Work-related stress, stress reactions and coping strategies in ambulance nurses: A qualitative interview study

AIM

To describe experiences of work-related stress, stress reactions and coping strategies among registered nurses (RNs) in the ambulance service (AS).

DESIGN

A descriptive and qualitative design.

METHODS

Participants were recruited from eight different ambulance stations from different geographical locations in central Sweden. Data were collected from 14 RNs during the period from January 2022 to May 2022 using a semi-structured interview guide. Qualitative content analysis was used to analyse data using an abductive approach.

RESULTS

Three categories describe the RNs' experiences; (1) Situations that cause work-related stress, (2) Reactions and feelings that occur and (3) Management of work-related stress. These three main categories included a total of 12 subcategories. Work-related stress was experienced when participants were a part of traumatic events or experienced insufficient cooperation or a disturbing event in the work environment. The different causes lead to different kinds of reactions with feelings of frustration, fear and loneliness being prominent. To manage the work-related stress, RNs used different kinds of strategies and support from colleagues or lack thereof seemed to have a major impact.

CONCLUSIONS

Findings revealed the importance of having competent colleagues in the AS. Working with a competent colleague can reduce experiences of stress and prevent feelings of loneliness. It is important for the AS to provide stress-reduction support, to promote cooperation and to maintain and develop RNs' professional competence to ensure quality care and patient safety in the AS.

Somatostatin-Expressing Neurons in the Ventral Tegmental Area Innervate Specific Forebrain Regions and Are Involved in Stress Response

Expanding knowledge about the cellular composition of subcortical brain regions demonstrates large heterogeneity and differences from the cortical architecture. Previously we described three subtypes of somatostatin-expressing (Sst) neurons in the mouse ventral tegmental area (VTA) and showed their local inhibitory action on the neighboring dopaminergic neurons (Nagaeva et al., 2020). Here, we report that Sst+ neurons especially from the anterolateral part of the mouse VTA also project far outside the VTA and innervate forebrain regions that are mainly involved in the regulation of emotional behavior, including the ventral pallidum, lateral hypothalamus, the medial part of the central amygdala, anterolateral division of the bed nucleus of stria terminalis, and paraventricular thalamic nucleus. Deletion of these VTASst neurons in mice affected several behaviors, such as home cage activity, sensitization of locomotor activity to morphine, fear conditioning responses, and reactions to the inescapable stress of forced swimming, often in a sex-dependent manner. Together, these data demonstrate that VTASst neurons have selective projection targets distinct from the main targets of VTA dopamine neurons. VTASst neurons are involved in the regulation of behaviors primarily associated with the stress response, making them a relevant addition to the efferent VTA pathways and stress-related neuronal network.

The stress response of intensive care unit medical doctors facing repeated severe emergencies

Objectives

This study assesses the psychopathological distress experienced by doctors working in an Intensive care unit (ICU) during the COVID-19 pandemic. These doctors were the same who faced the consequences of a previous natural disaster, a severe 6.3 magnitude earthquake. A second objective is to evaluate their current mental attitude, professional performances and coping strategies adopted in the pandemic in relation to the conditioning effect of that first emergency, the earthquake.

Methods

Thirty-seven ICU medical doctors were recruited and assessed using Rapid Stress Assessment (RSA) rating scale, Symptom Checklist-90 Revised (SCL-90-R), Zung Self-Rating Anxiety Scale, Beck Depression Inventory, Beck Hopelessness Scale, Millon Clinical Multiaxial Inventory III. Comparison between exposure to the earthquake and COVID pandemic has been made in terms of professional role and psychological burden.

Results

Comparison between 2009 earthquake catastrophe and COVID pandemic conditions evidenced relevant changes in professional role, team, environment, shifts, and work organization.

