Stress and Health

The purpose of this research was to examine the relationship between psychological distress and aspects of health insurance status, including lack of coverage, types of coverage and disruption in coverage, among US adults. Data from the 2001-2010 National Health Interview Survey were used to conduct analyses representative of the US adult population aged 18-64 years. Multivariate analyses regressed psychological distress on health insurance status while controlling for covariates. Adults with private or no health insurance coverage had lower levels of psychological distress than those with public/other coverage. Adults who recently (≤1 year) experienced a change in health insurance status had higher levels of distress than those who had not recently experienced a change. An interaction effect indicated that the relationship between recent change in health insurance status and distress was not dependent on whether an adult had private versus public/other coverage. However, for adults who had not experienced a change in status in the past year, the average absolute level of distress is higher among those with no coverage versus private coverage. Although significant relationships between psychological distress and health insurance status were identified, their strength was modest, with other demographic and health condition covariates also being potential sources of distress. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

We examined the impact of the 921 Taiwan Earthquake on internalizing and externalizing behaviours among junior high school students 2 and 4 years after the earthquake. This study was a secondary analysis using data extracted from the Taiwan Education Panel Survey and included 12111 students. The impact of the earthquake was assessed by the length of time to restore the home environment and whether a family member died or was severely injured in the earthquake. Generalized estimating equations showed that living in an urban area and a longer duration after the earthquake were associated with increased internalizing and externalizing behaviours. Boys reported more externalizing but fewer internalizing behaviours than girls. After adjustment for those variables, having a family member who had died or was severely injured was not significantly associated with increased internalizing and externalizing behaviours. However, a longer duration of time to restore the home environment was significantly associated with these behaviours. Regardless of the impact level of the disaster, adolescents had increased internalizing and externalizing behaviours from the seventh to ninth grades. Post-disaster mental health services should continue monitoring and supporting children whose ordinary home living is affected by a natural disaster up to 4 years post-disaster. Copyright © 2013 John Wiley & Sons, Ltd.

The aim of this study was to analyse the impact of the effort-reward imbalance and learning motivation on sickness absence duration and sickness absence frequency among beginning teachers in Flanders (Belgium). A total of 603 teachers, who recently graduated, participated in this study. Effort-reward imbalance and learning motivation were assessed by means of self-administered questionnaires. Prospective data of registered sickness absence during 12 months follow-up were collected. Multivariate logistic regression analyses were performed. An imbalance between high efforts and low rewards (extrinsic hypothesis) was associated with longer sickness absence duration and more frequent absences. A low level of learning motivation (intrinsic hypothesis) was not associated with longer sickness absence duration but was significantly positively associated with sickness absence frequency. No significant results were obtained for the interaction hypothesis between imbalance and learning motivation. Further research is needed to deepen our understanding of the impact of psychosocial work conditions and personal resources on both sickness absence duration and frequency. Specifically, attention could be given to optimizing or reducing efforts spent at work, increasing rewards and stimulating learning motivation to influence sickness absence. Copyright © 2012 John Wiley & Sons, Ltd.

Our study aimed to identify two types of stressors from supervisors: abusive supervision (AS) and workload demands from supervisors (WDS). AS reflects the relationship dimension of supervisor-related stressors, and WDS reflects the task dimension of supervisor-related stressors. In Study 1, we attempted to distinguish between AS and WDS. The results of confirmatory factor analysis showed that AS and WDS are two distinct dimensions of supervisor-related stressors. In Study 2, we utilized job demands-resources model and investigated whether AS and WDS can uniquely predict subordinates' emotional exhaustion (EE). We also explored whether perceived job characteristics (PJCs) have differential moderating effects on the relationships between the two dimensions of supervisor-related stressors (AS and WDS) and EE. Consistent with our predictions, the results showed that both AS and WDS have incremental predictive effects on EE after controlling for the effect of the other. The results also revealed that PJCs weaken the WDS-EE relationship, not the AS-EE relationship. We discussed the theoretical and practical implications at the end. Copyright © 2012 John Wiley & Sons, Ltd.

In a sample of 368 Chinese high school students, the present study examined the different effects of Chinese high school students' academic stress on their depressive symptoms and the moderating effects of gender and students' perceptions of school climate on the relationships between their academic stress and depressive symptoms. Regression mixture model identified two different kinds of subgroups in the effects of students' academic stress on their depressive symptoms. One subgroup contained 90% of the students. In this subgroup, the students' perceptions of academic stress from lack of achievement positively predicted their depressive symptoms. For the other 10% of the students, academic stress did not significantly predict their depressive symptoms. Next, multinomial regression analysis revealed that girls or students who had high levels of achievement orientation were more likely to be in the first subgroup. The findings suggested that gender and students' perceptions of school climate could moderate the relationships between Chinese high school students' academic stress and their depressive symptoms. Copyright © 2011 John Wiley & Sons, Ltd.

