The impact of the Systematic Assessment for Resilience (SAR) framework on students' resilience, anxiety, depression, burnout, and academic-related stress: a quasi-experimental study.

BACKGROUND: Medical students face significant psychological stress, impacting their academic performance and well-being. The Systematic Assessment for Resilience (SAR) framework is designed to enhance resilience and mitigate stress among medical students, addressing the need for interventions within the assessment system in medical education. The aim of this study was to evaluate the implementation of SAR framework on medical students' resilience, anxiety, depression, burnout, and academic stress. METHODS: This study employed a quasi-experimental design with pre- and post-testing. It involved the training of course coordinators in implementing the SAR framework and its integration into the daily learning activities. Fourth-year medical students were assessed before and after the intervention using standardized measures of resilience, anxiety, depression, burnout, and academic stress. Data were analyzed using quantitative methods and thematic analysis for qualitative feedback. RESULTS: Post-intervention, students demonstrated a significant increase in resilience scores (p < 0.001) and a notable decrease in measures of anxiety, depression, and academic stress (p < 0.001). The burnout types were also statistically different (p < 0.001) except client-related burnout (p > 0.05). Qualitative feedback of the course coordinators highlighted an improved learning environment, increased coping strategies, and a more supportive academic culture. CONCLUSION: The SAR framework significantly contributes to enhancing medical students' resilience and reducing psychological distress. Its implementation suggests a promising approach to fostering a supportive educational environment that not only addresses the psychological challenges faced by medical students but also enhances their academic performance and overall well-being. Further research is warranted to explore the long-term impacts of SAR across different medical education contexts.

'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course.

INTRODUCTION: Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. METHODS: A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. RESULTS: The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). CONCLUSIONS: The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. PATIENT OR PUBLIC CONTRIBUTION: We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.

Challenges and support needs in psychological and physical health among pilots: a qualitative study.

Introduction: Physical and mental health problems among pilots affect their working state and impact flight safety. Although pilots' physical and mental health problems have become increasingly prominent, their health has not been taken seriously. This study aimed to clarify challenges and support needs related to psychological and physical health among pilots to inform development of a more scientific and comprehensive physical and mental health system for civil aviation pilots. Methods: This qualitative study recruited pilots from nine civil aviation companies. Focus group interviews via an online conference platform were conducted in August 2022. Colaizzi analysis was used to derive themes from the data and explore pilots' experiences, challenges, and support needs. Results: The main sub-themes capturing pilots' psychological and physical health challenges were: (1) imbalance between family life and work; (2) pressure from assessment and physical examination eligibility requirements; (3) pressure from worries about being infected with COVID-19; (4) nutrition deficiency during working hours; (5) changes in eating habits because of the COVID-19 pandemic; (6) sleep deprivation; (7) occupational diseases; (8) lack of support from the company in coping with stress; (9) pilots' yearly examination standards; (10) support with sports equipment; (11) respecting planned rest time; and (12) isolation periods. Discussion: The interviewed pilots experienced major psychological pressure from various sources, and their physical health condition was concerning. We offer several suggestions that could be addressed to improve pilots' physical and mental health. However, more research is needed to compare standard health measures for pilots around the world in order to improve their physical and mental health and contribute to overall aviation safety.

Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK.

OBJECTIVES: Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN: National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING: Households in Wales, UK. PARTICIPANTS: 1880 Welsh residents aged ≥18 years. MEASURES: Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS: The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS: Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.

Clinical Education: Psychosocial Assessment and Treatment Planning for Patients with Inflammatory Bowel Disease.

Psychosocial factors play an important role in the disease course and illness experience of patients with inflammatory bowel disease (IBD). Consultation with a health psychologist is an important component of care for many IBD patients and provides an opportunity to identify areas of psychosocial concern, recognize coping deficits and strengths, and facilitate treatment recommendations. Psychosocial assessment in IBD requires a nuanced approach that goes beyond general mental health screening and considers the disease-specific concerns that impact patients. In this paper, we outline strategies for an IBD-focused psychological evaluation, including specific guidance for assessing disease-specific concerns of anxiety, depression, post-traumatic stress, sleep, pain, body image disturbance, food-related quality of life, and psychological resilience.

Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

An assessment of the psychometric properties of the Coping Strategies Questionnaire - Sickle Cell Disease (CSQ-SCD) among adults in the United States.

BACKGROUND: Previous studies have reported conflicting factor structures of the Coping Strategies Questionnaire - Sickle Cell Disease (CSQ-SCD). This study examined the psychometric properties of the CSQ-SCD among adults with SCD in the United States. METHODS: This study implemented a cross-sectional study design with web-based self-administered surveys. Individuals with SCD were recruited via an online panel. Psychometric properties, including factorial and construct validity, and internal consistency reliability, of the CSQ-SCD were assessed. RESULTS: A total of 196 adults with SCD completed the survey. Confirmatory factor analysis (CFA), using maximum likelihood estimation and the 13 subscale scores as factor indicators, supported a three-factor model for the CSQ-SCD compared to a two-factor model. Model fit statistics for the three-factor model were: Chi-square [df] = 227.084 [62]; CFI = 0.817; TLI = 0.770; RMSEA [90% CI] = 0.117 [0.101-0.133]; SRMR = 0.096. All standardized factor loadings (except for the subscales isolation, resting, taking fluids, and praying and hoping) were > 0.5 and statistically significant, indicating evidence of convergent validity. Correlations between all subscales (except praying and hoping) were lower than hypothesized; however, model testing revealed that the three latent factors, active coping, affective coping, and passive adherence coping were not perfectly correlated, suggesting discriminant validity. Internal consistency reliabilities for the active coping factor (α = 0.803) and affective coping factor (α = 0.787) were satisfactory, however, reliability was inadequate for the passive adherence coping factor (α = 0.531). Given this overall pattern of results, a follow-up exploratory factor analysis (EFA) was also conducted. The new factor structure extracted by EFA supported a three-factor structure (based on the results of a parallel analysis), wherein the subscale of praying and hoping loaded on the active coping factor. CONCLUSIONS: Overall, the CSQ-SCD was found to have less than adequate psychometric validity in our sample of adults with SCD. These results provide clarification around the conflicting factor structure results reported in the literature and demonstrate a need for the future development of a SCD specific coping instrument.

Impact of stress coping strategy in modifying perceptions of school stress among adult learners enrolled in Home Economics and Indigenous Textiles Education in Nigerian Universities.

BACKGROUND/OBJECTIVE: Studying some professions is so demanding that if not well managed it leads to severe stress, withdrawal, burnout, and other health-related problems. Hence, practical engagement and exhibition of catering, cooking, and home management are so tasking as they are time-consuming and very intensive. Many students in the specialties experience excess academic loads and internal and external demands. Given these, this study tested the impact of cognitive behavior coping strategy on school stress among adult learners enrolled in Home Economic and Indigenous Textile Education. METHODS: A pretest-posttest randomized control group design was applied. Ninety-five students (43 [45.3%] males; 52 [54.7%] females) participated in the current study. Stress assessment was induced and then students were randomly allocated to the cognitive behavior coping strategy group and the waitlist conditions. Later, students on the waitlist received the cognitive behavior coping strategy contents. Data collected were analyzed using analysis of covariance. RESULTS: Results showed that at pretest, there was no significant difference among the participants in the 2 groups as measured by Educational Stress Scale and Perceived Stress Scale scores. However, the post-intervention test result showed a long-term impact of cognitive behavior coping strategy in improving the management of school stress among students. CONCLUSION: This study suggests that cognitive behavior coping strategy has a long-term impact on modifying the students' perception of school stress in a sample of adult learners enrolled in Home Economic and Indigenous Textile Education.