Conclusion

The doctors, who already experienced the 2009 earthquake reported a feeling of greater insecurity facing this latter catastrophe, the COVID pandemic, as well as perception of greater concern for their family and the global situation. However, having participated in the medical management of another emergency (the 2009 earthquake) appears to have contributed to limiting demoralization and psychological distress. The feeling of having greater decision-making possibilities and participation in the organization of work, strengthen coping skills in the face of the emergency.

Grief Symptoms Promote Inflammation During Acute Stress Among Bereaved Spouses

The death of a spouse is associated with maladaptive immune alterations; grief severity may exacerbate this link. We investigated whether high grief symptoms were associated with an amplified inflammatory response to subsequent stress among 111 recently bereaved older adults. Participants completed a standardized psychological stressor and underwent a blood draw before, 45 min after, and 2 hr after the stressor. Those experiencing high grief symptoms (i.e., scoring > 25 on the Inventory of Complicated Grief) experienced a 45% increase in interleukin-6 (IL-6; a proinflammatory cytokine) per hour, whereas those experiencing low grief symptoms demonstrated a 26% increase. In other words, high grief was related to a 19% increase in IL-6 per hour relative to low grief. The grief levels of recently bereaved people were associated with the rate of change in IL-6 following a subsequent stressor, above and beyond depressive symptoms. This is the first study to demonstrate that high grief symptoms promote inflammation following acute stress.

Narratives of Mothers Whose Children Had Been Sexually Abused: Maternal Reactions and Comprehension Regarding Child and Adolescent Sexual Abuse

Child and adolescent sexual abuse is considered to be a serious public health concern and a devastating form of violence with serious physical, mental, and behavioral consequences in the short and long term. This qualitative study aimed to identify maternal reactions to the disclosure of sexual violence and explore the comprehension regarding child and adolescent sexual abuse held by the mothers of child victims. Twelve mothers were interviewed, whose children had experienced a situation of sexual abuse and were receiving psychosocial care in a municipality in southern region of Brazil. The collected data were organized and analyzed using the principles of Grounded Theory with the Atlas.ti 7.5.7 software. From the analysis of the narratives, three main categories emerged: mothers with positive reactions, mothers with ambivalent reactions, and mothers with negative reactions. Mothers that presented positive reactions believed the report and supported their children, showing a comprehension that sexual abuse can occur in different ways and not only when there is penetration. The participants that had ambivalent reactions oscillated between maintaining or breaking off the relationship with the perpetrator of the violence, expressed initial disbelief regarding the report of the abused child, and had a comprehension that sexual abuse could be a form of affection. Mothers that had a negative reaction to the disclosure of abuse presented a contradictory narrative, minimizing the effects of the violence and placing the victims at fault regarding the abuse suffered. The importance of considering the possible relationships between the maternal comprehensions regarding child and adolescent sexual abuse and the reactions of these mothers during the professional intervention was demonstrated.

The Impact of Extended E-Learning on Emotional Well-Being of Students during the COVID-19 Pandemic in Saudi Arabia

Educational institutions in Saudi Arabia extended e-learning until the third semester of the academic calendar to prevent the spread of COVID-19 infection and to achieve 70% inoculation for the Saudi population. This study assesses the impact of extended e-learning and other associated stressors on the emotional health of university students in Saudi Arabia. An online cross-sectional survey collected data between the months of January–March 2021. The emotional signs of stress were measured by using a subset of items from the COVID-19 Adolescent Symptom and Psychological Experience Questionnaire (CASPE). Data about demographic variables, educational characteristics and academic performance were also collected. A regression analysis was performed to determine predictors of emotional health. A total of 434 university students including females (63%) and males (37%) provided responses. One-third of students (33%) indicated that the COVID-19 pandemic and its resulting changes including online distance studies greatly influenced their daily lives in a negative way. The regression analysis demonstrated that female students and students with average academic performance had increased vulnerability to experience emotional signs of stress (p < 0.05). The factors ‘Not going to university’ and ‘Not having a routine life’ were significant predictors of stress responses (p < 0.01) and (p < 0.001) respectively. E-learning during the COVID-19 pandemic made it possible for students to complete their studies as per academic calendar; simultaneously, it increased the vulnerability to experience stress, particularly for female students and students with average academic performance. These findings imply that academic advising and counseling services should be more readily available during digital studies to support at risk students.

