Chronic stress, catecholamines, and sleep disturbance at Three Mile Island

The present study was concerned with the relationship between chronic stress and sleep disturbance. Previous research has provided evidence of chronic stress responding among people living near the Three Mile Island nuclear generating facility. Compared to control subjects, the TMI group has exhibited greater symptom reporting, poorer performance on behavioral measures of concentration, and elevated levels of urinary norepinephrine and epinephrine. Other research has suggested a relationship between arousal and insomnia. The extent to which stress and sleep disturbances were experienced by residents at TMI was examined and compared to levels of stress and sleep disturbance among a group of control subjects. The relationship between stress and sleep disturbances was also examined. Results indicated that TMI area residents exhibited more stress than the controls and reported greater disturbance of sleep. Modest relationships among stress and sleep measures suggested that the symptoms of stress measured in this study were not primary determinants of sleep problems.     

Coping with cancer

This study examined coping strategies in head and neck cancer patients. The relationships between the use of approach and avoidant coping strategies and the physical and emotional distress of 35 newly diagnosed head and neck cancer patients during the early stages of cancer treatment were evaluated. Patients were categorized on the basis of coping strategy at the time of diagnosis and then evaluated twice during the course of their treatment at four- to six-week intervals. Cancer patients who predominantly employed either approach or avoidant strategies had lower initial levels of emotional distress than patients who did not use either of these strategies. Although symptoms of distress decreased in patients using approach or avoidance, symptoms increased for those patients who did not use these strategies. The level of stress for this cancer population is highest at the point of confirmed diagnosis and recedes during the course of treatment. The theoretical and clinical implications of these findings are discussed.     

Psychological Distress and Coping amongst Higher Education Students: A Mixed Method Enquiry

Background

Psychological distress among higher education students is of global concern. Students on programmes with practicum components such as nursing and teacher education are exposed to additional stressors which may further increase their risk for psychological distress. The ways in which these students cope with distress has potential consequences for their health and academic performance. An in-depth understanding of how nursing/midwifery and teacher education students experience psychological distress and coping is necessary to enable higher education providers to adequately support these students.

Methods

This mixed method study was employed to establish self-reported psychological distress (General Health Questionnaire), coping processes (Ways of Coping Questionnaire) and lifestyle behaviour (Lifestyle Behaviour Questionnaire) of a total sample (n = 1557) of undergraduate nursing/midwifery and teacher education students in one university in Ireland. Individual interviews (n = 59) provided an in-depth understanding of students experiences of psychological distress and coping.

Results

A significant percentage (41.9%) of respondents was psychologically distressed. The factors which contributed to their distress, included study, financial, living and social pressures. Students used varied coping strategies including seeking social support, problem solving and escape avoidance. The positive relationship between elevated psychological distress and escape avoidance behaviours including substance use (alcohol, tobacco and cannabis) and unhealthy diet is of particular concern. Statistically significant relationships were identified between “escape-avoidance” and gender, age, marital status, place of residence, programme/year of study and lifestyle behaviours such as diet, substance use and physical inactivity.

Conclusion

The paper adds to existing research by illuminating the psychological distress experienced by undergraduate nursing/midwifery and teacher education students. It also identifies their distress, maladaptive coping and the relationship to their lifestyle behaviours. The findings can inform strategies to minimise student distress and maladaptive coping during college and in future professional years.     

Coping with severe burns in the early stage after burn injury

This study examined the relationship between coping strategies, anxiety and depression levels and burn injury characteristics in the early phase of the treatment in burn-injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. Coping strategies were measured by the coping with burns questionnaire (CBQ). Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no statistically significant gender differences in various coping strategies. Avoidance was associated with higher levels of anxiety, depression and hopelessness. The percentage of total body surface area (TBSA) and localization of burns were not associated with coping patterns. Implications for the assessment and management of burn injured patients were discussed.     

Biology versus engineering: the TMI accident as a case study in problems of dosimetry

Official investigations concluded that no environmental damage was caused by the 1979 accident at the Three Mile Island nuclear generation plant, Unit 2 (TMI). Years later, highly-exposed populations were discovered through investigation of anecdotal information. Absorbed doses in the order of 1 Gy were confirmed by cytogenic and immune status tests.     

