Brief Self-Compassion Intervention for Women of Higher Weight and Internalized Weight Bias: A Randomized Pilot Study.

BACKGROUND: Internalized weight bias (IWB) negatively impacts mental and physical health, and disproportionately affects women of higher weight. Although self-compassion training may be advantageous for reducing IWB and associated sequalae, further examination of its clinical significance and cultural acceptability is warranted. METHOD: A randomized pilot study was conducted to evaluate the feasibility, including cultural acceptability, and clinical significance of a 3-session self-compassion intervention (SCI) for women with IWB. Women with BMIs of > 25 and IWB (N = 34) were randomly assigned to the SCI or a waitlist control group. Participants completed pre, post, and 1-month follow-up surveys on IWB, self-compassion, body image, eating behaviors, physical activity, and affect. Analyses of covariance were employed and percentages of change were calculated to examine post-intervention between-group differences in outcomes. Cultural acceptability was evaluated through participants' ratings of the perceived inclusivity and relevancy of the SCI. RESULTS: There were 59% (n = 10) and 47% (n = 8) completion rates in the SCI and waitlist control groups, respectively. Compared to the waitlist control group, SCI participants reported greater pre-post improvements in self-compassion, IWB, body shame and surveillance, uncontrolled eating, and physical activity with medium to large effect sizes, and emotional eating with small effects. The SCI was perceived to be beneficial overall, and cultural acceptability ratings were mostly favorable despite individual differences. CONCLUSION: This brief SCI may be beneficial for women impacted by weight stigma and IWB. Attention to increased diversity and cultural acceptability is warranted in future trials.

Compounding stress: A mixed-methods study on the psychological experience of miscarriage amid the COVID-19 pandemic.

BACKGROUND: Experiencing a miscarriage can have profound psychological implications, and the added strain of the COVID-19 pandemic may have compounded these effects. This study aimed to explore the psychological experiences, assess the levels of psychological distress (depression, anxiety, and post-traumatic stress disorder), and examine the relationships of personal significance of miscarriage and perceived stress with psychological distress of women in North Carolina who suffered a miscarriage of a desired pregnancy between March 30, 2020, and February 24, 2021, of the COVID-19 pandemic, at 14 to 31 months after the loss. METHODS: We conducted a cross-sectional mixed-methods study using a convergent parallel design. A total of 71 participants from North Carolina completed the online survey and 18 completed in-depth interviews. The survey assessed demographics, mental health and reproductive history, personal significance of miscarriage, perceived stress, anxiety, depression, and PTSD. Interview questions asked about the psychological experience of the miscarriage and how the COVID-19 pandemic affected them and their experience. RESULTS: Findings indicated moderate to severe levels of depression, anxiety, and PTSD, which persisted 14 to 31 months post-miscarriage. After conducting hierarchical binary logistic regressions, we found that perceived stress and prior trauma increased the odds of depression, perceived stress increased the odds of anxiety, and personal significance and prior trauma increased the odds of PTSD symptoms 14-31 months post-miscarriage. Notably, a subsequent successful childbirth emerged as a protective factor against depression, anxiety, and PTSD. Qualitative findings depicted emotions such as profound isolation, guilt, and grief. Women noted that additional pandemic-specific stressors exacerbated their distress. The categories identified via conventional content analysis fell under five broader thematic groups: mental health disorders, negative emotions/feelings, positive emotions/feelings, thoughts, and other experiences. CONCLUSIONS: Miscarriage during the COVID-19 pandemic intensified and added complexity to the psychological distress experienced by affected women. The study underscores the need for comprehensive mental health screenings, specialized support for vulnerable groups, and the necessity of trauma-informed care. Providers are strongly encouraged to adopt a multifaceted, individualized approach to patient care that is cognizant of the unique stressors introduced by the pandemic.

A mixed-methods investigation of COVID-19 pandemic-specific stress in college students.

