No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Effects of perceived stress and coping strategies on physical symptoms
Abstract
This study examines direct and indirect effects of the level of perceived daily stress and coping strategies on the physical symptoms. The respondents were 153 healthy students from the Faculty of Philosophy, University of Rijeka. Three models concerning three groups of physical symptoms were tested by causal structural modeling procedure (LISREL). In each of the models, three coping styles (problem oriented, emotion oriented and avoidance) and perception of the stress intensity have been included, while as the outcome variable the first model included symptoms of respiratory infections, the second symptoms of autonomous dysfunction, and the third other physical symptoms (problems with locomotion, digestion and skin). The results show that coping styles do not exert significant direct effects on any group of the physical symptoms examined. When the effects of the coping styles on perceived stress are concerned, the results show that problem oriented coping significantly lowers, while avoidance significantly increases perceived stress. However, the level of perceived stress has significant positive effects only on the symptoms of the autonomous dysfunction and not on other two groups of symptoms, which is not in accord with the other research results. The need for the improvement of the measurement of the respiratory infections symptoms, as well as psychological interventions that would enable students to be aware of their own physical sensations that are attributable to the side effects of perceived stress is discussed.
... Perceived stress was measured using the Perceived Stress Scale-10 (PSS; Cohen, Kamarck, & Mermelstein, 1983), translation by Hudek-Knežević, Kardum, and Lesić (1999). PSS-10 is a 10 item self-report scale measuring the level of experienced stress during the previous month. ...
... Higher scores indicate higher levels of perceived stress. The scale has shown good reliability both in English and Croatian with reliability coefficients ranging from .78 (Cohen et al., 1983) to .88 (Hudek-Knežević et al., 1999). Cronbach alpha in our study was .88 for the entire sample, .84 for parents of children without intellectual disability, .87 for parents of children with mild intellectual disability, and .83 ...
Our study aims to examine the relationship of child’s intellectual disability, parental education, employment and perceived stress with parenting sense of competence (satisfaction and self-efficacy). Three groups of parents (children without intellectual disability, children with mild intellectual disabilities, and children with moderate/severe intellectual disability) completed measures of perceived stress, parenting sense of competence and socio-demographic questions. Results show that child’s intellectual disability affects parenting satisfaction but not parenting self-efficacy. Parental employment predicted parenting satisfaction, but not parenting self-efficacy, while perceived stress predicted parenting satisfaction and self-efficacy. Results further suggest that parental employment moderates the relationship of child's disability with parenting satisfaction and perceived stress. Result suggest a need for interventions aimed at supporting parents in dealing with emotional consequences of their child’s disability.
... The total sum of the responses determined the overall score, ranging from 0 to 75, with higher scores indicating more severe distress levels related to the COVID-19 pandemic. As suggested for the IES scale, according to the total score, respondents were categorized into four different ranges: "subclinical" (0-8), "mild" (9-25), "moderate" (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) and "severe" (≥44), with a score of 26 being the cut-off point over which significant clinical reaction is documented [30][31][32]. To ensure the quality of the IES-COVID19 translation, a back translation technique was used by an English language professional. ...
... For this study, a score ranging from 0 to 13 was considered as low perceived stress, a score between 14 and 26 as moderately perceived stress, while a score from 27 to 40 was considered as high perceived stress. PSS has already been adapted and validated in the Croatian population [35,36], while it showed excellent internal consistency in our sample too, with Cronbach's alpha coefficient of 0.91. ...
During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) are the backbone of the healthcare system with considerable impact on the general population, and their well-being is of great importance. The aim of this investigation was to assess FPs mental health, as well as knowledge, attitudes and practices (KAPs) regarding the pandemic, and opinions on non-communicable disease (NCD) health care provided to patients. A cross-sectional study was carried out with a sample of 613 FPs. Anxiety and depression levels were estimated with the Hospital Anxiety and Depression Scale, subjective perceived stress with the Perceived Stress Scale, while trauma-related symptoms were assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and opinions regarding NCD patients were evaluated with questionnaires accordingly. Results have shown that age (β = −0.02, p = 0.013) and personal risk of COVID‑19 (β = 1.05, p < 0.001) were significant independent correlates of the knowledge score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an independent predictor of perceived stress (β = −0.33, p = 0.023) and anxiety (β = −0.31, p = 0.006) levels. Limited accessibility to healthcare services and decreased number of newly-diagnosed NCD cases were mostly agreed on. The pandemic puts a considerable strain on FPs mental health, as well as on public health measures, due to the decreased overall quality of NCD patient health care. Educational programs may bridge the gaps between FPs’ knowledge. Thus lowering anxiety and improving patient care.
... Th e Perceived Stress Scale (PSS) 50 is a 10-item scale measuring three major components of stress in general, i.e. how much a person perceives life as unpre- dictable, uncontrollable or overwhelming 51 on a 5-point scale, where higher numbers indicate a higher level of stress. PPS was translated and validated for use in Croatia 52 . It was administered during pregnancy and in the early postpartum period, with Cronbach's α of 0.81 and 0.85, respectively. ...
Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cutoff score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress , stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not completely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.
... It consists of 54 items (eg, racing heart, chest pain, indigestion, diarrhea). This inventory was translated and adapted for the Croatian language in one of our previous studies (33). Participant responded to each of 54 symptoms on a 5-point intensity scale, with 0 -not at all, 1 -slightly, 2moderately, 3 -strongly, and 4 -extremely. ...