Genetic variation in Batrachospermum helminthosum (Batrachospermales, Rhodophyta) among and within stream reaches using intersimple sequence repeat molecular markers

Intersimple sequence repeat molecular markers were utilized to investigate the genetic relationship among individual gametophyte thalli of the freshwater red alga Batrachospermum helminthosum among distant stream reaches and within a stream reach. Fifteen thalli per stream reach were sampled from 11 streams throughout the known distribution in eastern North America from three locations in Ohio, and one location in Indiana, Michigan, North Carolina, Tennessee, Louisiana, Rhode Island, Massachusetts and Connecticut. The pairwise φ_ST analysis showed significant genetic differences (P<0.05) among all streams. The partitioning of genetic variation was almost equal within and among streams (45% and 55%, respectively). Genetic variation among populations did not reflect geographic distance, suggesting that long distance dispersal may be important in the distribution of this alga. Fifty‐eight individuals from Five Mile Creek, Ohio, were investigated from three distinct segments of the stream (upstream, middle and downstream) to examine small‐scale genetic variation within a stream reach. A much higher proportion of genetic variation was observed within a stream segment (79%) than among the three segments (21%). Among these stream segments within Five Mile Creek, the individuals were variously related, with genetic similarity and spatial distance uncorrelated. A similar result was obtained among individuals within other stream reaches, suggesting that genetic structure within a stream reach may be more complex than just reproduction among closely located individuals.     

Coping with abortion

This study evaluated individual differences in coping style in response to an abortion procedure. The 55 subjects displayed a wide range of responses, although the average level of distress was fairly high. These women were quite similar to other stressed populations in their response to the Impact of Event Scale, providing evidence for a generalized stress response syndrome. When divided into groups based on coping style, "avoiders" were found to experience more distress that "nonavoiders," and "approachers" decreased in distress over time while "nonapproachers" did not. The implications of these findings are discussed in the context of the interaction between coping styles and counseling strategies.     

The Impact of Coping Flexibility on the Risk of Depressive Symptoms

Objective

According to the dual-process theory, coping flexibility is defined as the ability to produce and implement a new coping strategy in place of an ineffective coping strategy. Specifically, coping flexibility includes two processes: evaluation coping and adaptive coping. Evaluation coping refers to sensitivity to feedback about the efficacy of a coping strategy, and adaptive coping involves the willingness to implement alternative coping strategies. The coping flexibility hypothesis (CFH) postulates that more flexible coping will be associated with more adaptive outcomes; importantly, there are numerous theories and studies that support the CFH. The main purpose of this study was to test the CFH based on dual-process theory.

Methods

A total of 1,770 Japanese college students participated and, completed a set of questionnaires that measured coping flexibility (evaluation coping and adaptive coping) and depressive symptoms. Depressive symptoms were measured via the Center for Epidemiologic Studies Depression Scale.

Results

The proportions of women and men who reported depressive symptoms were 58.69% (95% CIs [55.74, 61.66]) and 54.17% (95% CIs [50.37, 57.95]), respectively when a cut-off score of 16 on the CES-D was used. A multivariable logistic regression analysis revealed that evaluation coping (OR = 0.86, 95% CIs [0.83, 0.0.89]) and adaptive coping (OR = 0.91, 95% CIs [0.88, 0.93]) were significantly associated with lower levels of depressive symptoms.

Conclusion

The results of the present study indicated that the CFH based on dual-process theory was supported in a Japanese sample.     

Impact of psychosocial factors on quality of life in overweight youth

Objective: The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non‐overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health‐related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL. Research Methods and Procedures: The sample consisted of 96 overweight and at‐risk‐for‐overweight children (mean age = 12.8 years) and their parents who were recruited from a Pediatric Endocrinology Obesity Clinic. Parents completed a demographic questionnaire, the Pediatric Quality of Life Inventory–parent‐proxy version, and the Brief Symptom Inventory. Children completed the Children's Depression Inventory–Short Form, the Schwartz Peer Victimization Scale, and the Pediatric Quality of Life Inventory. Results: Increased parent distress, child depressive symptoms, and peer victimization were associated with lower QOL by both parent‐proxy and self‐report. Child depressive symptoms mediated the relationship between psychosocial variables (parent distress and peer victimization) for self‐reported QOL but not for parent‐proxy‐reported QOL. Discussion: This study documented the important impact of peer victimization and parental distress on the QOL of overweight children. Expanding our understanding of how overweight children experience and interact with their environment is critical. Further research is needed to examine the mechanisms by which parent distress and peer victimization impact the development of depressive symptoms in overweight children, including coping and support strategies that may buffer these children against the development of depressive symptoms and ultimately lower QOL.     