OBJECTIVE: To identify pandemic-specific stressors among college students and compare patterns of stressors in samples obtained during early and chronic phases of the pandemic. METHOD: Different undergraduate student samples from a Southeastern university completed an online survey in Spring 2020 (early pandemic; N = 673) and Fall 2020 (chronic pandemic; N = 439). This repeated cross-sectional survey study used a mixed methods triangulation design to validate and expand on quantitative findings using qualitative data. RESULTS: Quantitative and qualitative analyses revealed 13 pandemic stressor domains, with academics and lifestyle adjustment among the most stressful in both samples, and more stressful in the chronic pandemic sample. Non-freshmen, female, and first-generation college students were at greater risk for pandemic stress. CONCLUSIONS: As college students continue to experience stressors related to COVID-19 and encounter future crises, colleges and universities must adapt to meet their unique needs specific to the context.

Relationships Among Adverse and Benevolent Childhood Experiences, Emotion Dysregulation, and Psychopathology Symptoms.

This cross-sectional study sought to examine adverse childhood experiences (ACEs), benevolent childhood experiences (BCEs), and emotion dysregulation as they relate to psychopathology symptoms (posttraumatic stress disorder [PTSD], anxiety, depression) in university students in emerging adulthood. Students at a United States university (N = 1,498) completed an online survey during the fall 2021 and spring 2022 semesters. Measures include the Adverse Childhood Experiences Questionnaire, Benevolent Childhood Experiences Scale, Difficulties in Emotion Regulation Scale-Short Form, PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders 5th edition, Patient Health Questionnaire 8, and Generalized Anxiety Disorder 7 Scale. ACEs significantly related to greater symptoms and positive screens for PTSD, depression, and anxiety. BCEs significantly related to fewer symptoms and positive screens for PTSD, depression, and anxiety. Emotion dysregulation was a significant mediator of relationships between ACEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Emotion dysregulation was a significant partial mediator of relationships between BCEs and all symptom types (direct and indirect effects were both significant, supporting partial mediation). Results showed significant small moderation effects of BCEs on the relationships of ACEs-emotion dysregulation, ACEs-depression symptoms, ACEs-anxiety symptoms, and emotion dysregulation-PTSD symptoms. Implications for colleges and universities are discussed.

Internalized Weight Bias, Weight-Related Experiences, And Peripartum Weight.

INTRODUCTION: The purpose of this study was to investigate internalized weight bias (IWB) and its relationship with pregnancy-related weight changes and postpartum depression. IWB is defined as the internalization of negative attitudes and beliefs about people due to their weight. Although IWB has been linked with weight change and depression in other samples, it has never been investigated in the postpartum period. METHODS: We used a cross-sectional survey design. Participants were 251 women recruited via social media who were living in the United States and 6 to 12 months postpartum. We calculated percentage of body weight gained during pregnancy and percentage of that weight that was retained postpartum from self-reported weights. Participants completed self-report measures of IWB (modified version of the Weight Bias Internalization Scale) and postpartum depression (Edinburgh Postnatal Depression Scale). RESULTS: Gestational weight gain was not significantly associated with IWB or depression. Postpartum retention of gestational weight was significantly positively associated with both IWB and depressive symptoms. Furthermore, IWB mediated the relationship between postpartum weight retention and depressive symptoms. DISCUSSION: Postpartum retention of weight gained during pregnancy, but not weight gain itself, was related to both IWB and depressive symptoms. The relationship between pregnancy-related weight changes and psychological distress is complex. Sociocultural pressures to return to a prepregnancy physical state swiftly after giving birth may increase risk for IWB during a time in life when stress is already likely to be high, posing additional psychological risk. IWB existing prepregnancy may also worsen postpartum self-concept, contributing to depression. This is the first study, to our knowledge, to directly assess associations among gestational weight change, IWB, and postpartum depression. In addition to discussing weight in pregnancy, perinatal care providers could improve postpartum health by helping women set realistic, body-positive goals postpartum.

Labor of love, or love of labor? Psychological capital's mitigating role in the relationship between workaholism and work stress.