To examine how 5-factor personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) and 3 higher-order health-related personality constructs (negative experience, optimistic control, and passivity) are related to self-reports of subjective health outcomes (positive and negative mood, physical symptoms, and general health concern) and objective health conditions (chronic illnesses, serious illnesses, and physical injuries).
The study was carried out on a sample of 822 healthy volunteers (438 women and 384 men, from 18 to 84 years). Data were analyzed by hierarchical regression analyses for measures of subjective health outcomes used as criterion variables and binary logistic regression analyses for objective health conditions used as criterion variables.
Three health-related personality constructs significantly predicted all subjective health measures above and beyond 5-factor personality dimensions. Out of the 5-factor personality dimensions, neuroticism was most consistently related to worse subjective health outcomes, while out of 3 health-related personality constructs, negative experience was related to worse and optimistic control to better subjective health outcomes. When objective health conditions were taken into account as criterion variables, both sets of variables were relatively weak predictors. Only 5-factor personality traits as a group of variables significantly predicted chronic illnesses (chi(2)(5)=15.06; P=0.012; Nagelkerke R(2)=0.032). Only neuroticism significantly predicted the presence of chronic illnesses (odds ratio [OR], 1.091; 95.0% confidence interval [CI], 1.040-1.144), whereas only optimistic control was related to more frequent physical injuries caused by accidents (OR, 1.285; 95.0% CI, 1.002-1.648).
Five-factor personality traits and 3 health-related personality constructs may be useful factors in a multidisciplinary approach to understanding personality-health relationship.
On the sample of 338 subjects the relations between Eysenck's personality dimensions, emotional functioning and various groups of physical symptoms were examined. Dimensions of emotional control were measured by Emotional Control Questionnaire (ECQ, Roger and Najarion, 1989), adopted for the purpose of this study. It comprises three dimensions: rehearsal, control and emotional inhibition. Physical symptoms were measured by Pennebaker Inventory of Limbic Languidness (PILL, Pennebaker, 1982), which measures two groups of physical symptoms, respiratory and nonrespiratory symptoms. It was hypothesized that physical symptoms ore not only the result of the main effects of personality dimensions or dimensions of emotional control but partly the result of the interactions of the two groups of dimensions, i.e. personality characteristics and emotional control mechanisms. The results of hierarchical regression analyses indicate that from Eysenck's personality dimensions only neuroticism has main positive effects on all groups of physical symptoms, while from the dimensions of emotional control only control has main effects on the less intensive symptoms of respiratory infections. However, interactions of control and rehearsal with neuroticism and psychoticism hove significant effects on respiratory as well as on nonrespiratory symptoms, while the interaction between extroversion and control predicts only nonrespiratory symptoms. The results obtained were explained by physiological mechanisms through which psychological processes influence the occurrence of physical symptoms.
The aim Of the research was to investigate the role of temperament in a successful adaptation of adolescents in the period of an increased exposure tostress. The Goninger's temperaments model was used to explore whether temperament contributes to a successful adaptation of adolescents in the period of an increased exposure to stress both directly and indirectly, through peripheral levels of stress. The research conducted in the city of Osijek included 233 third-year grammar school students. Temperament was studied using the Temperament Scale (Cloninger et al., 1994), while perceived levels of stress were measured using the Perceived Stress Scale (Cohen, Kamarck and Mermelstein, 1983), and the successful adaptation by the Youth Self-Report (Achenbach, 1991). Multiple regression analysis was used and resulted in the conclusion that temperament directly and indirectly contributes to both a successful adaptation and its components. Low harm avoidance and low novelty seeking are predictors of a successful adaptation of adolescents.In addition to the possibility of predicting the general level of adaptation, the combination of individual temperament dimensionsdirectly contributes to a series of symptoms that arise as a consequence of stress. When it comes to indirect relations, stress is confirmed as a mediator of the correlation between temperament and a successful adaptation. It has been proved that stress is a mediator of the relationship between one of temperament dimensions, harm avoidance and a series of criteria. Overall, the research results show that temperament contributes to the level of adaptation of adolescents in the period of increased stress as well as to the probability of appearance of deviant conditions and behaviour,which are common reactions to stress.
A great number of research suggests that hardiness acts as a protective factor in stressful situations, especially in work context. In the present research the factor structure of Dispositional Resilience Scale (DRS; Bartone, Ursano, Wright, & Ingraham, 1989), and its factorial invariance across gender was examined. Furthermore, the relationships of hardiness to five-factor personality traits and several mental health outcomes (positive affect, negative affect and physical symptoms) were also explored. Research was carried out on the sample of 597 employees from different companies. Five hypotheses about the structure of this scale were tested by using confirmatory factor analysis. The results mostly supported one-factor structure of abridged version of DRS (12 items), from which three negatively oriented items originally aimed at measuring challenge were excluded. Regarding measurement invariance across gender, the results of multi-group confirmatory factor analysis show that factor loadings are invariant across the samples of men and women, but error variances of items were not equivalent across samples. Furthermore, the results show that hardiness scales are in low to moderate correlations with five-factor personality traits, suggesting that they could not be subsumed under the five-factor personality traits. Hierarchical regression analyses show the incremental effect of abridged hardiness scale over five-factor personality traits in predicting mental health measures. Predictive strength of hardiness was the highest for positive affect, and considerably lower for negative affect and subjective physical symptoms.