Effects of supervisor support and coping on shiftwork tolerance

This study examines the effects of supervisor support and coping on work/non-work conflict and health in shiftwork. It describes a model of shiftwork tolerance that is tested on samples from two populations of shiftworkers. The samples--of nurses and ambulance workers--differed by occupation, gender and shift schedule. Quantitative (survey questionnaire) and qualitative methods (in-depth interviews) were used to triangulate results and to yield richer data on psychosocial variables. Structural equation modelling, using EQS, was used to describe the common path relationships observed within both samples of shiftworkers. The results demonstrated important relationships between social support from supervisors, coping strategies, work/non-work conflict and symptoms that transferred robustly between the two populations of shiftworkers.     

Relationship between Coping with Interpersonal Stressors and Depressive Symptoms in the United States,Australia, and China: A Focus on Reassessing Coping

Objective

Reassessing coping involves efforts to wait patiently for an appropriate opportunity to act or for a change or improvement in the situation, and can be observed in individuals encountering a stressful relationship event. It was hypothesized that reassessing coping would be negatively associated with depressive symptoms.

Methods

A cross-sectional Web-based survey was conducted in order to test this hypothesis by examining relationships between coping strategies including reassessing coping, distancing coping and constructive coping for stressful relationship events and depressive symptoms. Participants were 1,500 individuals recruited from the general populations of the United States, Australia, and China.

Results

Structural equation modeling analysis revealed that scores on coping strategies predicted depressive symptom scores in the samples from all three countries with medium or large effect sizes. Further, the beta values for reassessing coping scores were negative and significant in all samples, indicating that the hypothesis was supported for each of the population samples surveyed. In addition, distancing coping, which reflects strategies that attempt to actively damage, disrupt, and dissolve a stressful relationship, was associated with high levels of depressive symptoms.

Conclusions

Reassessing coping for interpersonal stressors was be negatively associated with depressive symptoms in sample from general populations of the United States, Australia, and China.     

Profiling coping strategies in male and female rats: Potential neurobehavioral markers of increased resilience to depressive symptoms

Coping strategies have been associated with differential stress responsivity, perhaps providing a valuable neurobiological marker for susceptibility to the emergence of depressogenic symptoms or vulnerability to other anxiety-related disorders. Rats profiled with a flexible coping phenotype, for example, exhibit increased neurobiological markers of emotional regulation compared to active and passive copers (Bardi et al., 2012; Lambert et al., 2014). In the current study, responses of male and female rats to prediction errors in a spatial foraging task (dry land maze; DLM) were examined after animals were exposed to chronic unpredictable stress (CUS). Brains were processed following the DLM training/assessment for fos-activation patterns and several measures of neuroplasticity in relevant areas. Behavioral responses observed during both the CUS and DLM phases of testing suggested that males and females employ different means of gathering information such as increased ambulatory exploration in males and rear responses in females. Fecal samples collected during baseline and following CUS swim exposure revealed higher corticosterone (CORT) in active copers, whereas flexible copers had higher dehydroepiandrosterone (DHEA) and DHEA/CORT ratios, both indications of enhanced emotional regulation. Focusing on the neural analysis, flexible copers exhibited fewer fos-immunoreactive cells in the basolateral amygdala and a trend toward lower activation in the insula while encountering the prediction error associated with the DLM probe trial. Coping profiles also differentially influenced markers of neuroplasticity; specifically, flexible copers exhibited higher levels nestin-immunoreactivity (ir). Further, less hippocampal glucocorticoid receptor-ir was observed in the flexible copers than the active and passive copers. In sum, flexible coping rats exhibited evidence of emotional resilience as indicated by several neurobiological measures; however, despite increased rates of depression and related symptoms reported in human females, sex effects weren't as pervasive as coping strategy profiles in the analysis of neurobiological markers employed in the current study.     