BACKGROUND: Workaholism is conceptualized as a compulsive need to work incessantly, and it is related to numerous detrimental organizational and individual consequences. For that reason, it is imperative that researchers uncover possible variables that can alleviate its potentially harmful effects. OBJECTIVE: This study aims to examine the relationship between workaholism, psychological capital (PsyCap), physical health, and work stress. The potential mitigating role that PsyCap could play between workaholism and physical health, as well as work stress, was also examined. METHODS: Data on workaholism, PsyCap, physical health, and work stress were collected from 343 full-time faculty and staff from a large Southeastern university. RESULTS: Results showed workaholism negatively related to physical health and positively related to work stress. Additionally, PsyCap had a positive relationship with physical health and a negative relationship with work stress. Moreover, PsyCap moderated the relationship between workaholism and work stress, such that as PsyCap increased, the relationship between workaholism and work stress weakened. CONCLUSIONS: PsyCap may be a fairly simple and cost-effective intervention for organizations to implement, as it can be learned through short training sessions. By incorporating PsyCap, organizations may be able to help mitigate levels of stress in their employees, specifically among those who suffer from workaholism.

Take a break! Leisure participation moderates the workaholism-work stress relationship.

Our primary aim was to gain a better understanding of how leisure activities (i.e., physical activity, mindfulness, and vacation) may beneficially relate to workaholism and work stress. Secondary aims included exploring motivations for participating in the three types of leisure activities. The job demands-resources theory; conservation of resources theory; and detachment-recovery, autonomy, mastery, meaning, and affiliation model provided context for hypothesized relationships among the variables. Full-time employees in the United States (N = 367) were recruited via Amazon's Mechanical Turk community, and they completed an online survey. Leisure participation significantly moderated the relationship between workaholism and work stress (weakening it). The majority of motivations for mindfulness and vacation were related to mental/emotional health, with a more even split between mental/emotional health and physical health/appearance motivations for physical activities. Several policy and practice-based recommendations for prioritizing leisure engagement are provided.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress.

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

Relationships of race and socioeconomic status to postpartum depressive symptoms in rural African American and non-Hispanic white women.

This study examines the potential racial disparity in postpartum depression (PPD) symptoms among a cohort of non-Hispanic white and African American women after taking into consideration the influence of socioeconomic status (SES). Participants (N = 299) were recruited from maternity clinics serving rural counties, with oversampling of low SES and African Americans. The Edinburgh Postnatal Depression Scale (EPDS) was administered 1 and 6 months postpartum, and subjective SES scale at 6 months postpartum. Demographic information was collected during enrollment and 1 month postpartum, with updates at 6 months postpartum. Separate logistic regressions were conducted for 1 and 6 month time points for minor-major PPD (EPDS ≥ 10) and major PPD (EPDS > 12); with marital status, poverty, education, subjective SES, and race predictors entered in block sequence. After including all other predictors, race was not a significant predictor of minor-major or major PPD at 1 or 6 months postpartum. Subjective SES was the most consistent predictor of PPD, being significantly associated with minor-major PPD and major PPD at 6 months postpartum, with higher subjective SES indicating lower odds of PPD, even after accounting for all other predictors. This study shows that significant racial disparities were not observed for minor-major or major PPD criteria at 1 or 6 months postpartum. The most consistent and significant predictor of PPD was subjective SES. Implications of these findings for future research, as well as PPD screening and intervention are discussed.

Resilience in the Context of Chronic Stress and Health in Adults.

Over the past several decades, stress research has experienced a broadening of its pathologic focus to encompass the concept of resilience. There is a wealth of research on resilience but no general consensus regarding its conceptualization. Some define resilience as attaining eventual favorable outcomes following exposure to adversity. Others define it as specific relatively short-term responses characterized by a return to homeostasis after initial disruption due to a stressor, and still others refer to resilience as resources that enable the individual to withstand or recover from major stressors. Many of the existing conceptualizations of resilience are not applicable in the context of chronic stress which is particularly harmful to health. How do adults who experience chronic stress survive, manage, and thrive, and what resources enable them to do so? In this paper, we consider these questions by reviewing traditions of research and definitions of resilience in order to inform an understanding of resilience in general, and for the study of chronic stress in adults. Based on a review of the literature, we developed a taxonomy of resilience resources that can be applied broadly, and guide future research.

A pilot study to reduce risk for antepartum depression among women in a public health prenatal clinic.

This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) > or = 10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS < or = 10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.

Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology.