Group Psychological Abuse and Psychopathological Symptoms: The Mediating Role of Psychological Stress

In the context of the long-term effects of psychological abuse, this study examined psychological stress and psychopathological symptoms in survivors of groups with cultic dynamics where abusive behaviors take place on an ongoing basis. We specifically tested the mediating role of psychological stress suffered after the departure from the group between the group psychological abuse experienced and current psychopathology. An online questionnaire was administered to 608 Spanish-speaking former members of different groups. We distributed participants into a sample of victims (N = 365) and a sample of nonvictims (N = 243), according to whether or not they reported having experienced group psychological abuse. Moderate associations were found among group psychological abuse, psychological stress, and psychopathological symptoms. Greater differences in psychological stress intensity between samples were related to personal conflicts (ηp2 = .30) and social relations (ηp2 = .29). Greater differences in psychopathological symptoms were related to paranoid ideation (ηp2 = .17), psychoticism (ηp2 = .15), depression (ηp2 = .15), and interpersonal sensitivity (ηp2 = .13). Moreover, mediation testing demonstrated that psychological stress partially mediated the impact of group psychological abuse on psychopathological symptoms. These findings contribute to a better understanding of the long-term effects of group psychological abuse. Survivors of abusive groups not only need help in dealing with psychopathological symptoms, but also need resources to cope with stressful environmental demands. Interventions should address both psychological stress and clinical symptoms to promote survivors' health and well-being during their integration process into the outgroup society.

Trauma and Coping Strategies in Police Officers: A Quantitative-Qualitative Pilot Study

Background. Because of their work, emergency workers, such as police officers (POs), are exposed to traumatic events on a daily basis. These experiences can have consequences in terms of physical and emotional stress. Primary attachment relationships affect the development of coping strategies for dealing with stressful events (primarily hyperactivating strategies in entangled adults and hypo-activating strategies in dismissing adults). In this study, we explored how POs describe the experience of traumatic accidents, the effects they reported and their coping strategies related to their attachment style. Methods. We used a quantitative-qualitative method. Thirty-nine POs were administered the Beck Depression Inventory, the Maslach Burnout Inventory and a semi-structured interview about traumatic events and reactions. Interviews were analyzed using Interpretative Phenomenological Analysis. Results. Traumatic events at work predominantly concerned aggressions, witnessing deaths, forced hospitalizations, and domestic violence involving children. POs with a responsible role were more likely than POs to use security-based strategies. Most POs narrated overactivation and deactivation strategies, which were associated with depressive symptoms, emotional exhaustion, and depersonalization. Conclusions. These results can be useful to improve trauma-informed interventions for POs based on their different attachment styles and coping strategies.

Relationship between stressors, stress reactions and hardiness in Japanese mothers of early neonatal babies: A cross-sectional study

AIM

Mothers of early neonatal babies are often in stressful situations. The stress of child rearing has been reported to influence the mental health of mothers. Hardiness, one of the individual factors affecting the cognitive evaluation of stress, may relate to stress for mothers of early neonatal babies. The aim of the present study is to clarify the relationship between stressors, stress reactions and hardiness of mothers with early neonatal babies.

METHODS

We conducted a cross-sectional study using self-administered questionnaires. Survey items included demographic characteristics, hardiness, stressors, and stress reactions. A total of 226 mothers returned the completed questionnaire. Data analyzed correlation, t tests and multiple regression using SPSS 24.0.