Routine academic events may cause stress and produce temporary elevations in blood pressure. Students who experience test anxiety may be especially prone to cardiovascular activation in response to academic stress. This study drew on self-reported stress and ambulatory blood pressure measurements provided by 99 undergraduate participants (30% men, mean age=21 years) who participated over 4 days. Posture, activity level, recent consumption and the previous same-day reading were considered as covariates in a series of hierarchical linear models. Results indicate elevations in systolic blood pressure at times of acute academic stressors; neither diastolic blood pressure nor heart rate was linked with academic stress. In addition, those participants higher in test anxiety exhibited especially pronounced elevations in systolic blood pressure during times of acute academic stress. This research suggests that everyday academic stressors are linked with temporary increases in blood pressure and that test anxiety may contribute to these elevations. Test anxiety has implications for future academic and job success, and cardiovascular responses to everyday stress may contribute to health problems later in life.

The purpose of this study was to analyse the associations of emotional control with sociodemographic and clinical variables in a sample of patients with a range of chronic somatic diseases. The relationships between emotional control, coping styles and adjustment to the disease were investigated. The sample consisted of 300 patients with the mean age of 54.60 ± 17.57 years. Courtauld Emotional Control Scale was used to measure the patients' tendency to suppress negative emotions, Coping Inventory for Stressful Situations was used to measure coping styles and Acceptance of Illness Scale was applied to determine adjustment to the disease. Patients with neurological conditions showed significantly lower suppression of anger. Levels of emotional control were found to be related to gender, age and educational level but not to the place of residence. Task-oriented style of coping with stress correlated positively with suppression of depression and anxiety, whereas acceptance of illness correlated negatively with suppression of anger. Levels of emotional control are only weakly related to the type of diagnosis; however, some clinical samples may show lower suppression of anger. Suppression of negative emotions is weakly related to adjustment indicators such as certain coping styles and acceptance of illness. Copyright © 2013 John Wiley & Sons, Ltd.

The aim of the present study conducted among 274 Finnish employees was to examine the relationships between job characteristics, recovery experiences and occupational well-being across 1 year. We hypothesized that these relationships would follow normal causation, that is, job characteristics at T1 predict recovery experiences (detachment, relaxation, mastery and control at off-job time) and well-being (fatigue at work and work engagement) at T2, and recovery experiences at T1 predict well-being at T2. The structural equation modelling analyses lent support to the hypothesized normal causation model compared with the reversed causation and reciprocal models. However, only the longitudinal relationships between job characteristics and recovery experiences were significant. More specifically, high job demands at T1 predicted poor detachment, relaxation and control during off-job time at T2; and high job resources at T1 predicted high mastery experiences in off-job time at T2. Thus, our study showed that job demands in particular inhibited recovery experiences in the long term, but this was not reflected in employee well-being across 1 year. Copyright © 2013 John Wiley & Sons, Ltd.

Measurement invariance of the 2-factor model of the Perceived Stress Scale-10-item version (Cohen & Williamson, 1988) was tested across men and women at two time points and in the combined total sample over a 2-year time frame (n = 871). Measurement invariance results indicated that the scale measured the latent factors, stress and counter-stress, equivalently in men and women and over time. With measurement invariance demonstrated, differences in latent means were tested. Results indicated that men had lower levels of frequencies of stressors, and at one time point, higher levels of counter-stress, when compared with women. When examining change in frequencies of stressors and counter-stress over 2 years with the combined male and female sample, stressors remained stable, yet counter-stress increased over time. These findings may aid in the interpretation of results when examining stressors and counter-stress in clinical samples where one would expect stress to increase, whereas positive psychological states decrease. Copyright © 2012 John Wiley & Sons, Ltd.

The present study aimed to investigate whether stress experienced early in life is associated with actigraphic and subjective sleep measures in a sample of adult psychiatric outpatients. A total of 48 psychiatric outpatients completed self-report questionnaires assessing current depression, current anxiety symptoms and stress load during childhood (before the age of 13 years), adolescence (between the age of 13 and 18 years) and adulthood (between the age of 19 and current age). Sleep-related activity was measured using 24-h wrist actigraphy over a 7-day period at home, during which participants also kept a sleep diary. High stress load in childhood, but not in adolescence, was associated with shortened actigraphically assessed total sleep time, prolonged sleep onset latency, decreased sleep efficiency and an increased number of body movements in sleep, even after accounting for the effects of later occurring stress and psychopathological symptoms such as depression and anxiety scores. Unexpectedly, no significant associations between early-life stress load and subjective sleep measures were found. Results are consistent with findings from previous studies indicating an association between childhood adversities and higher levels of nocturnal activity. The findings suggest that high stress load during childhood might be a vulnerability factor for sleep continuity problems in adulthood. Copyright © 2012 John Wiley & Sons, Ltd.

It was investigated (1) whether employee health and well-being (H&W) improve during short vacations (4-5 days), (2) how long this improvement lasts after returning home and resuming work and (3) to what extent vacation activities and experiences explain health improvements during and after short vacations. Eighty workers reported their H&W 2 weeks before vacation (Pre), during vacation (Inter), on the day of return (Post 1) and on the third and 10th day after returning home (Post 2 and Post 3, respectively). The results showed improvements in H&W during short vacations (d = 0.62), although this effect faded out rather quickly. Partial correlations and regression analyses showed that employees reported higher H&W during vacation, the more relaxed and psychologically detached they felt, the more time they spent on conversations with the partner, the more pleasure they derived from their vacation activities and the lower the number of negative incidents during vacation. Experiences of relaxation and detachment from work positively influenced H&W even after returning home. Working during vacation negatively influenced H&W after vacation. In conclusion, short vacations are an effective, although not very long lasting, 'cure' to improve employees' H&W. Copyright © 2011 John Wiley & Sons, Ltd.