Abstract The researchers' aim was to examine whether it was better to predict new-onset postpartum depression (PPD) during pregnancy or immediately after childbirth. A prospective study conducted in Croatia followed women (N=272) from the third trimester of pregnancy, through the early postpartum period (within the first three postpartum days), to six weeks postpartum. Questionnaires on depression, anxiety, stress, coping, self-esteem and social support were administered. Through regression analyses we showed that PPD symptoms could be equally predicted by variables from pregnancy (30.3%) and the early postpartum period (34.0%) with a small advantage of PPD prediction in the early postpartum period.
eprint link: http://www.tandfonline.com/eprint/7WmxvDtcKn4dX3IZcbmF/full
As there are currently no specific measures of anxiety due to prenatal diagnostic procedures, the aim of the study was to develop and validate a new measure called the Prenatal Diagnostic Procedure Anxiety Scale (PDPAS).
Seventy-four pregnant women scheduled for amniocentesis and ultrasound completed the PDPAS, the State-Trait Anxiety Inventory (STAI), the Edinburgh Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS) before undergoing the diagnostic procedure. Reliability, concurrent validity, factor structure, scale sensitivity and specificity were analyzed. Differences between amniocentesis and ultrasound groups in the PDPAS score were analyzed with a t-test.
The final scale comprised 11 items and two subscales measuring 'fear of procedure' and 'fear of abnormal result'. Concurrent validity analysis showed that the PDPAS is an independent measure of anxiety. At a cut-off score of >11, sensitivity was 75.0% and specificity 72.01% with moderate accuracy. Fear of procedure was higher in the amniocentesis group, while fear of abnormal result was equally present in both amniocentesis and ultrasound groups.
The PDPAS has good internal consistency and concurrent validity with satisfactory psychometric characteristics. As a short measure of situation specific anxiety, it can be used as a screening tool in prenatal clinical settings. This article is protected by copyright. All rights reserved.
It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses.
After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer.
The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings.
Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.
the question of the relationship between emotion and physical illness is one of the most important, and at the same time most contentious, issues in the behavioral sciences / one of the problems in this area is that research findings tend to be considered in isolation, without an overall theoretical conceptualization / [draw] upon recent reviews to establish certain basic points / present a general theoretical position—developmental interactionist theory—from which, it is argued, these findings can be related to one another in a coherent way / this position will be used to examine the following areas of application: the effects of life stress, the definition and measurement of the phenomenon of alexithymia and social support of illness, the relationship of individual differences and illness (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study investigates the association between self-reported somatic complaints (GSCL, Giessen Symptom Check List), medically evaluated global health and coping style (MBHI, Millon Behavior Health Inventory), current emotions (TESI, Tension Effort Stress Inventory), subjective well-being, and mental absorption (ABS, Tellegen Absorption Scale). The MBHI basic coping scales denoted introversive, sociable, confident, and respectful were negatively correlated with the GSCL, while the inhibited and the sensitive scales were positively correlated with the GSCL. The forceful and the cooperative scales were uncorrelated with symptoms. All the psychogenic attitude scales were firmly positively associated with reported somatic complaints. Mental absorption was weakly positively associated with the GSCL. Current emotions were firmly positively and negatively related to symptom report. Medically assessed health status was almost uncorrelated with the MBHI scales, current mood, well-being, and absorption. © 1997 John Wiley & Sons, Ltd.
In confirmatory factor analysis, hypothesized models reflect approximations to reality so that any model can be rejected if the sample size is large enough. The appropriate question is whether the fit is adequate to support the model, and a large number of fit indexes have been proposed for this purpose. In the present article, we examine the influence of sample size on different fit indexes for both real and simulated data. Contrary to claims by Bentler and Bonett (1980), their incremental fit index was substantially affected by sample size. Contrary to claims by Joreskog and Sorbom (1981), their goodness-of-fit indexes provided by LISREL were substantially affected by sample size. Contrary to claims by Bollen (1986), his new incremental fit index was substantially affected by sample size. Hoelter's (1983) critical N index was also substantially affected by sample size. Of the more than 30 indexes considered, the Tucker-Lewis (1973) index was the only widely used index that was relatively independent of sample size. However, four new indexes based on the same form as the Tucker-Lewis index were also relatively independent of sample size., (C) 1988 by the American Psychological Association <2>
This article reviews research on the role of stress in infectious disease as measured either by illness behaviors (symptoms and use of health services) or by verified pathology. Substantial evidence was found for an association between stress and increased illness behavior, and less convincing but provocative evidence was found for a similar association between stress and infectious pathology. Introverts, isolates, and persons lacking social skills may also be at increased risk for both illness behaviors and pathology. Psychobiological models of how stress could influence the onset and progression of infectious disease and a psychological model of how stress could influence illness behaviors are proposed.
Several existing self-report measures of coping and the relevant research using these instruments are reviewed. Many of these coping measures suffer from a variety of psychometric weaknesses. A self-report instrument, the Multidimensional Coping Inventory (MCI), was constructed that identifies 3 types of coping styles: task-oriented, emotion-oriented, and avoidance-oriented coping. Support for the multidimensional nature of the MCI is presented, along with support for the reliability of the MCI coping scales. Two studies are presented that assessed the validity of the MCI. The 1st study assessed the construct validity of the MCI by comparing it with the Ways of Coping Questionnaire. The 2nd study also assessed the criterion validity of the MCI by comparing it with measures of depression, anxiety, Type A behaviour, neuroticism, and extraversion. Overall, the results suggest that the MCI is a valid and highly reliable multidimensional measure of coping styles.