OBJECTIVE: In this pilot study, the authors examined the effectiveness of a 4-week resilience intervention to enhance resilience, coping strategies, and protective factors, as well as decrease symptomatology during a period of increased academic stress. PARTICIPANTS AND METHODS: College students were randomly assigned to experimental (n = 30) and wait-list control (n = 27) groups. The experimental group received a psychoeducational intervention in 4 two-hour weekly sessions. Measures of resilience, coping strategies, protective factors, and symptomatology were administered pre- and postintervention to both groups. RESULTS: Analyses indicated that the experimental group had significantly higher resilience scores, more effective coping strategies (i.e., higher problem solving, lower avoidant), higher scores on protective factors (i.e., positive affect, self-esteem, self-leadership), and lower scores on symptomatology (i.e., depressive symptoms, negative affect, perceived stress) postintervention than did the wait-list control group. CONCLUSIONS: These findings indicate that this resilience program may be useful as a stress-management and stress-prevention intervention for college students.

Barriers to seeking help and treatment suggestions for prenatal depressive symptoms: focus groups with rural low-income women.

Interviews were conducted with 21 pregnant or recently pregnant African American and Caucasian low-income women living in a rural southeastern community to elicit perceived barriers to seeking help for depressive symptoms in pregnancy and ways to overcome these barriers, as well as intervention suggestions. Participants identified themes regarding barriers to seeking help. These were: (1) lack of trust, (2) judgment/stigma, (3) dissatisfaction with the health care system, and (4) not wanting help. Themes identified regarding overcoming barriers were: (1) facilitating trust and (2) offering support and help. These and other findings point to the importance of integrating women's ideas into culturally sensitive interventions for women with depressive symptoms or depression in pregnancy that can be provided by a psychiatric nurse-practitioner or other mental health provider.

Relationships of protective factors to stress and symptoms of illness.

OBJECTIVE: To examine relationships of work and individual protective factors to health outcomes. METHODS: Participants from 2 corporate samples completed measures of supervisor support, hardiness, coping, global stress, and symptoms of illness. RESULTS: Regression analyses indicated that higher scores on hardiness and approach coping and being male predicted lower scores on stress and symptoms of illness. Additionally, supervisor support predicted fewer symptoms of illness but did not have a spillover effect onto stress. CONCLUSIONS: Interventions that enhance individual protective factors primarily and work protective factors secondarily may be most effective in reducing stress and illness among employees.

The relationships among acculturation, biobehavioral risk, stress, corticotropin-releasing hormone, and poor birth outcomes in Hispanic women.

OBJECTIVE: To determine the predictive ability of acculturation as an antecedent of stress, biobehavioral risk, corticotropin-releasing hormone levels, and poor birth outcomes in pregnant Hispanic women. DESIGN: A prospective, observational design with data collected at 22-25 weeks of gestation and at birth through medical record review. SETTING: Public prenatal health clinics in south Texas serving low-income women. PARTICIPANTS: Self-identified Hispanic women who had singleton pregnancies, no major medical risk complications, and consented to answer questionnaires as well as a venipuncture and review of their prenatal and birth medical records. MAIN OUTCOME MEASURES: Gestational age, Apgar scores, length, weight, percentile size, and head circumference of the infant at birth. RESULTS: Significant differences were seen in infant birth weight, head circumference, and percentile size by acculturation. English acculturation predicted stress, corticotropin-releasing hormone, biobehavioral risk, and decreased gestational age at birth. CONCLUSIONS: Investigation must continue to understand the circumstances that give rise to the decline in birth outcomes observed in Hispanics with acculturation to the dominant English culture in the United States.

Hardiness and support at work as predictors of work stress and job satisfaction.

PURPOSE: To test a theoretically and empirically based model linking potential protective resources (hardiness, coworker and supervisor support) to the outcomes of work stress and job satisfaction and replicating the relationship of work stress to job satisfaction while accounting for the potential influence of negative affectivity. DESIGN: A cross-sectional research design using survey data collected from two convenience samples. SETTING: Two worksites: (1) a high-tech company and (2) a government agency. SUBJECTS: High-tech employees (N = 310; response rate, 73.8%) and government agency employees (N = 745; response rate, 49.7%). MEASURES: The Dispositional Resilience Scale measured hardiness and the Positive and Negative Affect Schedule measured negative affectivity. Coworker and supervisor support were measured using the Coworker Support Scale and the Supervisor Support Scale, respectively. The Perceived Work Stress Scale measured work stress, and a single item from the Job Satisfaction Scale assessed overall job satisfaction. RESULTS: A multiple-group path analysis examined the proposed model. Similar patterns of association were found for both samples and suggested a more parsimonious model without the path from negative affectivity to job satisfaction. The model supports the protective nature of hardiness and support at work with regard to work stress and job satisfaction. CONCLUSION: Explanations of relationships depicted in the model, practical implications for reducing work stress and enhancing job satisfaction, limitations and future directions are discussed.