Few studies have investigated the effect of an acute psychosocial stress paradigm on impaired attention and working memory in humans. Further, the duration of any stress-related cognitive impairment remains unclear. The aim of this study was to examine the effect of an acute psychosocial stress paradigm, the Trier Social Stress, on cognitive function in healthy volunteers. Twenty-three healthy male and female subjects were exposed to an acute psychosocial stress task. Physiological measures (salivary cortisol, heart rate and blood pressure) and subjective stress ratings were measured at baseline, in anticipation of stress, immediately post-stress and after a period of rest. A neuropsychological test battery including spatial working memory and verbal memory was administered at each time point. Acute psychosocial stress produced significant increases in cardiovascular and subjective measures in the anticipatory and post-stress period, which recovered to baseline after rest. Salivary cortisol steadily declined over the testing period. Acute psychosocial stress impaired delayed verbal recall, attention and spatial working memory. Attention remained impaired, and delayed verbal recall continued to decline after rest. Acute psychosocial stress is associated with an impairment of a broad range of cognitive functions in humans and with prolonged abnormalities in attention and memory. Copyright © 2014 John Wiley & Sons, Ltd.

A variety of techniques exist for eliciting acute psychological stress in the laboratory; however, they vary in terms of their ease of use, reliability to elicit consistent responses and the extent to which they represent the stressors encountered in everyday life. There is, therefore, a need to develop simple laboratory techniques that reliably elicit psychobiological stress reactivity that are representative of the types of stressors encountered in everyday life. The multitasking framework is a performance-based, cognitively demanding stressor, representative of environments where individuals are required to attend and respond to several different stimuli simultaneously with varying levels of workload. Psychological (mood and perceived workload) and physiological (heart rate and blood pressure) stress reactivity was observed in response to a 15-min period of multitasking at different levels of workload intensity in a sample of 20 healthy participants. Multitasking stress elicited increases in heart rate and blood pressure, and increased workload intensity elicited dose-response increases in levels of perceived workload and mood. As individuals rarely attend to single tasks in real life, the multitasking framework provides an alternative technique for modelling acute stress and workload in the laboratory. Copyright © 2013 John Wiley & Sons, Ltd.

Exposure to racial discrimination has been linked to physiological reactivity. This study investigated self-reported exposure to racial discrimination and parasympathetic [high-frequency heart rate variability (HF-HRV)] and sympathetic (norepinephrine and cortisol) activity at baseline and then again after acute laboratory stress. Lifetime exposure to racial discrimination was measured with the Schedule of Racist Events scale. Thirty-two women (16 Black and 16 White) with type 2 diabetes performed a public speaking stressor. Beat-to-beat intervals were recorded on electrocardiograph recorders, and HF-HRV was calculated using spectral analysis and natural log transformed. Norepinephrine and cortisol were measured in blood. Higher discrimination predicted lower stressor HF-HRV, even after controlling for baseline HF-HRV. When race, age, A1c and baseline systolic blood pressure were also controlled, racial discrimination remained a significant independent predictor of stressor HF-HRV. There was no association between lifetime discrimination and sympathetic markers. In conclusion, preliminary data suggest that among women with type 2 diabetes mellitus (T2DM), exposure to racial discrimination is adversely associated with parasympathetic, but not sympathetic, reactivity. Copyright © 2013 John Wiley & Sons, Ltd.

This study investigated the effect of self-reported racial discrimination on endothelial responses to acute laboratory mental stress among post-menopausal women. One-hundred thirteen women (n = 94 self-identified as White and n = 19 self-identified as racial/ethnic minority), 43% with type 2 diabetes, reported lifetime experiences of racial/ethnic discrimination. Repeated assessments of flow-mediated dilation were performed at baseline, immediately after 5 min of mental arithmetic and at 20-min recovery. Both White and racial/ethnic minority women reported lifetime discrimination, with rates significantly higher among minorities. Self-reported lifetime discrimination was associated with attenuated flow-mediated dilation at recovery. Confounding variables, including clinical characteristics, mood, personality traits, other life stressors and general distress, did not better account for the effect of racial discrimination. Neither race/ethnicity nor diabetes status moderated the effect. The perceived stressfulness of the mental arithmetic was not associated with the endothelial response. In conclusion, self-reported lifetime discrimination is associated with attenuated endothelial recovery from acute mental stress. Elucidating the effects of discrimination and the biological mechanisms through which it affects the vasculature may suggest interventions to improve health. Copyright © 2012 John Wiley & Sons, Ltd.