[Experiences of Burden and Coping Strategies and their Associations with Mental Health and Well-Being in COPD - a Mixed Methods Study]. / Zusammenhänge von Belastungsthemen und Coping-Strategien mit psychischer Gesundheit und Lebenszufriedenheit bei COPD ­ eine Mixed-Methods-Studie.

Understanding trigger and maintaining factors regarding psychiatric comorbidities in COPD is of great importance. In the presented mixed-methods study, qualitative interview data on burden experience and coping were related to psychiatric comorbidity (using PHQ-D) and quality of live (Positive Affect Negative Affect Schedulde, PANAS and Satisfaction with Life Scale, SWLS) and extended by the Freiburg Questionnaire on Coping with Illness (FKV-LIS). The two interview questions prompting narrative were 1.) "What is currently bothering you most?"; 2.) "How do you cope with your chronic disease in everyday life?" A total of 62 patients who were hospitalized due to COPD participated. The severity of physical impairment was assessed using GOLD stage and the Charlson Comorbidity Index (CCI). The interviews conducted were content analyzed and then quantified. The collected data were then compared between two groups with regard to mental distress. 13 themes of burden and 11 coping strategies were identified by content analysis. A total of 42 patients showed signs of mental distress, while 20 patients did not show signs of distress. There were no significant differences between the two groups in terms of sociodemographic characteristics and the severity of their physical symptoms. In the first interview question, the stressed group more frequently addressed issues related to death (35.7% versus 15.0%) and social stress (21.4% versus 0.0%). With respect to the second interview question, the nonstressed group was significantly more likely to mention strategies for consciously emphasizing positive emotions (70.0% versus 31.0%). In addition, higher scores on the FKV scales for depressive coping and trivialization and wishful thinking were evident in the stressed group. Quality of life and mental distress should be considered in clinical care for COPD. Interventions to influence illness perception and related coping styles are important, especially with regard to the development of a realistic and optimistic perspective on life and disease burden, as well as the inclusion of group and family therapeutic interventions.

Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers.

BACKGROUND: Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. METHODS: We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. RESULTS: In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. CONCLUSIONS: Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. CLINICALTRIALS.GOV REGISTRATION: NCT05876325.

Understanding food insecurity in Los Angeles County during the COVID-19 pandemic and its aftermath: A qualitative interview study.

The COVID-19 pandemic brought increases in food insecurity in Los Angeles (L.A.) County, defined as lacking household access to adequate food because of limited money or other resources. Here, we aimed to understand the lived experiences of food insecurity during the COVID-19 pandemic and its aftermath. In August-December 2022, we interviewed 30 residents of L.A. County who were participants in an ongoing internet panel and had reported experiencing food insecurity between April 2020 and July 2021. A stratified-sampling approach was used to recruit a diverse sample with and without government food assistance. We report five key findings, which underscore the stress and worry associated with the experience of food insecurity, and the coping strategies people implemented: (1) The pandemic prompted food insecurity as well as stressful shifts in eating behaviors compared to before the pandemic, with some eating much less food, some eating less nutritious food, and some eating much more due to being stuck at home; (2) Buying food became more effortful and financially challenging; (3) Government food assistance from the Supplemental Nutrition Assistance Program (SNAP) was important for reducing food insecurity, but was sometimes insufficient, inconsistent, and didn't cover all retailers or food items; (4) Interviewees had to rely on their social networks, food banks or pantries, churches, and schools to meet their food needs and cope with food insecurity, but some faced barriers in doing so; (5) For some, food insecurity was worse in late 2022, almost two years after the pandemic started. We conclude with implications for policymakers and practitioners, emphasizing the importance of meeting the needs of diverse residents and addressing food insecurity in the aftermath of the COVID-19 pandemic.

The Costs of Coping: Long-Term Mortality Risk in Aging Men.