Cell aging in relation to stress arousal and cardiovascular disease risk factors.

We previously reported that psychological stress is linked to and possibly accelerates cellular aging, as reflected by lower PBMC telomerase and shortened telomeres. Psychological stress is a major risk factor for cardiovascular disease (CVD), with multiple behavioral and physiological mediators. Telomere shortness has been associated with CVD, but the relationship between low telomerase activity, a potential precursor to telomere shortening, and CVD risk factors has not been examined in humans. Here we examine whether telomere length and telomerase in leukocytes are associated with physiological signs of stress arousal and CVD risk factors in 62 healthy women. Low telomerase activity in leukocytes was associated with exaggerated autonomic reactivity to acute mental stress and elevated nocturnal epinephrine. Further, low telomerase activity was associated with the major risk factors for CVD -smoking, poor lipid profile, high systolic blood pressure, high fasting glucose, greater abdominal adiposity-as well as to a composite Metabolic Syndrome variable. Telomere length was related only to elevated stress hormones (catecholamines and cortisol). Thus, we propose that low leukocyte telomerase constitutes an early marker of CVD risk, possibly preceding shortened telomeres, that results in part from chronic stress arousal. Possible cellular mechanisms by which low telomerase may link stress and traditional risk factors to CVD are discussed. These findings may implicate telomerase as a novel and important mediator of the effects of psychological stress on physical health and disease.

Reliability and validity of a single-item measure of job satisfaction.

PURPOSE: To investigate the reliability and validity of a single-item overall job satisfaction measure. METHODS: Public agency employees (n = 745) were surveyed regarding job satisfaction, work, personality, and health variables. The single-item measure underwent the following analyses: correction for attenuation formula to estimate minimum reliability; correlations with multiple-item job satisfaction, work, personality, and health measures to determine concurrent validity, construct validity, and specific relevance to health promotion; and logistic regression to determine the predictability of turnover intention. RESULTS: For the single-item measure the minimum reliability estimate was high, all correlational tests for validity were significant, logistic regression indicated substantial predictability of turnover intention, and correlations with the health measures were significant. DISCUSSION: These results are consistent with other studies and support the psychometric properties of this single-item overall job satisfaction measure. Limitations of the study and its implications for worksite health promotion are discussed.

The relationship between hardiness, supervisor support, group cohesion, and job stress as predictors of job satisfaction.

PURPOSE: This study tested a conceptual model based on research supporting the relationship between the predictors of hardiness, supervisor support, and group cohesion and the criterions of job stress and job satisfaction and between the predictor of job stress and the criterion of job satisfaction. DESIGN: The study employed a cross-sectional research design. Survey data were collected as part of the baseline measures assessed prior to an organizational hardiness intervention. SETTING: Worksite of Dell Computer Corporation in Austin, Texas. SUBJECTS: The subjects included 160 full-time Dell employees recruited from a convenience sample representing nine work groups (response rate = 90%). MEASURES: Hardiness was measured using the Dispositional Resilience Scale (DRS), job stress was measured using the Perceived Work Stress Scale (PWSS), and supervisor support, group cohesion, and job satisfaction were measured using a proprietary employee attitude survey. RESULTS: In the proposed model, high hardiness, supervisor support, and group cohesion were related to lower levels of job stress, which in turn was related to higher levels of job satisfaction. The model also proposed direct paths from hardiness, supervisor support, and group cohesion to job satisfaction. Path analysis was used to examine the goodness of fit of the model. The proposed model was a good fit for the data (chi 2[1, N = 160] = 1.85, p = .174) with the exception of the direct path between group cohesion and job satisfaction. Substantial portions of the variances in job stress (R2 = .19) and job satisfaction (R2 = .44) were accounted for by the predictors. CONCLUSION: Implications for targeted worksite health promotion efforts to lower job stress and enhance job satisfaction are discussed.