Addiction to social media has now become a problem that societies are concerned with. The aim of the present study is to investigate the impacts that social media addiction has on mindfulness and choice of coping strategy, as well as to explore the consequences on emotional exhaustion. The survey data were collected from 211 employees in 13 enterprises in Thailand. Results from partial least square structural equation modelling revealed that people who are highly addicted to social media tended to have lower mindfulness and tended to use emotion-focused coping to deal with stress. Lack of mindfulness and the decision to use emotion-coping strategy are also subsequently associated with higher emotional exhaustion. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Internet addiction (IA) is an emerging social and mental health issue among youths. Analysis of risk factors, as well as their interactions, is crucial for understanding the development of IA. This study investigated the relationship between recent stressful life events, personality traits, perceived family functioning and IA in 892 college students. Subjects were classified into categories (non-addicted, mild IA or severe IA) using the Chen Internet Addiction Scale. Stressful life events, personality traits and family functioning were assessed using the Adolescent Self-Rating Life Events Checklist, the Eysenck Personality Questionnaire, and the Family Adaptability and Cohesion Scale, respectively. The results indicated that compared with non-addicted subjects, subjects with severe IA (9.98%) had lower family functioning, lower extraversion, higher neuroticism and psychoticism, and more stressful life events, and subjects with mild IA (11.21%) had higher neuroticism and more health and adaptation problems. Neuroticism and health and adaptation problems were potential predictors of IA. An interaction effect between psychoticism and total life stress on IA was also found. These findings highlight the role of personality traits and life stress and their interactions in college students' IA. Further research should explore the mechanisms underlying the interaction effect of psychoticism with life stress on IA. Copyright © 2013 John Wiley & Sons, Ltd.

The current study tested whether emotion regulation and rumination moderated and/or mediated the relationship between accumulated adverse life experience and psychological distress in adolescence. In class, Australian high school students (n = 2637, 12-18 years, 68% female) from 41 schools completed well-validated measures of adverse life experience, emotion regulation, rumination and psychological distress, and were followed up 1 year later (n = 1973, 75% retention rate). Adjusting for age, gender and baseline psychological distress, adverse life experience predicted psychological distress 1 year later. Expressive suppression and rumination were positively associated with psychological distress. Cognitive reappraisal was negatively associated with psychological distress and moderated the relationship between adverse life experience and psychological distress. This relationship was also partially mediated by cognitive reappraisal, expressive suppression and rumination. Promoting cognitive reappraisal and minimizing expressive suppression and rumination may be useful strategies to improve mental health for adolescents who have experienced adverse life events. Future research should examine whether adolescents who have experienced adverse life events can be trained in effective emotion regulation strategies and whether this training can prevent development of psychological maladjustment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

We tested whether emotion regulation (cognitive reappraisal and expressive suppression) and coping (distraction, avoidance, support seeking and active coping) mediate or moderate the association between change in life stress (change in number of adverse life events) and change in adolescent problem behaviour. We used prospective and retrospective longitudinal data from a community sample. We measured change in problem behaviour as emotional and behavioural problems at Time 2 controlling for emotional and behavioural problems at Time 1, a year earlier. We measured change in life stress as life stress between Times 1 and 2, controlling for total previous life stress (before Time 1). Neither coping nor emotion regulation mediated the association between change in life stress and change in problem behaviour. Avoidance and expressive suppression were related to an increase in problem behaviour. Only cognitive reappraisal moderated the effect of increase in life stress on worsening of problem behaviour, suggesting that, as expected, cognitive reappraisal was a protective factor. In adolescents who reported they habitually reappraise, the association between change in life stress and change in emotional and behavioural problems was non-significant. Copyright © 2012 John Wiley & Sons, Ltd.

A survey of adolescents aged 15 to 16 years was used to examine the relationship between their perceptions of indulgent parenting and adolescent weight status to overall satisfaction with life, as associated with adolescent perceptions of body image, health and stress. In addition, perceptions of parental indulgence were examined in terms of their association with adolescent eating behaviours and health. The results revealed a paradox related to indulgent parenting, with both positive and negative outcomes for adolescents. Structural equation analyses showed that parental indulgence was not only related to lower stress and higher life satisfaction, but also to unhealthy eating behaviours. Path analysis indicated that both positive and negative eating outcomes for adolescents were related to parental indulgence. This research has many implications for both parent and adolescent health education, focusing on parenting styles, stress and healthy lifestyles.

Mental toughness has been explored predominantly within sport contexts. Nevertheless, it is difficult to conceive mental toughness as only applicable to athletes. This study examines whether mentally tough participants exhibit resilience against stress. This is a cross-sectional study based on two different samples: Sample 1 consisted of 284 high school students (99 males, 185 females, M = 18.3 years). Sample 2 consisted of 140 first through fifth semester undergraduate students (53 males, 87 females, M = 20.0 years). Participants provided information about their level of perceived stress (10-item Perceived Stress Scale), mental toughness (48-item Mental Toughness Questionnaire) and depressive symptoms (Beck Depression Inventory). Consistent across the two samples, mental toughness mitigated the relationship between high stress and depressive symptoms. The interaction between stress and mental toughness explained 2% of variance in the adolescent sample and 10% of variance among young adults. The promotion of protective factors that foster resilient adaptation is a relevant issue. Mental toughness may appeal to individuals that are typically difficult to be reached with health interventions. Because mental toughness is part of young people's daily speech, it may serve as a less academic resource than other health psychology concepts. Copyright © 2012 John Wiley & Sons, Ltd.

This study explores coping strategies used by war-affected eastern Congolese adolescents across age and sex, and the association between post-traumatic stress symptoms and engagement and disengagement coping. Cross-sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13-21 years (M = 15.83, standard deviation = 1.81) participated in self-report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post-traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war-affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.