This study addressed the effects of a commonplace stressful event on interferon production and natural killer (NK) cell activity and numbers. The quantity of interferons (IFN) produced by concanavalin A stimulated leukocytes obtained from 40 medical students during examinations was significantly lower when compared with IFN levels produced by peripheral blood leukocytes (PBLs) taken 6 weeks earlier (baseline). In addition, three different assays measuring NK cells also showed significant decrements during examinations when compared with baseline samples. These assays included lysis of MOLT-4 target cells, percentage of anti-Leu-7+ (NK) cells, and percentage of large granular lymphocytes. Self-report data documented the significantly greater distress associated with examinations in comparison with baseline samples. The data have implications for immunosuppressive disorders and stress-associated illnesses.
This study examines pain coping strategies in a relatively neglected pain population, sickle cell disease (SCD) patients. Seventy-nine patients diagnosed with SCD were given a structured interview to assess pain, activity level, and health care use during painful episodes. Patients also completed the SCL-90-R as an index of psychological distress and the Coping Strategies Questionnaire. Regression analyses controlled for age, sex, and disease severity measures. Results indicated that the coping strategies factors were important predictors of pain and adjustment. Individuals high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health care services. Individuals high on Coping Attempts were more active during painful episodes.
This study investigates the effects of coping style and cognitive hardiness on physical and psychological health status. Measures of coping styles (intrusive positive thoughts, intrusive negative thoughts, avoidance, problem-focused coping), cognitive hardiness, stress, health habits, psychological distress, and physical illness were collected for 194 professional employees. Multiple regression analyses revealed that intrusive negative thoughts and avoidance coping approaches significantly contributed to predictions of psychological distress and physical illness outcomes, respectively. Cognitive hardiness significantly contributed to predictions of psychological distress but not physical illness outcomes. Health habits were significantly related to both measures of health status. Two coping approaches, intrusive positive thoughts and problem-focused coping, did not significantly contribute to predictions of either physical or psychological health status.
We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotional-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measure coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies.
Despite wide spread popular belief in the activation of recurrent lesions ingenital herpes simplex virus (HSV) by psychosocial stress, little empirical evidence supports that contention. This study retrospectively examined the role of stress in activation of HSV lesions as mediated by social support. Participants were 59 volunteers who had self-reported culture-positive genital HSV for at least 10 months. Measures of stress proneness (State-Trait Anxiety Inventory; STAI-Trait), recent stressful events (Schedule of Recent Events; SRE), and subjective appraisal of stress (global self-rating) were administered along with measures of general social support and herpes-specific social support. When retrospective reports of HSV symptoms were examined using a multiple-regression approach, duration of disease and amount of herpes-specific social support were found to be significant moderators of the relation between stress and number of HSV recurrences in the preceding 12 months. When duration of disease was short (less than 4years), stress (SRE) and number of recurrences were positively associated; when disease duration was longer, there was no relationship. Similarly, at low levels of herpes-specific social support, a positive relation between stress(SRE) and number of recurrences was found. However, at higher levels of herpes-specific social support, no association was found. No relation was found between stress proneness (STAI-Trait) and HSV symptoms. However, subjective appraisal (global rating) of stress in the preceding 12 months was positively and significantly correlated with reported number of recurrences. Results are discussed in terms of their clinical implications.
Key words: genital herpes simplex virus (HSV), stress, social support, disease duration
Recent evidence from animal models of stress suggests that stress can impair immunologic competence, rendering the host more vulnerable to infection and neoplasm. The present authors review studies on the relationship between psychosocial factors and human immunologic functioning, focusing on studies bearing on the relationship of psychosocial factors to altered susceptibility to infectious diseases and those bearing on the relationship of such factors to specific aspects of the human immune response. Findings indicate that a variety of psychosocial variables, disease states, and aspects of both humoral and cell-mediated immune responses have been investigated, and evidence favors the view that psychosocial variables may play a role in modulating the human immune response. More research is needed before it can be definitively concluded that the relationship between stress and human susceptibility to infectious diseases is a psychoimmunologic nexus. Relationships between the endocrine and immune systems are also discussed. (5 p ref)
Laboratory and field research indicates that the relationships between personal control and stress, coping, and adaptational outcomes are more complex than was once assumed. Believing that an event is controllable does not always lead to a reduction in stress or to a positive outcome, and believing that an event is uncontrollable does not always lead to an increase in stress or to a negative outcome. These complex relationships involving control are examined in the context of Lazarus's cognitive theory of stress and coping. The first part of the article elaborates this theory and shows how two forms of control, generalized beliefs about control and situational appraisals of control, fit into the overall model. Situational appraisals of control are explored in this section, including the question, Control over what? which must be addressed in order to explain some of the perplexing findings. The second part of the article draws on the theoretical formulation of stress and coping to examine three important issues: (a) how believing one has control in a stressful transaction can heighten threat, (b) the relationship between control and coping, and (c) pathways through which control can affect the adaptational outcomes of stressful encounters.