Confronting and coping with weight stigma: an investigation of overweight and obese adults

Objective: This study examined experiences of weight stigmatization, sources of stigma, coping strategies, psychological functioning, and eating behaviors in a sample of 2671 overweight and obese adults. Research Methods and Procedures: The total sample was partitioned into two subsamples for investigation. Sample I was comprised of 2449 adult women, and Sample II was a matched sample of adult men and women (N = 222) that was disaggregated to investigate gender differences. Both samples completed an online battery of self‐report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias, the most common sources of the bias, symptoms of depression, self‐esteem, attitudes about weight and obesity, and binge eating behaviors. Results: Experiences of weight stigmatization, in many forms and across multiple occasions, was common in both samples. A variety of coping strategies were used in response. More frequent exposure to stigma was related to more attempts to cope and higher BMI. Physicians and family members were the most frequent sources of weight bias reported. No gender differences were observed in types or frequency of stigmatization. Frequency of stigmatization was not related to current psychological functioning, although coping responses were associated with emotional well‐being. Discussion: These findings raise questions about the relationship between stigma and psychological functioning and have important implications for obesity treatment and stigma reduction intervention efforts, both of which are discussed.     

Panic Disorder in African-Americans: Symptomatology and Isolated Sleep Paralysis

While attention has been paid to thestudy of panic disorder (PD) with or withoutagoraphobia among Caucasians, surprisinglylittle empirical research within the UnitedStates has looked at the phenomenology of PDamong minority groups. In this paper wepresent data we have collected and review otherresearch on the phenomenology, social supports,and coping behavior among African-Americanswith panic disorder. Our studies indicate that,in comparison to Caucasians, African-Americanswith PD reported more intense fears of dying orgoing crazy, as well as higher levels ofnumbing and tingling in their extremities. African-Americans reported higher rates ofcomorbid post traumatic disorder and moredepression. African-Americans also usedsomewhat different coping strategies (such asreligiosity and counting one's blessings), lessself-blame, and were somewhat more dissatisfiedwith social supports. The incidence ofisolated sleep paralysis was, as per previousreports, higher in African-Americans. Thesefindings, results of other research, and theimplications for assessment and treatment arediscussed within a semantic network analysis of panic (Hinton and Hinton 2002, thisissue).     

Turkish Migrant Women Encountering Health Care in Stockholm: A Qualitative Study of Somatization and Illness Meaning

This paper presents the results from a qualitative study conducted withthe aim of exploring structures of illness meaning among somatizingTurkish-born migrant women (age 31–48) living in a poor and lowstatus suburb of Stockholm in contact with local health care services.Two to three interviews regarding experiences and understanding ofillness were conducted as well as one year, validating follow-upinterviews. Interviews were analysed with a grounded theory approach.Results are presented as the participants' agenda of understanding.Distress was communicated by concrete expressions about the body,emotions, social and life situation. Pain was prominent and oftenlateralised to one side of the body. The use of traditional expressionsof distress ranged from open use to avoidance. Attribution wascharacterised by verbalising links of coherence between health andaspects of life. Psychiatric attribution was rarely accepted or valuedas a tool for recovery, or as helpful in linking bodily symptoms toemotional distress. Three main sources for healing were used: medicalcare in Sweden and in Turkey and traditional treatment. Own capacity toinfluence recovery was mostly regarded as low. Relations to family andthe clinician were regarded as important to recovery. The encounter withlocal health care had brought the participants in contact with apsychological agenda of understanding their illness and new ways ofdealing with illness and healing. Some expressed a feeling of beingmisunderstood whereas some related positive experiences ofre-evaluation. They were all actively trying, but experiencing varyingdegrees of difficulty, to grasp the meaning of the caregiver. Theresults of the study point to the mutual need of exploring meaning inthe clinical encounter to help patients make sense out of differentperspectives of illness and healing. The need for enhanced knowledgeabout this process in a migration context will be discussed.     

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

     

Cancer during adolescence: negative and positive consequences reported three and four years after diagnosis

Persons diagnosed with cancer during adolescence have reported negative and positive cancer-related consequences two years after diagnosis. The overall aim was to longitudinally describe negative and positive cancer-related consequences reported by the same persons three and four years after diagnosis. A secondary aim was to explore whether reports of using vs. not using certain coping strategies shortly after diagnosis are related to reporting or not reporting certain consequences four years after diagnosis. Thirty-two participants answered questions about coping strategies shortly after diagnosis and negative and positive consequences three and four years after diagnosis. Answers about consequences were analysed with content analysis, potential relations between coping strategies and consequences were analysed by Fisher's exact test. The great majority reported negative and positive consequences three and four years after diagnosis and the findings indicate stability over time with regard to perceived consequences during the extended phase of survival. Findings reveal a potential relation between seeking information shortly after diagnosis and reporting a more positive view of life four years after diagnosis and not using fighting spirit shortly after diagnosis and not reporting good self-esteem and good relations four years after diagnosis. It is concluded that concomitant negative and positive cancer-related consequences appear stable over time in the extended phase of survival and that dialectical forces of negative and positive as well as distress and growth often go hand-in-hand after a trauma such as cancer during adolescence.     