This study investigated the relationship between stress and body satisfaction in adolescence. A sample consisting of 515 adolescents aged 12-16 years completed a series of self-report questionnaires assessing general and specific aspects of adolescent stress, body satisfaction and the psychological constructs of self-esteem, depressive symptoms and body importance. Results revealed a significant association between higher body dissatisfaction and higher ratings of peer stress, lower self-esteem and greater body importance for female and male adolescents. These findings suggest that adolescent stress relates to satisfaction with the body and that this stress is specifically focused on the peer environment for both genders during adolescence. This may have implications for intervention programmes aimed at improving body satisfaction, suggesting that the inclusion of stress management training in these programmes could specifically focus on difficulties within the peer domain. Copyright © 2013 John Wiley & Sons, Ltd.

The objective of the present study is to test the validity of the integrated cognitive model of depression proposed by Kwon and Oei () with a Chinese adolescent sample. A two-wave panel design was used. We hypothesized that the interaction between dysfunctional attitudes measured at time 1 and adolescents' negative life events experienced between times 1 and 2 would predict changes in the frequency of automatic thoughts between times 1 and 2. We further hypothesized that changes in the frequency of automatic thoughts would, in turn, predict changes in the severity of depressive symptoms. Participants were 329 Chinese adolescents. As a comparison, we tested three other competing models: linear mediation, alternative aetiologies and symptom models. All participants completed the Adolescent Self-Rating Life Events Checklist, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire and Center for Epidemiological Studies Depression Scale on two occasions-5 months apart. Path analysis was used to test all models. Results of the path analysis indicated that the integrated cognitive model showed an adequate fit for the Chinese adolescent data. During phases of increased depression, dysfunctional attitudes were common cognitive moderators of depression, whereas automatic thoughts were specific cognitive mediators of depression. Copyright © 2013 John Wiley & Sons, Ltd.

The main aims of this study were to evaluate the intensity of stress, anxiety and depression as well as the effectiveness of coping strategies adopted pre-operatively in brain neoplasm patients. A descriptive-explorative study design was undertaken. During 2008, patients admitted to a large Italian hospital neurosurgical unit with their first (n = 21) or recurrent (n = 15) brain neoplasm, on the day before their surgical procedure, were consecutively recruited into the study. The Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Jalowiec Coping Scale were administered via face-to-face interview. Patients with their first occurrence of neoplasm perceived the same stress intensity as those with recurrent neoplasm (mean ± standard deviation: 14.9 ± 6.7 versus 17.2 ± 8.8, p = 0.36). They also reported the same likelihood of anxiety at a borderline level (odds ratio (OR) 4.88, 95%CI 0.42 to 40.97, p = 0.06) and at a clinically relevant level (OR 0.32, 95%CI 0.01 to 5.37, p = 0.35) as well as the same likelihood of depression at a borderline level (OR 1.25, 95%CI 0.20 to 8.40, p = 0.78). Only one case of clinically relevant depression emerged among patients at their first diagnosis. Patients at their first occurrence, as well as those at recurrence, reported that they adopted optimistic coping strategies (mean 2.20, 95%CI 2.01 to 2.38 versus mean 1.96, 95%CI 1.71 to 2.20) and sought support (mean 1.81, 95%CI 1.58 to 2.05 versus mean 1.89, 95%CI 1.63 to 2.15). According to the findings of this exploratory study, on the pre-operative day, brain neoplasm patients at their first diagnosis and at recurrence wish to confront the situation: they adopt optimistic coping strategies, they seek support and they wish to take a constructive problem-solving approach. Knowledge of the intensity of stress, anxiety and depression as well as the coping strategies adopted by the patients is important for clinicians in their efforts to tailor care to patients' individual needs. Copyright © 2012 John Wiley & Sons, Ltd.

Stress is a contributor of many cardiovascular diseases. Positive inotropic and chronotropic effects of catecholamines are regulated via β-adrenergic receptors (ARs). Many reports exist concerning changes of cardiac β1 - and β2 -ARs in stress, but only a few deal with modulation of cardiac β3 -AR. Our aim was to analyze the expression and binding sites of β1 -, β2 - and β3 -ARs and adenylyl cyclase activity in the left ventricle, and β3 -AR expression and binding in the left atrium of rats exposed to acute and chronic immobilization stress (IMO). The concentration of noradrenaline in the ventricle decreased, while adrenaline increased, especially after repeated IMO. The mRNA and protein levels, and binding sites of β3 -subtype significantly rose following chronic IMO, while all parameters for β2 -AR dropped after single and repeated exposure. Similarly, the mRNA levels and binding sites for β3 -subtype increased in the left atrium as a consequence of chronic IMO. The rise in β3 -subtypes and a drop in β2 -subtypes resulted in inhibition of adenylyl cyclase activity within the left ventricle. Taken together, among other factors, up-regulation of β3 -AR could represent an adaptation mechanism, which might be related to altered physiological function of the left ventricle and atrium during prolonged emotional stress and might serve cardioprotective function during catecholamine overload. Copyright © 2013 John Wiley & Sons, Ltd.