State and trait negative affect (NA) were measured in healthy people immediately before an illness was induced through exposure to a respiratory virus. State NA, disease-specific health complaints (e.g., runny nose, congestion, and sneezing), and an associated objective marker of disease severity (mucus secretion weights) were assessed daily during the illness. Baseline trait and state NA were both associated with increased numbers of subsequent complaints. Although greater numbers of complaints among people high in state NA were explicable in terms of greater disease severity, the association of trait NA and symptoms was independent of objective disease. The trait NA complaint association was also independent of state NA and hence not attributable to trait-elicited state affect. Greater trait NA was associated with biases in complaining during but not before illness. This suggested failure to discriminate between symptoms rather than increased sensitivity or hypochondriacal response.
Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.
After completing questionnaires assessing stressful life events, perceived stress, and negative affect, 394 healthy Ss were intentionally exposed to a common cold virus, quarantined, and monitored for the development of biologically verified++ clinical illness. Consistent with the hypothesis that psychological stress increases susceptibility to infectious agents, higher scores on each of the 3 stress scales were associated with greater risk of developing a cold. However, the relation between stressful life events and illness was mediated by a different biologic process than were relations between perceived stress and illness and negative affect and illness. That these scales have independently relations with illness and that these relations are mediated by different processes challenges the assumption that perceptions of stress and negative affect are necessary for stressful life events to influence disease risk.
Attempting to understand the body’s signals is similar to trying to interpret the noises and sensations of the automobile that we drive. We do not have a computer printout of either the current physiological status of our body or the condition of the various systems of our car. Given this, we are in the position of attempting to understand a large array of ambiguous sensations about which we have at best a modicum of knowledge. Whether we are dealing with human bodies or inanimate cars, the awareness and reporting of symptoms are dependent on psychological or perceptual processes. Throughout this book, a large number of studies have outlined some of the parameters that determine when and why symptoms are reported. Before discussing some of the implications of symptom research, we present the following brief review of our current knowledge about the perception of physical symptoms.
This chapter discusses the psychosocial influences on immunity and infectious disease in humans. There is evidence for the plausibility of psychosocial influences on infectious disease in humans as well as evidence for a role of stress in determining susceptibility for a small number of infectious agents. Little is known about the characteristics of psychosocial factors that increase or decrease risk of disease onset and progression and of the nature of behavioral, endocrine, and immune changes that are responsible for psychosocial-induced changes in disease risk. Until there is more empirical evidence for specific mechanisms linking psychosocial factors to infectious disease, there would be little real understanding of the extent to which evidence deriving from present work generalizes to other disease models. It is likely that the following years would result in an understanding of the relations between psychosocial factors and immunity, the mechanisms that link psychosocial influence to immune change, and the range of immune function that is subject to alteration.
The primary aim of this study was to develop a Croatian inventory for assessing coping strategies that people use when under stress. As a basis for this inventory, a translation of the multidimensional coping inventory (COPE) by Carver, Scheier and Weintraub (1989) was used. The second purpose was to compare the results of the original version of the COPE with the translated Croatian version. Three additional scales (Humour, Turning to Religion, and Drug and Alcohol Use) were also analysed. The results were obtained using a sample consisting of undergraduate students (N=403) from the University of Rijeka, Croatia. When comparing the original version of the COPE inventory with the Croatian version, a similar factor structure emerged. The differences obtained are interpreted by taking into account different sociocultural and economic conditions in Croatia and the USA. Copyright © 1999 John Wiley & Sons, Ltd.
In confirmatory factor analysis, hypothesized models reflect approximations to reality so that any model can be rejected if the sample size is large enough. The appropriate question is whether the fit is adequate to support the model, and a large number of fit indexes have been proposed for this purpose. In the present article, we examine the influence of sample size on different fit indexes for both real and simulated data. Contrary to claims by Bentler and Bonett (1980), their incremental fit index was substantially affected by sample size. Contrary to claims by Joreskog and Sorbom (1981), their goodness-of-ftt indexes provided by LISREL were substantially affected by sample size. Contrary to claims by Bollen (1986), his new incremental fit index was substantially affected by sample size. Hoelter's (1983) critical N index was also substantially affected by sample size. Of the more than 30 indexes considered, the Tucker-Lewis (1973) index was the only widely used index that was relatively independent of sample size. However, four new indexes based on the same form as the Tucker-Lewis index were also relatively independent of sample size. The purpose of the present investigation was to examine the influence of sample size on goodness-of-f it indicators used in confirmatory factor analysis (CFA). Although the present inves- tigation was limited to CFA, the problems, issues, and most of the results generalize to the analysis of covariance structures. The advantages of CFA are well-known, and numerous intro- ductions to the LISREL approach used in the present investiga- tion are available elsewhere (e.g., Bagozzi, 1980; Joreskog &
Objective:
To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection.
Design:
After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold.
Setting:
Quarantine.
Participants:
A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant.
Outcome measures:
Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication.
Results:
In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds.