OBJECTIVES: Prospective associations between coping and all-cause mortality risk are understudied, particularly among nonmedical samples. We assessed independent and joint associations of multiple components of the transactional stress and coping model with all-cause mortality in a cohort of community-dwelling men. We were particularly interested in how coping effort related to mortality. METHODS: Participants included 743 men from the Veterans Affairs Normative Aging Study who completed 1+ stress and coping assessment in 1993-2002 (baseline age: M = 68.4, standard deviation [SD] = 7.1) and had mortality follow-up through 2020. The Brief California Coping Inventory assessed coping with a past-month stressor. Cox regression evaluated associations of problem stressfulness, coping strategies, total coping effort, and coping efficiency with all-cause mortality risk. RESULTS: Over a mean follow-up of 16.7 years (SD = 7.1), 473 (64%) men died. Problem stressfulness was not associated with mortality risk (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 0.98-1.17), adjusted for demographics and health conditions. When examining coping via specific strategies, only social coping was associated with higher mortality risk (HR: 1.15, 95% CI: 1.05-1.26) after Bonferroni correction. Total coping effort was associated with 14% greater risk of all-cause mortality (95% CI: 1.04-1.26), independent of problem stressfulness, demographics, and health conditions. Coping efficiency, a benefit-cost ratio of coping efficacy to total coping effort, was not associated with mortality risk in adjusted models. DISCUSSION: Total coping effort may be an important indicator for longevity among aging men, above and beyond problem stressfulness and specific coping strategies, which have been the foci in prior research.

Care burden and resilience in parents of children with special needs and chronic diseases.

AIM: Comparison of care burden and resilience levels in parents of children with special needs and chronic diseases. METHODS: This study, designed with a cross-sectional and relationship-seeking design, was conducted in a Training and Research Hospital in Turkey. Data was obtained from parents of children with special needs (n = 102) and chronic diseases (n = 102) who presented to the outpatient clinic for routine follow-up between October 2022 and February 2023. The consecutive sampling method was used while choosing the sample. The "Descriptive Characteristics Questionnaire," "Zarit Caregiver Burden Scale (ZCB)," and "Resilience Scale for Adults (RSA)" were used to collect data. Data were evaluated using the SPSS 22.0 statistical program. RESULTS: The burden of care in parents differed significantly between the two groups (p < 0.001), the majority of parents of children with chronic diseases (PCCD) had a mild/moderate care burden, and the majority of parents of children with special needs (PCSN) had a moderate/severe level of care. The care burden scores and total resilience scores were found to be higher in the PCSN group, and the care burden scores and total resilience scores were found to be lower in the PCCD group (p < 0.001). CONCLUSION: This research determined that PCSN showed more care burden and less resilience than PCCD. In this context, it is recommended to regularly monitor the resilience, caregiver burden, and quality of life of caregivers of children with special needs and conduct preventive and strengthening programs.

Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US.

OBJECTIVES: In 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures. METHODS: Households with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type). RESULTS: In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset. CONCLUSIONS FOR PRACTICE: Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.

Early maladaptive schemas in female patients with migraine and tension-type headache.

Chronic headache is a serious clinical problem in women which psychological factors play major role and requires an approach with bio-psycho-social integrity. Psychiatric comorbidities such as anxiety disorder and major depression are frequent. Young described Early Maladaptive Schemas (EMS) as maladaptive and dysfunctional patterns that appear due to unpleasant situations occurred between patient and people who were important to him. EMS affect perception, emotions, thoughts and behaviors that makes a basis for many disorders. EMS are found to be related with depression, anxiety and somatization within recent literature. In literature, chronic pain and migraine's relationship with EMS were studied before in a few separate articles. However, there is a lack of data that compares the relationship between EMS and clearly distinguished headache types: migraine (MH) and tension-type headache (TTH) especially in female patients who are more prone to somatic complaints/findings. Our study directly compared three groups, migraine and tension type headache and healthy controls. 150 female patients with chronic headache were enrolled for study in consecutive fashion. Exclusion criteria were as follows: age < 18 or > 60 years, male gender, existence of comorbidity affecting central nervous system, headache due to drug/substance abuse, previous diagnosis of migraine with aura, previous diagnosis of psychotic disease, mental retardation, cognitive disorders, being in delirium state. Patients were grouped into two categories according to type of headache and a third control group. All patients were evaluated with Young Schema Questionnaire (YSQ) and their scores were noted and categorized in related schema domains. Sociodemographic data were comparable among groups. However, there were significant differences in terms of previous psychiatric diagnosis and psychiatric drug usage. When we compared YSQ scores, groups differed in many schema categories. MH group showed significantly higher scores in dependency/incompetency, unrelenting standards and punitiveness schemas when compared to remaining two groups. TTH group had significantly more points in emotional deprivation, vulnerability to harm or illness schemas among all groups. On the other hand, control group had significantly higher scores in insufficient self-discipline and entitlement/grandiosity schemas when compared to both MH and TTH groups. Presence of EMS in female patients with headache significantly differed from control group. Types of EMS were also significantly different between patients with MH and TTH among this whole headache group. We suggest that a comprehensive psychotherapeutic approach that targets to improve coping methods for distinct EMS in distinct headache types would provide critical aid to general treatment of headaches especially in resistant cases.