This study compared altruistically and egoistically framed messages for encouraging adult children to support a parent providing care for an elderly relative. Undergraduate students imagined their mother filling a caregiving role while reading a message about family caregiving and the physical and psychological stresses it involves. The message encouraged participants to support the caregiver either for altruistic (other-oriented) or egoistic (self-oriented) reasons. Thereafter, participants completed self-assessment surveys of attachment style and willingness to provide support. Securely attached (less self-oriented) participants were not differentially influenced by the two messages. However, insecurely attached (more self-oriented) participants were more willing to help if they received the egoistic message than if they received the altruistic message. Thus, knowledge of a family member's attachment style can be useful for selecting an appropriate method for encouraging caregiver support. Whereas the type of message used does not matter for securely attached individuals, an egoistically framed message may be more influential than an altruistically framed message among insecurely attached individuals. It is important that clinicians work with families to establish appropriate levels of individual commitment to caregiving responsibilities or supportive behaviours such that involvement is beneficial to the health of the caregiver, the care recipient and supporters. Copyright © 2013 John Wiley & Sons, Ltd.

This study analyses distinct trajectories of vital exhaustion (VE; a measure of mental health incorporating signs of stress and depression) over a period of 15 years in healthy adults and investigates further the consequences for markers of low-grade inflammation as indicators of cardiovascular disease risk. Data of 341 participants of the Amsterdam Growth and Health Longitudinal Study were utilized. VE was measured by the Maastricht Questionnaire. Markers of low-grade inflammation included interleukin-6, interleukin-8 and tumour necrosis factor-α. Distinct trajectories of VE were obtained by latent class growth models, and consequences for markers of low-grade inflammation of the trajectories were analysed by linear regressions. We found comparable trajectories of VE for men and women; a 'never vitally exhausted' subgroup (16.9% and 25.1%, respectively), a 'stable preclinical VE' subgroup (51.7% and 68.1%) and a 'chronic VE state' subgroup (31.5% and 6.7%). The subgroups had similar levels of the markers investigated. This study is the first to analyse VE longitudinally in healthy adults and indicates that although distinct trajectories of VE were identified, differential consequences for cardiovascular disease risk were unapparent. Copyright © 2013 John Wiley & Sons, Ltd.

Body piercing, which is prevalent in young adults, has been suggested to be associated with features usually related to posttraumatic stress disorder (PTSD) such as high-risk behaviours and psychopathological symptoms and might be motivated by a wish to deal with prior traumatic experiences. However, to date, no research has investigated the relationship between this practice and PTSD symptoms. The present research aims to investigate the possible relationship between body piercing and PTSD symptoms in French-speaking young adults. According to our results, having two or more body piercings was associated with a twofold increased risk for scoring above the cut-off score for PTSD on the PTSD checklist. Our findings suggest that two or more body piercings might serve as an identifiable marker for PTSD symptoms and may have important implications for clinical screening. Copyright © 2012 John Wiley & Sons, Ltd.

This study assesses whether experiencing multiple deaths of loved ones clustered in time increases risk for substance use problems. Using survey data from a community sample of young adults in Miami, Florida (N = 1747), time-clustered deaths were categorized based on the age of the respondent at the time of each death, with less time between deaths representing greater time-clustering. Results indicate that young adults experiencing multiple deaths that are highly time clustered are at increased risk for substance use disorder and alcohol use. This study provides an alternative way of thinking about how young people may be affected by major life events. It suggests that the increased risk for substance use disorder associated with multiple deaths may be more likely to materialize when the deaths are highly clustered in time. Copyright © 2014 John Wiley & Sons, Ltd.

The ability to measure cumulative stress exposure is important for research and teaching in stress and health, but until recently, no structured system has existed for assessing exposure to stress over the lifespan. Here, we report the results of two experimental studies that examined the pedagogical efficacy of using an automated system for assessing life stress, called the Stress and Adversity Inventory (STRAIN), for teaching courses on stress and health. In Study 1, a randomized, wait-list controlled experiment was conducted with 20 college students to test whether the STRAIN, coupled with a related lecture and discussion, promoted learning about stress and health. Results showed that this experiential lesson led to significant learning gains. To disentangle the effects of completing the STRAIN from participating in the lecture and discussion, we subsequently conducted Study 2 on 144 students using a 2 (STRAIN versus control activity) by 2 (STRAIN-specific lecture versus general stress lecture) repeated-measures design. Although the STRAIN-specific lecture was sufficient for promoting learning, completing the STRAIN also generated significant learning gains when paired with only the general stress lecture. Together, these studies suggest that the STRAIN is an effective tool for promoting experiential learning and teaching students about stress and health. Copyright © 2013 John Wiley & Sons, Ltd.

The psychological impact of a cancer diagnosis can extend through treatment, well into cancer survivorship and can be influenced by a range of psychosocial resources. At different stages in this trajectory, optimism is known to affect well-being directly. This study focusing upon the potential to flourish after cancer, investigates the relationship between optimism and positive affect during cancer survivorship together with four possible mediators: social support, fighting spirit, internal health locus of control and cancer worry, all of which have been shown to be important predictors of well-being in cancer patients. Participants (n = 102) from online cancer forums completed standardized questionnaires, and path analysis confirmed that optimism had a direct effect on positive affect in cancer survivors. Social support and fighting spirit were also shown to be significant mediators of this relationship, accounting collectively for 50% of the variance in positive affect. Whilst cancer worry and internal health locus of control could be predicted from levels of optimism, they did not mediate the optimism-positive affect relationship. Efforts to promote optimism and thus encourage fighting spirit at diagnosis through treatment may be worthwhile interventions, as would ensuring appropriate social support through the trajectory. Copyright © 2012 John Wiley & Sons, Ltd.

Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modelling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β = -0.10, P < 0.001) and statistically significant indirect effects of resilience on fibromyalgia symptom burden through affect (β = -0.36, P < 0.001), suggesting that both resilience and affect influence fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden. Copyright © 2013 John Wiley & Sons, Ltd.

Evidence suggests that gender differences appear in a variety of biological and psychological responses to stress and perhaps in coping with acute and chronic illness as well. Dysfunctional parenting is also thought to be involved in the process of coping with stress and illness; hence, the present study aimed to verify whether dysfunctional remembered parenting would influence psychological distress in a gender-specific manner in patients suffering from cancer. Patients attending an outpatient oncology clinic completed the Remembered Relationships with Parents (RRP), Hospital Anxiety and Depression and Spielberger's State-Trait Anxiety Inventory scales and the National Cancer Center Network Distress Thermometer. Although no baseline gender differences were detected, a multivariate analysis confirmed that anxiety and depression symptoms of men and women suffering from cancer are differentially affected by the RRP Control and Alienation scores. Women with remembered parental alienation and overprotection showed significantly more anxiety symptoms than men, whereas men were more vulnerable to remembered alienation than overprotection with regard to the Distress Thermometer scores. These results suggest that remembered dysfunctional parenting is crucially, and in a gender-specific manner, involved in the coping strategy adopted by male and female cancer patients. Copyright © 2012 John Wiley & Sons, Ltd.

The purpose of the study being reported here was to investigate the relationship of job burnout and work engagement with self-reported received treatment for health conditions (cardiovascular condition, high cholesterol, depression, diabetes, hypertension and irritable bowel syndrome), while controlling for age, gender, smoking and alcohol use. The sample comprised 7895 employees from a broad range of economic sectors in the South African working population. A cross-sectional survey design was used for the study. Structural equation modelling methods were implemented with a weighted least squares approach. The results showed that job burnout had a positive relationship with self-reported received treatment for depression, diabetes, hypertension and irritable bowel syndrome. Work engagement did not have any significant negative or positive relationships with the treatment for these health conditions. The results of this study make stakeholders aware of the relationship between job burnout, work engagement and self-reported treatment for health conditions. Evidence for increased reporting of treatment for ill-health conditions due to burnout was found. Therefore, attempts should be made to manage job burnout to prevent ill-health outcomes. Copyright © 2014 John Wiley & Sons, Ltd.

Objective: The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment. Material and methods: A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics. Results: Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning. Conclusions: Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.

Using the theoretical perspectives offered by stressor-stress-strain framework and fairness theory, the authors propose that psychological climate will mediate the positive relationship between interpersonal aggression and employee burnout. Data from a survey of 1893 hospital employees suggested that psychological climate partially mediated the relationship between interpersonal aggression and two of the three dimensions of burnout, emotional exhaustion and depersonalization. The theoretical and practical implications of these findings and directions for future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

This article describes the rationale, implementation and results of a pilot study evaluating the personal and organizational impact of an educational intervention on the stress of health team members. The compelling imperative for the project was to find a positive and effective way to address the documented stress levels of healthcare workers. Pilot study of oncology staff (n = 29) and healthcare leaders (n = 15) exploring the impact of a positive coping approach on Personal and Organizational Quality Assessment-Revised (POQA-R) scores at baseline and 7 months using paired t-tests. Personal and organizational indicators of stress decreased in the expected directions in both groups over the time intervals. The majority of POQA-R categories were statistically significantly improved in the oncology staff, and many of the categories were statistically significantly improved in the leadership group. The findings from this project demonstrate that stress and its symptoms are problematic issues for hospital and ambulatory clinic staff as evidenced by baseline measures of distress. Further, a workplace intervention was feasible and effective in promoting positive strategies for coping and enhancing well-being, personally and organizationally. Copyright

This study examined the hypotheses that contingent self-esteem would be positively associated with alcohol-related problems and that global self-esteem would be negatively associated with such problems. It also examined the hypothesis that high stress and maladaptive coping would mediate these relationships. A sample of college students (n = 399) who were predominantly Hispanic (89%) completed measures of global and contingent self-esteem; stress and coping; and alcohol-related problems. Correlational and latent variable analyses indicated that contingent self-esteem positively related to alcohol-related problems, with maladaptive coping mediating this relationship. In contrast, global self-esteem negatively related to such problems, a relationship that was also mediated by maladaptive coping and stress. Overall, the results highlight the potentially harmful consequences of contingent self-worth and the adaptive nature of non-contingent self-esteem. They also demonstrate the important role that coping plays in mediating self-esteem's associations with alcohol-related problems. Copyright © 2012 John Wiley & Sons, Ltd.