Conclusions:
More diverse social networks were associated with greater resistance to upper respiratory illness.
reviews literature on the psychosocial modulation of herpesvirus infections in conjunction with related data on the psychological mediation of cellular immune function
immunosuppression and changes in the control of latent herpes viruses
stress and cellular immune function
stress and herpesvirus-associated morbidity and mortality
stress-related changes in herpesvirus antibody titers
cellular immune function and herpesvirus latency in psychiatric patients
herpesvirus infections and health-associated risks (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book focuses on human studies, as well as relevant animal models for human infectious and autoimmune illness. We chose to highlight these particular animal models because they demonstrate the direct impact of various stressors on the immune system and the subsequent modulation of infectious and autoimmune diseases. In addition, these animal studies help to demonstrate the range of physiological changes associated with stressors. The chapters in this book will provide the reader with a current summary of the field of psychoneuroimmunology as it pertains to stress and illness outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
symptoms, the primary focus of this chapter, are usually measured via oral or written self-reports and thus exemplify verbal modes of responding / verbal measures can be used to obtain information about highly specific physical sensations (e.g., heart rate, tight stomach), emotional states (anger, guilt), or general characterization of physical state (fatigue, arousal, healthiness) / the other response systems studied by psychophysiologists emphasize signs and undetected bodily responses, but verbal responses tap subjects' perceptions of their world
physical context [receptor and sensory projections, brain mechanisms] / inferential context [measurement techniques, paradigms for studying symptoms] / social context [social context of symptom measurement, social and psychological meaning of symptoms] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
consider the merits of breaking with traditional approaches to coping which emphasize static, structural elements (such as traits and styles) and of turning to the study of coping from a process vantage point / explore the relationship between coping and emotion / argue that coping is a mediator of emotion (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the effects of family functioning and stress on the incidence of influenza infection among 58 families containing 2 adults and at least 1 child between the ages of 1 and 18 yrs. Baseline (preinfluenza) data included a serum determination for influenza A and B antibodies and measures of family functioning and parental stress. All family members of patients with upper respiratory tract infection symptoms or fever were seen by a physician, and throat swabs were obtained for viral culture. Approximately 2 wks after the influenza epidemic ended, sera for antibodies were again collected from all family members. Infection was significantly associated with both cohesion and adaptability. Neither the Family APGAR (G. Smilkstein, 1978) nor the social adjustment rating scale was associated with influenza B infection. Data indicate that family dysfunction may lead to altered immune responses, thus increasing susceptibility to infection. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A model of the stress and coping process in specific stressful situations is examined in this study. The effects of some aspects of self-concept, coping styles and perceived social support as antecedent variables, as well as primary and secondary appraisal as mediating variables in coping with conflicts between professional and family roles are predicted in this model.A hypothetical model was tested by linear structural equation modelling (LISREL VI) and relations between variables were derived from transactional, structural and additive approaches to the stress and coping process. The model presented in this study was tested in an attempt to answer two relevant questions.The first is whether coping styles are directly derived from personality traits or represent relatively independent personality characteristics. The second question is whether chosen antecedent variables influence coping strategies in some specific situations and whether it is exerted through a mediating role of cognitive appraisal or independently.The research results suggest that the majority of self-concept variables are related to coping styles, although they are conceptually different. Coping styles, along with other personality dimensions, environmental and situational variables influence coping strategies utilized in some specific stressful transactions.The results also show that antecedent variables influence coping in specific situations both directly and indirectly. Although cognitive appraisal shows significant effects on coping strategies in specific situations, it is not under the influence of all antecedent variables nor do the antecedent variables influence coping only through mediation of cognitive appraisal.The results obtained partly confirm the assumptions for all three approaches to the stress and coping process.
The purpose of this study was to examine the effects of Eysenck's personality traits on coping styles and moods, as well as the effects of coping styles on moods. On the sample of 177 subjects Eysenck's Personality Questionnaire (EPQ), a Coping Orientation to Problems Experienced questionnaire (COPE) and mood scale aimed at assessing the usual positive and negative moods were administered.The results obtained show a strong direct effect of Eysenck's personality traits on positive and negative moods, while their effects on coping styles in stressful situations were considerably lower. Coping styles, especially avoidance and problem-focused, contribute to the emotional outcomes directly and indirectly, mediating the effects of Eysenck's personality traits on moods.
Previous studies of rhinovirus infection indicate that about one third of the persons with confirmed viral infection do not show evidence of cold symptoms. Factors that determine which infected individuals will develop colds are not known. Using a rhinovirus inoculation protocol, the authors explored the possible role of recent life events, current mood, and perceived stress in the development of symptoms in individuals known to be infected. As part of a larger study, 17 subjects were exposed to a rhinovirus and were individually isolated for 5 consecutive days; cold symptoms, mucus weights, and tissue use were monitored on a daily basis during this period. Although all 17 subjects had confirmed rhinovirus infection, only 12 subjects developed clinical colds, as indicated by self-reported symptoms and by objective symptom indices. The average number of reported major life events for the previous year was significantly higher for those who developed colds than for those who did not (p < .05). Measures of affect and perceived stress before the inoculation were not different for those who did and did not develop colds. Complementing recent research demonstrating psychosocial influences on experimental infection rates, these results provide evidence that the development of cold symptomatology in experimentally infected individuals is related to prior life events.