Coping strategies and social support in nursing students during clinical practice: A scoping review.

AIM: To identify the coping strategies and social support received by nursing students during clinical practice. DESIGN: Scoping review. METHODS: Primary studies on coping strategies and social support, in full text, in English, French, Spanish or Portuguese and published in 2018 or later were included. Search was carried out in January 2023 on EBSCOhost, PubMed, SciELO, ScienceDirect, OpenAIRE, MedNar Search, WorldWideScience and the references of previously selected articles. RESULTS: A total of 24 studies were identified. Seven studies mentioned social support as a useful strategy and several instruments were identified that allow measurement. CONCLUSIONS: Few studies establish a direct relationship between the effectiveness of coping strategies with stressful situations. Positive coping strategies are associated with effective stress management. The relationship between social support and stress reduction is scarcely addressed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Stressful situations can have an impact on students' health and on the quality of care. Nursing schools and healthcare institutions must work together in programmes to improve students coping abilities. IMPACT: This review addressed coping strategies used by nursing students during clinical practice. A set of relevant coping strategies were identified that can be used by teachers to improve students' outcomes. REPORTING METHOD: The review was performed according to Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden.

INTRODUCTION: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN: Prospective longitudinal study. METHODS: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.

Experience of financial toxicity and coping strategies in young and middle-aged patients with stroke: a qualitative study.

BACKGROUND: While financial toxicity (FT) is prevalent in patients with cancer, young and middle-aged patients with stroke are also affected by FT, which can exacerbate their physical and psychological challenges. Understanding the patient's experience and response measures can further understand the impact of FT on patients with stroke, to help alleviate FT. However, little is known concerning the experience of patients with stroke with FT or their coping strategies. Therefore, this study aimed to describe the experiences of FT in young and middle-aged patients with stroke and their coping strategies. METHODS: A phenomenological method was utilized. Semi-structured interviews were conducted with 21 young and middle-aged stroke patients (aged 18-59) between October 2022 and March 2023. The participants were recruited from a tertiary hospital in Shanghai, China. The research team used NVivo 12.0 software. Giorgi's phenomenological analysis method was used to analyse the interview data. RESULTS: The interview results were divided into two categories in terms of patients' experiences of FT and their coping strategies. Nine subthemes were constructed. The experience category included four subthemes: (1) taking on multifaceted economic pressure, (2) dual choice of treatment, (3) decline in material living standards, and (4) suffering from negative emotions such as anxiety and depression. The coping strategy category included five subthemes: (1) reducing expenses, (2) improving living habits, (3) proactive participation in medical decision-making, (4) making a job position choice, and (5) seeking social support. CONCLUSIONS: FT in young and middle-aged patients with stroke, which affected their physical and mental health, led them to implement strategies for dealing with FT. The Chinese government needs to broaden the reach of health insurance coverage and advance the fairness of healthcare policies. Healthcare professionals must pay active attention to FT in such patients in terms of strengthening their health education and considering their needs and preferences. Patients need to improve their sense of self-efficacy, actively reintegrate into society, and adhere to rehabilitation and treatment. Individuals at a high risk of stroke are recommended to purchase health insurance. Multifaceted efforts are needed to reduce the impact of FT in young and middle-aged patients with stroke.