RESULTS

The mothers' hardiness was not related to their demographic characteristics. Hardiness had a negative correlation with stressors and stress reactions. Hardiness mitigated especially anxiety/uncertainty and depression/feeling of insufficiency. Compared with those with high levels of hardiness, mothers with low hardiness exhibited higher levels of newborn baby stressors, breast-feeding stressors, anxiety/uncertainty and depression/feeling of insufficiency.

CONCLUSION

Hardiness showed a buffering relationship with stressors and stress reactions, especially anxiety. Understanding hardiness levels may be useful for choosing which nursing care methods are implemented as each mother begins child rearing.

How women experience and cope with daily hassles after sexual abuse - a retrospective qualitative study

The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of 'protecting armor in daily life' emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three-phase process: (1) avoiding and escaping-coping after experiencing sexual abuse; (2) accepting and disclosing-starting a process of recovery; and (3) reconciling and repossessing-living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowledge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life.

The Relative Salience of Daily and Enduring Influences on Off-Job Reactions to Work Stress

Work stress is an important determinant of employee health and wellness. The occupational health community is recognizing that one contributor to these relationships may be the presence of negative off-job reactivity to work, which we argue involves continued thoughts directed towards work (cognitive reactivity), continued negative mood stemming from work (affective reactivity), and the alteration of post-work behaviours in response to work factors (behavioural reactivity). We explored the relative contributions of daily work stressors, affective traits, and subjective job stress perceptions to negative off-job reactivity. These relationships were evaluated in a study of hospital nurses (n = 75), who completed trait measures and then provided self-assessments of daily work stress and off-job reactions for four work days. The results of several multilevel analyses indicated that a main-effects model best described the data when predicting cognitive, affective, and behavioural reactivity from daily work stressors, affective traits, and subjective job stress perceptions. A series of multilevel dominance analyses revealed that subjective job stress perceptions dominated the prediction of behavioural reactivity, while trait negative affect dominated the prediction of affective reactivity. Theoretical implications and the relative salience of daily and enduring contributors to negative off-job reactivity are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

Vagal Tone and Children's Delay of Gratification: Differential Sensitivity in Resource-Poor and Resource-Rich Environments

Children from different socioeconomic backgrounds have differing abilities to delay gratification, and impoverished children have the greatest difficulties in doing so. In the present study, we examined the role of vagal tone in predicting the ability to delay gratification in both resource-rich and resource-poor environments. We derived hypotheses from evolutionary models of children's conditional adaptation to proximal rearing contexts. In Study 1, we tested whether elevated vagal tone was associated with shorter delay of gratification in impoverished children. In Study 2, we compared the relative role of vagal tone across two groups of children, one that had experienced greater impoverishment and one that was relatively middle-class. Results indicated that in resource-rich environments, higher vagal tone was associated with longer delay of gratification. In contrast, high vagal tone in children living in resource-poor environments was associated with reduced delay of gratification. We interpret the results with an eye to evolutionary-developmental models of the function of children's stress-response system and adaptive behavior across varying contexts of economic risk.

Secure Infant-Mother Attachment Buffers the Effect of Early-Life Stress on Age of Menarche

Prior research indicates that being reared in stressful environments is associated with earlier onset of menarche in girls. In this research, we examined (a) whether these effects are driven by exposure to certain dimensions of stress (harshness or unpredictability) during the first 5 years of life and (b) whether the negative effects of stress on the timing of menarche are buffered by secure infant-mother attachment. Results revealed that (a) exposure to greater harshness (but not unpredictability) during the first 5 years of life predicted earlier menarche and (b) secure infant-mother attachment buffered girls from this effect of harsh environments. By connecting attachment research to its evolutionary foundations, these results illuminate how environmental stressors and relationships early in life jointly affect pubertal timing.