Interest in the field of neuroimmunoendocrinology is in full expansion. With regard to this, steroid influence on the immune system, in particular sex steroids and glucocorticoids, has been known for a long time. Sex steroids are part of the mechanism underlying the immune sexual dimorphism, as particularly emphasized in autoimmune diseases. Immunosuppressive and anti-inflammatory effects of glucocorticoids are now considered a physiological negative feedback loop to cytokines produced during an immune and/or inflammatory response. Psychosocial factors may play a role in the development of immunologically-mediated diseases, e.g. autoimmune diseases. The nonobese diabetic (NOD) mouse, that develops an immunologically-mediated insulin-dependent diabetes mellitus (IDDM) is an interesting model to study the role of endogenous steroids. Insulitis is present in both sexes, but diabetes has a strong preponderance in females. Hormonal alteration, such as castration, modulates the incidence of diabetes, whereas environmental factors, such as stress, accelerate the disease. In the present paper, we have reviewed the role of gender, sex steroid hormones, stress and glucocorticoids in autoimmunity as well as analyzed their different levels of actions and interrelationships, focusing particular attention on the immunologically-mediated IDDM of the NOD mouse.
This study used a year-long prospective design to assess linkages among distress, immunity, and illness. Serial blood samples were collected from 40 first-year medical students at the first, third, and fifth examination periods, as well as 1 month before each. There were significant decrements in the production of gamma-interferon by concanavalin A-stimulated lymphocytes obtained at the time of examinations. Antibody titers to Epstein-Barr virus (EBV) increased during examination periods, suggesting reactivation of latent EBV and therefore poorer cellular immune control of latent virus. We obtained data that suggest that T-cell killing by memory T lymphocytes of EBV transformed autologous B lymphocytes also declined during examination periods. The activity of a lymphokine, leukocyte migration inhibition factor, normally suppressed during recrudescence of herpes simplex virus type 2 infections, was altered during examination periods and an increase in both plasma and intracellular levels of cyclic AMP associated with examination stress was observed. An increase in the incidence of self-reported symptoms of infectious illness was also associated with examination periods. The data support the linkage between stress-related immunosuppression and health.
This study used a prospective design to examine the influence of examination stress and loneliness on herpesvirus latency as measured by changes in antibody levels to three herpesviruses, Epstein-Barr virus (EBV), Herpes simplex type I (HSV-1), and cytomegalovirus (CMV). Three blood samples were obtained from 49 first-year medical students, with the first sample drawn 1 month before final examinations, the second on the first day of final examinations, and the third during the first week after their return from summer vacation. A median split on the UCLA Loneliness Scale divided subjects into high- and low-scoring loneliness groups. There were significant changes in the antibody titers to all three herpesviruses across the sample points, with the lowest levels found in the third (low stress) sample. High-loneliness subjects had significantly higher EBV antibody titers than low-loneliness subjects. These data suggest that stress-related immunosuppression can significantly modulate herpesvirus latency.
There is now clear evidence that stress, bereavement, and depression can compromise specific components of the immunologic apparatus. The first part of this paper gives an overview of fundamental immunology and is followed by a review of the patterns, possible causes, and potential clinical implications of abnormal immunoregulation. After a discussion of the immunomodulating properties of glucocorticoids, the authors conclude with an overview of the many factors that mediate the complex interdependence between immunologic function, the brain, and neuroendocrine regulation.
Although acute stress has been associated with transient immunosuppression, little is known about the immunologic consequences of chronic stress in humans. In order to investigate possible health-related consequences of a long-term stressor, we obtained blood samples for immunologic and nutritional analyses and psychologic data from 34 family caregivers of Alzheimer's disease (AD) victims and 34 sociodemographically matched comparison subjects. Family caregivers for AD victims were more distressed than comparison subjects without similar responsibilities. Greater impairment in the AD victim was associated with greater distress and loneliness in caregivers. Caregivers had significantly lower percentages of total T lymphocytes and helper T lymphocytes than did comparison subjects, as well as significantly lower helper-suppressor cell ratios; caregivers also had significantly higher antibody titers to Epstein-Barr virus than did comparison subjects, presumably reflecting poorer cellular immune system control of the latent virus in caregivers. The percentages of natural killer cells and suppressor T lymphocytes did not differ significantly. These data suggest that chronically stressed AD family caregivers do not show immunologic or psychologic adaptation to the level of their well-matched age peers.
To examine the relationship between stress and upper respiratory tract infection, 235 adults aged 14-57 years, from 94 families affiliated with three suburban family physicians in Adelaide, South Australia, participated in a six-month prospective study. High and low stress groups were identified by median splits of data collected from the Life Events Inventory, the Daily Hassles Scale, and the General Health Questionnaire, which were administered both before and during the six months or respiratory diary data collection. Using intra-study stress data, the high stress group experienced significantly more episodes (mean of 2.71 vs. 1.56, p < 0.0005) and symptom days (mean of 29.43 vs. 15.42, p = 0.005) of respiratory illness. The two groups were almost identical with respect to age, sex, occupational status, smoking, passive smoking, exposure to air pollution, family size, and proneness to acute respiratory infection in childhood. In a multivariate model with total respiratory episodes as the dependent variable, 21% of the variance was explained, and two stress variables accounted for 9% of the explained variance. Significant, but less strong relationships were also identified between intra-study stress variables and clinically 'definite' episodes and symptom days in both clinically definite and total respiratory episodes. Pre-study measures of stress emphasized chronic stresses and were less strongly related to measures of respiratory illness than those collected during the study. However, significantly more episodes (mean of 2.50 vs. 1.75, p < 0.02) and symptom days (mean of 28.00 vs. 17.06, p < 0.03) were experienced in the high stress group. In the multivariate analyses, pre-study stress remained significantly associated with total respiratory episodes and symptom days in total and 'definite' respiratory episodes. In all of the multivariate analyses performed, sex (female) and age also appeared as important correlates of respiratory illness.