Predictive testing for hereditary nonpolyposis colorectal cancer: subjective perception regarding colorectal and endometrial cancer, distress, and health-related behavior at one year post-test

This study evaluated illness representations, distress, and health-related behavior one year after disclosure of a predictive genetic test result for hereditary nonpolyposis colorectal cancer (HNPCC) in 36 carriers and 36 noncarriers. Post-test, no significant differences between carriers and noncarriers were found in perceived risk and perceived seriousness of colorectal and endometrial cancer or in perceived control over endometrial cancer. Confidence in the controllability of colorectal cancer by means of medical examinations was higher for carriers than noncarriers post-test. Mean levels of distress (cancer-specific distress, state anxiety, psychoneuroticism) were within normal ranges and none of the participants had an overall pattern (on all scales) of clinically elevated levels of distress. Carriers had significantly higher cancer-related distress one year posttest than noncarriers. In both groups, colorectal cancer-related distress decreased. Noncarriers additionally showed decreased endometrial cancer-related distress and state anxiety. Within the year after testing, none of the noncarriers had a colonoscopy and all carriers where adherent to the recommendations regarding colorectal cancer screening. Although interview data delineated individually different problems specifically related to predictive testing (e.g., worry, difficulties in relation to other relatives, burden of regular follow-up), generally, predictive testing for HNPCC does not seem to induce major psychological problems. Moreover, the presented data are promising regarding the impact on health-related behavior.     

Coping with an Acute Psychosocial Challenge: Behavioral and Physiological Responses in Young Women

Despite the relevance of behavior in understanding individual differences in the strategies used to cope with stressors, behavioral responses and their relationships with psychobiological changes have received little attention. In this study on young women, we aimed at analyzing the associations among different components of the stress response and behavioral coping using a laboratory psychosocial stressor. The Ethological Coding System for Interviews, as well as neuroendocrine, autonomic and mood parameters, were used to measure the stress response in 34 young women (17 free-cycling women in their early follicular phase and 17 oral contraceptive users) subjected to the Trier Social Stress Test (TSST) and a control condition in a crossover design. No significant differences in cardiac autonomic, negative mood and anxiety responses to the stressor were observed between the two groups of women. However, women in the follicular phase showed a higher cortisol response and a larger decrease in positive mood during the social stress episode, as well as greater anxiety overall. Interestingly, the amount of displacement behavior exhibited during the speaking task of the TSST was positively related to anxiety levels preceding the test, but negatively related to baseline and stress response values of heart rate. Moreover, the amount of submissive behavior was negatively related to basal cortisol levels. Finally, eye contact and low-aggressiveness behaviors were associated with a worsening in mood. Overall, these findings emphasize the close relationship between coping behavior and psychobiological reactions, as well as the role of individual variations in the strategy of coping with a psychosocial stressor.     

Symptom Experienced Three Years after Liver Transplantation under Immunosuppression in Adults

Background & Aims

Immunosuppression-related symptom experience has not been covered thoroughly in long-term liver transplant recipients. The aim of this study was to assess the symptom experience of immunosuppressive therapy three years after liver transplantation and to correlate it with adherence to medications and sociodemographic or disease-related characteristics.

Methods

This study included 94 liver transplant recipients who had survived for more than 3 years after liver transplantation. Symptom experience was measured by the 59-Item Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) at the outpatient visits. Adherence to immunosuppressive drugs was assessed using the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS).

Results

Itching, concentration or memory problems, and fatigue were the three most frequent or most distressing symptoms. Factors significantly associated with a higher level of symptom frequency and distress were 3- to 5-year time cohort (i.e., time post-transplantation), and younger age. At the item level, concentration or memory problems were the most frequent and distressing symptoms in the 3- to 5-year time cohort. Itching was the most frequent and distressing symptom in the 5- to 9-year time cohort. Finally, relationship was found between symptom experience and nonadherence to immunosuppressive drugs.

Conclusions

Symptoms related to physical complaints or impairments were more often perceived and more distressing for liver transplant recipients 3 years after transplantation. Furthermore, the 3- to 5-year time cohort and younger age were associated with a higher degree of perceived symptom occurrence and symptom distress. Finally, recipients who perceived higher levels of symptom frequency and symptom distress reported higher levels of nonadherence.