Economic burden and coping mechanisms by tuberculosis treatment supporters: a mixed method approach from Bono Region, Ghana.

BACKGROUND: The Directly Observed Therapy Short Course (DOTS) strategy recommended by World Health Organization for tuberculosis control requires multiple clinic visits which may place economic burden on treatment supporters especially those with low socio-economic status. The End tuberculosis goal targeted eliminating all tuberculosis associated costs. However, the economic burden and coping mechanisms by treatment supporters is unknown in Ghana. OBJECTIVES: The study determined the economic burden and coping mechanism by treatment supporters in Bono Region of Ghana. METHODS: Cross-sectional study using mixed method approach for data collection. For the quantitative data, a validated questionnaire was administered to 385 treatment supporters. Sixty in-depth interviews with treatment supporters to elicit information about their coping mechanisms using a semi-structured interview guide for the qualitative data. Descriptive statistics, costs estimation, thematic analysis and bivariate techniques were used for the data analysis. RESULTS: Averagely, each treatment supporter spent GHS 112.4 (US$21.1) on treatment support activities per month which is about 19% of their monthly income. Borrowing of money, sale of assets, used up saving were the major coping mechanisms used by treatment supporters. Highest level of education, household size, marital status and income level significantly influence both the direct and indirect costs associated with tuberculosis treatment support. The significant levels were set at 95% confidence interval and p < 0.05. CONCLUSION: We concludes that the estimated cost and coping mechanisms associated with assisting tuberculosis patients with treatment is significant to the tuberculosis treatment supporters. If not mitigated these costs have the tendency to worsen the socio-economic status and future welfare of tuberculosis treatment supporters.

Perspectives, risk factors, and coping mechanisms in patients with self-reported financial burden following lung cancer surgery.

OBJECTIVE: We evaluated self-reported financial burden (FB) after lung cancer surgery and sought to assess patient perspectives, risk factors, and coping mechanisms within this population. METHODS: Patients with lung cancer resected at our institution between January 1, 2016, and December 31, 2021, were surveyed. Descriptive and multivariable analyses were performed to evaluate the association between clinical and financial characteristics with patient-reported major ("significant" or "catastrophic") FB. RESULTS: Of 1477 patients contacted, 31.3% (n = 463) completed the survey. Major FB was reported by 62 (13.4%) patients. multivariable analyses demonstrated increasing age (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), credit score >740 (OR, 0.29; 95% CI, 0.14-0.60), and employer-based insurance (OR, 0.24; 95% CI, 0.07-0.80) were protective factors. In contrast, an out of pocket cost greater than expected (OR, 3.63; 95% CI, 1.67-7.88), decrease in work hours (OR, 4.42; 95% CI, 1.59-12.25), or cessation of work (OR, 5.13; 95% CI, 2.06-12.78), chronic obstructive pulmonary disease diagnosis (OR, 5.39, 95% CI, 1.87-15.50), and hospital readmission (OR, 4.87; 95% CI, 1.11-21.42) were risk factors for FB. To pay for care, some patients reported "often" or "always" decreasing food (n = 102 [23.4%]) or leisure spending (n = 179 [40.7%]). Additionally, use of savings (n = 246 [62.9%]), borrowing funds (n = 72 [16.6%]), and skipping clinic visits (n = 36 [8.3%]) at least once were also reported. Coping mechanisms occurred more often in patients with major FB compared with those without (P < .001). CONCLUSIONS: Patients with resected lung cancer may experience major FB related to treatment with several identifiable risk factors. Targeted interventions are needed to limit the adoption of detrimental coping mechanisms and potentially affect survivorship.