Recent research has shown that chewing gum increases subjective alertness. Upper respiratory tract illnesses (URTIs) lead to reduced alertness, and it has been shown that stimulants such as caffeine can reverse this effect. It is now important to determine whether menthol chewing gum can produce a similar effect. Young adults with an URTI (N = 16) and a healthy control group (N = 12) rated their mood and symptoms on two occasions (the first when those with a URTI were ill and the second when both groups were healthy). During each session, volunteers provided a rating while chewing gum and when they were not chewing. Those with a URTI reported reduced alertness, which persisted into convalescence. Chewing gum was associated with greater alertness in both those with URTIs and the healthy group. Chewing gum reduced the severity of nasal symptoms in those with a cold. The effects of the URTI and menthol gum may reflect changes in trigeminal stimulation. Copyright © 2012 John Wiley & Sons, Ltd.

The current study examined the association between alexithymia and coping styles (planning, positive reinterpretation and growth, social-emotion coping, and denial), and trauma symptoms in a clinical sample of 170 male and female veterans who experienced sexual trauma during military service. Denial was the only coping style positively associated with trauma symptoms, and it mediated the relationship between alexithymia and trauma symptoms. Alexithymia was negatively associated with planning. Likewise, alexithymia was negatively associated with social-emotional coping and with positive reinterpretation and growth. The results speak to the significant role that alexithymia has in predicting individual coping styles. Copyright © 2014 John Wiley & Sons, Ltd.

The purpose of the present study was to examine the construct validity of the Hungarian language version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A sample of 653 healthcare professionals (420 physicians and 233 nurses and nursing assistants) completed the MBI-HSS. A series of confirmatory factor analyses showed that a hierarchical bifactor model including a global burnout factor and three specific factors of emotional exhaustion, depersonalization and reduced personal accomplishment had the closest fit to the data, compared with an alternative second-order three-factor hierarchical model as well as to non-hierarchical one-factor, two-factor, three-factor, four-factor and five-factor models. However, only the global burnout factor and the specific personal accomplishment factor explained a considerable unique proportion of variance in observed scores. Our study confirms the validity of the MBI-HSS and suggests an alternative structural model, which may contribute to further understanding of the burnout construct. Copyright © 2013 John Wiley & Sons, Ltd.

The aim of this study is to explore the efficacy of implementing a stress management programme based on a combined approach using cognitive behavioural therapy and complementary and alternative medicine for elementary school teachers who experienced mild level of stress, anxiety and/or depressive symptoms in Hong Kong. A 12-h programme involving cognitive behavioural therapy, self-management, relaxation techniques (diaphragmatic breathing and progressive muscle relaxation), mindful exercises (qigong and yoga), aromatherapy and acupressure was conducted. A quasi-experimental design was used to compare the intervention groups (n = 47) with the wait-list control groups (n = 46). The primary outcome measures were depression, anxiety and stress. Results indicated that the intervention group had significant reduction in depression [(F = 3.93; degrees of freedom (df) = 2.90; p = 0.023)], anxiety (F = 3.37; df = 2.90; p = 0.039) and stress (F = 3.63; df = 2.89; p = 0.031) when compared with the control group. Participants in both groups demonstrated lowered level of salivary cortisol at the post-assessment. The pilot results provided preliminary support to the multi-component stress management programme in relieving affective symptoms of teachers. The programme may be considered as an initial strategy to empower teachers with the abilities to cope with their affective symptoms. Further evaluation using a better designed randomized study with a larger sample size is warranted. (word: 198; max.: 200). Copyright © 2013 John Wiley & Sons, Ltd.

There is increasing evidence that occupational stress increases psychosomatic health complaints in the long run. However, the underlying mechanisms are still unclear. The present longitudinal actigraphy field study investigated the role of sleep quality-objectively assessed sleep-onset latency, sleep efficiency and sleep fragmentation, and subjectively assessed sleep quality-as a mediator in the relationship between stressful work conditions at time 1 and psychosomatic health complaints at time 2. A longitudinal hierarchical regression analysis revealed that social stressors at work were positively related to objectively assessed sleep fragmentation and to psychosomatic health complaints. Moreover, objectively assessed sleep fragmentation mediated the effect of social stressors at work on psychosomatic health complaints. Contrary to our expectations, social stressors at work were not related to other sleep quality parameters (i.e. sleep-onset latency, sleep efficiency and subjectively assessed sleep quality) during follow-up. Sleep fragmentation is discussed as an important consequence of social stressors at work that increase the risk of psychosomatic health complaints in the long run. Copyright © 2013 John Wiley & Sons, Ltd.

The aim of the present study was to investigate whether reduced autobiographical memory and future event specificity were associated with elevated depressive and stress symptoms immediately and 1 week following exposure to a trauma film. A non-clinical sample comprising 101 participants completed all phases of the study, which included the following: baseline tests of autobiographical memory and future event specificity; a diary recording intrusions of the film over a 7-day period; and self-report questionnaires assessing depressive, posttraumatic stress and ruminative symptoms 7 days following the trauma film viewing. Overgeneral autobiographical memory was significantly related to deficits in the specificity with which participants imagined future events. Participants who were more specific when remembering past and imagining future events reported less intrusions related to the trauma film over the 7-day period following the film; however, event specificity was not associated with depressive and stress symptoms 7 days later. These findings suggest that reduced past and future event specificity may play a role in the experience of intrusions following the experience of a stressful event. Copyright © 2014 John Wiley & Sons, Ltd.