Despite the nearly universal finding that life event stress is related to psychopathology, the strength of these relationships is weak. In an attempt to increase the strength of the correlation between life event stress and psychopathology, this study evaluated the simultaneous contribution of life event stress and coping style, as well as the independent contribution of each, to psychopathology. Seventy-six male and 74 female college students served as primary subjects, while an additional 57 male and 60 female college students served as a cross validation sample. Each subject completed the Life Experiences Survey, the Coping Strategies Inventory, and the MMPI. Sex differences were found in the type of coping style related to psychopathology, the relative contributions of coping style and negative life stress to psychopathology, and the percentage of variance accounted for in psychopathology. Future research was recommended to include other variables, such as chronic life stress and physiological reactivity, and to control better for such methodological problems as response sets.
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
This study addressed the effects of a naturally occurring stressor on components of the immune response. Blood was drawn twice from 75 first-year medical students, with a baseline sample taken one month before their final examinations and a stress sample drawn on the first day of final examinations. Median splits on scores from the Holmes--Rahe Social Readjustment Rating Scale and the UCLA Loneliness Scale produced a 2 X 2 X 2 repeated measures ANOVA when combined with the trials variable. Natural killer (NK) cell activity declined significantly from the first to the second sample. High scorers on stressful life events and loneliness had significantly lower levels of NK activity. Total plasma IgA increased significantly from the first to second sample, while plasma IgG and IgM, C-reactive protein, and salivary IgA did not change significantly.
The impact of occupational stress on self-reported cigarette, coffee, and alcohol consumption was investigated in a longitudinal field study. Substance consumption and subjective stress indicators were measured repeatedly for 34 men performing a job with known systematic variation in stress. Habitual cigarette smoking and coffee drinking were positively associated with chronic tendencies to perceive high stress; no associations were found between chronic alcohol consumption and stress perceptions. Consumption of all three substances varied significantly across days that differed in perceived stress level. On the average, there was more cigarette smoking and more coffee drinking, but less alcohol consumption, under high stress. These general effects of stress appeared to depend largely on the behavior of only a few of the participants, as the association between subjective stress indicators and substance consumption within individuals was not consistent across all of them. These findings suggest that there can be important individual differences in the tendency to increase or decrease habitual substance consumption in response to varying levels of stress. This possibility should be considered when constructing models that include behavioral response to stress.
Recent research shows upper respiratory infections (URIs) are influenced by minor daily events, especially those that are desirable and interpersonal in nature. The present study used a longer time frame, broader health measures and a between-subjects design to examine this effect. It also predicted that optimism and self-esteem would interact with minor events to affect health. One hundred and fifty participants provided information regarding minor events, disposition and physical health on two separate occasions. Results show that increases in both desirable and undesirable events (hassles and uplifts) affected URIs over a two-week period. Interpersonal hassles interacted with optimism, having a greater impact on physical symptoms for optimists than for pessimists. Self-esteem did not interact with minor events to affect health. These results extend previous findings to show that minor events affect URIs and not other health outcomes, and that this effect is apparent between subjects over a number of days. Further, the influence of interpersonal events on health appears to be moderated by optimism. It is concluded that consideration and integration of findings from studies with different methodologies will be beneficial in furthering our understanding of minor event effects on health.
To assess the influence of life event stress and hassles, and the moderating effects of psychological coping style, social support, and family environment, on susceptibility to upper respiratory tract infectious illness.
One hundred seven adults aged 18 to 65 years took part in a 15-week study. Measures of life event stress were obtained for the 12 months preceding the study and for the study period itself, and social support, information seeking and avoidant coping styles, and family environment were assessed. Hassles and perceived stress were measured weekly, whereas dysphoric mood and changes in personal health practices (smoking, alcohol consumption, exercise, and sleep patterns) were assessed at three weekly intervals. Episodes of upper respiratory tract infectious illness were verified by clinical examination.
During the study period, 29 individuals experienced at least one clinically verified episode of upper respiratory tract illness. There were no differences in cigarette smoking, sleep habits, or exercise between those who did and did not become ill but alcohol consumption was lower among those who experienced verified episodes. Risk of infectious illness was greater in those who experienced high life event stress both before and during the study period, but the impact of life events was buffered by an avoidant coping style. Strict family organization was associated with illness risk. The three weeks preceding illness onset were characterised by high levels of perceived stress, but also by a decrease in the number of hassles reported.
Results suggest that under naturalistic conditions, the influence of stressful experience on risk of infectious illness is moderated by psychosocial resources. Variations in personal health practices do not seem to be responsible.
To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection.
After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold.
Quarantine.
A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant.
Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication.
In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds.
More diverse social networks were associated with greater resistance to upper respiratory illness.
health and environmental stress
- J I Sur
- Efekti
- Stresa
HUDEK-KNE@EVI], J.
I SUR.:
EFEKTI PERCIPIRANOG
STRESA...
health and environmental stress. New York: Plenum Press.
Personality and health
- R J Contrada
- H Leventhal
- A Leary
Contrada, R. J., Leventhal, H. i O'Leary, A. (1990). Personality and
health. U: L.A. Pervin (Ur.), Handbook of personality: Theory and
research (638-669). New York: The Guilford Press.