Stress contagion: physiological covariation between mothers and infants

Emotions are not simply concepts that live privately in the mind, but rather affective states that emanate from the individual and may influence others. We explored affect contagion in the context of one of the closest dyadic units, mother and infant. We initially separated mothers and infants; randomly assigned the mothers to experience a stressful positive-evaluation task, a stressful negative-evaluation task, or a nonstressful control task; and then reunited the mothers and infants. Three notable findings were obtained: First, infants' physiological reactivity mirrored mothers' reactivity engendered by the stress manipulation. Second, infants whose mothers experienced social evaluation showed more avoidance toward strangers compared with infants whose mothers were in the control condition. Third, the negative-evaluation condition, compared with the other conditions, generated greater physiological covariation in the dyads, and this covariation increased over time. These findings suggest that mothers' stressful experiences are contagious to their infants and that members of close pairs, like mothers and infants, can reciprocally influence each other's dynamic physiological reactivity.

How bad could it be? Alcohol dampens stress responses to threat of uncertain intensity

Stress response dampening is an important motive for alcohol use. However, stress reduction via alcohol (alcohol SRD) is observed inconsistently in the laboratory, and this has raised questions about the precise mechanisms and boundary conditions for these effects. Emerging evidence indicates that alcohol SRD may be observed selectively during uncertain but not certain threats. In a final sample of 89 participants, we measured stress response via potentiation of defensive startle reflex in response to threat of shock in blocks with certain (low and high) and uncertain shock intensity. Our alcohol-administration procedure produced blood alcohol concentrations (BACs) across a broad range (0.00%-0.12%) across participants. Increasing BACs were associated with linearly decreasing startle potentiation and self-reported anxiety. This SRD effect was greater during uncertain than certain threat. More broadly, these results suggest that distinct mechanisms are involved in response to threats of uncertain intensity and threats of certain intensity.

Maternal stress and infant mortality: the importance of the preconception period

Although preconception and prenatal maternal stress are associated with adverse outcomes in birth and childhood, their relation to infant mortality remains uncertain. We used logistic regression to study infant mortality risk following maternal stress within a population-based sample of infants born in Sweden between 1973 and 2008 (N = 3,055,361). Preconception (6-0 months before conception) and prenatal (between conception and birth) stress were defined as death of a first-degree relative of the mother. A total of 20,651 offspring were exposed to preconception stress, 26,731 offspring were exposed to prenatal stress, and 8,398 cases of infant mortality were identified. Preconception stress increased the risk of infant mortality independently of measured covariates, and this association was timing specific and robust across low-risk groups. Prenatal stress did not increase risk of infant mortality. These results suggest that the period immediately before conception may be a sensitive developmental period with ramifications for infant mortality risk.

Loneliness promotes inflammation during acute stress

Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.

Relationship between sense of coherence in final stage of pregnancy and postpartum stress reactions

OBJECTIVE

In this study, we evaluated postpartum stress using a postpartum depression scale and by measuring the level of a stress-related substance, to clarify the relationship between the stresscoping capabilities of women in the final stage of pregnancy and their postpartum stress reactions.

METHODS

Between April 2004 and October 2004, 54 women participated in a question naire survey and the measurement of their secretory immunoglobulin A (s-IgA) level as a stress-related substance two times in the final stage of their pregnancy (prepartum) and in their early puerperium (postpartum) was carried out. The questionnaire used in the prepartum stage included the following parameters: "basic features", "Sense of Coherence (SOC)" and "Japanese version of the self-assessment depression scale" of Zung. The questionnaire employed in the postpartum stage included the following parameters: "course of delivery", "Self-evaluation of delivery experience", and "Postpartum depression scale".

RESULTS

The depression score was higher and the s-IgA level was lower in the low-SOC score group than in the high-SOC score group, indicating that stress reactions were more intense in the low-SOC score group.

CONCLUSION

It was revealed that stress reactions were more intense for women with a low SOC score. Moreover, the finding of a relationship between the low SOC score in the prepartum stage and depressive tendency suggests that women who are likely to develop depressive tendency can be predicted in the prepartum stage, and the significance of measuring SOC in the prepartum stage is thus suggested.