical well-being. Social support interventions may not be sufficient to address this problem. Existing recommendations to help address loneliness include cognitive and psychological reframing, one-on-one and group therapy, befriending, resilience training, and technology-based interventions. Conclusions: As a condition of growing importance, loneliness can lead to poor outcomes in social, emotional, and physical health when left unaddressed. Limited understanding regarding loneliness in cancer caregivers poses a two-fold problem that has the potential to impact patient and caregiver outcomes. Future efforts should include intervention development to address loneliness as a determinant of health in this unique population, especially given the pivotal role of caregivers in providing care and impacting health outcomes for people with cancer.

Mentoring in research-focused doctoral nursing programs and student perceptions of career readiness in the United States

BACKGROUND

Research-focused doctorate nursing programs are expanding and seek to double the number of doctoral-prepared nurses by 2020. There is little empirical evidence of the contributions of mentoring to doctoral nursing students' readiness for their desired careers.

PURPOSE

This study assessed characteristics and practices of nursing PhD students, the mentoring practices of their advisors, and the likelihood of self-reported career readiness.

DESIGN

A nationwide descriptive, cross-sectional study of PhD students in the United States was conducted using an electronic survey platform. A sample of 380 PhD students representing 64 schools was surveyed from January to July 2016.

METHODS

Descriptive statistics and ordered logistic regression were used to describe the sample and determine likelihood of career readiness by three readiness levels.

FINDINGS

Results revealed greater likelihood of career readiness for students that: (1) perceived their proficiency in key scholarly skills as high, (2) were older, (3) worked a larger number of hours per week, (4) had more responsibilities outside of school, (5) had both advising and mentoring support, (6) had a co-advisor, and (7) attended a private university.

CONCLUSION

Enrollment targets should be based on a faculty-to-doctoral student ratio that optimizes advising and mentoring and schools should provide mentoring guidelines and training for faculty.

Keeping It Contemporary: Ensuring Dynamism in an Online Population Health Course

BACKGROUND

Population health is a dynamic area that nurses must grasp to meet the demands of the evolving health care system. Staying current on public health priorities, health policies, and population health analytic approaches poses a challenge for nurse educators.

METHOD

This article describes strategies used by nurse educators in a prelicen-sure population health course for student engagement on contemporary population health issues and highlights opportunities to develop skills and build competencies to lead population health initiatives.

RESULTS

Innovations in course content, assignments, and evaluation strategies are useful in training nurses to thrive in health care systems addressing population health. Strategies to remain current on developments in the field promote population health competencies.

CONCLUSION

Prelicensure nursing students can attain knowledge and skills in population health to prepare them to lead population health initiatives, analyze population-level data, provide care coordination, support complex patient groups, and optimize the use of research to promote evidence-based care. [J Nurs Educ. 2019;58(1):53-56.].

Loneliness in middle age and biomarkers of systemic inflammation: Findings from Midlife in the United States

OBJECTIVE

Middle-aged adults who are lonely have an elevated likelihood of death. Systemic inflammation may contribute to these increased odds. Using population-level data, this study tested if systemic inflammation is associated with loneliness in a broad age range of middle-aged adults in the United States.

METHODS

This study used data from the Midlife in the US (MIDUS) survey Biomarker Project, which collected data on psychological, social, and physiological measures from a sample of middle-aged adults. This sample included the 927 participants who were 35-64 years at Biomarker Project data collection. MIDUS collected baseline data from 1995-1996 and a follow-up survey was conducted from 2004-2006. The baseline Milwaukee sample of African Americans was collected in 2005-2006 and the biomarker database was collected in 2004-2009. Biomarkers were obtained from a fasting blood sample. Self-reported loneliness was categorized as feeling lonely or not feeling lonely. Hierarchical regressions examined the association between biomarkers of systemic inflammation (interleukin-6, fibrinogen, C-reactive protein) and feeling lonely, adjusted for covariates.

RESULTS

Twenty-nine percent of the sample reported feeling lonely most or some of the time. There was a positive significant relationship between loneliness and the three systemic inflammation biomarkers after controlling for covariates: interleukin-6 (n = 873) (b [se] = 0.07 [0.03], p = .014); fibrinogen (n = 867) (b [se] = 18.24 [7.12], p = .011); and C-reactive protein (n = 867) (b [se] = 0.08 [0.04], p = .035).

CONCLUSIONS

Feeling lonely is associated with systemic inflammation in middle-aged community-dwelling US adults.

Improved Sleep in Military Personnel is Associated with Changes in the Expression of Inflammatory Genes and Improvement in Depression Symptoms

STUDY OBJECTIVES

Sleep disturbances are common in military personnel and are associated with increased risk for psychiatric morbidity, including posttraumatic stress disorder (PTSD) and depression, as well as inflammation. Improved sleep quality is linked to reductions in inflammatory bio-markers; however, the underlying mechanisms remain elusive.

METHODS

In this study, we examine whole genome expression changes related to improved sleep in 68 military personnel diagnosed with insomnia. Subjects were classified into the following groups and then compared: improved sleep (n = 46), or non-improved sleep (n = 22) following three months of standard of care treatment for insomnia. Within subject differential expression was determined from microarray data using the Partek Genomics Suite analysis program and the ingenuity pathway analysis (IPA) was used to determine key regulators of observed expression changes. Changes in symptoms of depression and PTSD were also compared.

RESULTS

At baseline, both groups were similar in demographics, clinical characteristics, and gene-expression profiles. The microarray data revealed that 217 coding genes were differentially expressed at the follow-up-period compared to baseline in the participants with improved sleep. Expression of inflammatory cytokines were reduced including IL-1β, IL-6, IL-8, and IL-13, with fold changes ranging from -3.19 to -2.1, and there were increases in the expression of inflammatory regulatory genes including toll-like receptors 1, 4, 7, and 8 in the improved sleep group. IPA revealed six gene networks, including ubiquitin, which was a major regulator in these gene-expression changes. The improved sleep group also had a significant reduction in the severity of depressive symptoms.

CONCLUSION

Interventions that restore sleep likely reduce the expression of inflammatory genes, which relate to ubiquitin genes and relate to reductions in depressive symptoms.