Predictors of parental stress from admission to discharge in the neonatal special care unit.

BACKGROUND: Exacerbated parental stress during a stay in the neonatal intensive care unit can negatively impact the development of the hospitalized infant, strain the dyadic relationship and put parents at risk for poor mental health. It is therefore important to identify risk factors of stress throughout the duration of a hospitalization. This longitudinal study aimed to investigate sources of stress for mothers and fathers who had a baby in the neonatal special care unit. METHODS: Parents of 57 singletons and 11 twins (68 infants) admitted to a neonatal special care unit (46% for prematurity) were recruited. Sixty-four mothers and 20 fathers were assessed at admission, and 60 mothers and 16 fathers at discharge. Participants reported their satisfaction with hospital information and completed the Perceived Stress Scale, the Brief Illness Perception Questionnaire and the Dyadic Adjustment Scale. RESULTS: Parents demonstrated similar stress trajectories, with stress on average declining over time. Higher maternal stress at admission was associated with a belief that the baby's illness would have a longer timeline, lower perceptions of treatment efficacy and lower satisfaction with the information received from medical staff. Younger age and lower levels of education predicted higher maternal stress at discharge. Fathers had higher stress at discharge when they were older, had a baby born at younger gestation and felt they had less control. At admission, information satisfaction was positively associated with parental beliefs about treatment efficacy and understanding the infant's condition. At discharge, information satisfaction was negatively associated with beliefs about illness severity and the likely time frame of the illness. CONCLUSION: The findings highlight that parents' perceptions of their baby's illness and treatment at admission and discharge have a significant association with stress. Clinical staff can use these factors to identify parents who are at risk of exhibiting a greater level of stress over the hospitalization period.

Parental experiences of family-centred care from admission to discharge in the neonatal intensive care unit.

AIM: It has been increasingly recognised that family-centred care (FCC) is associated with enhanced well-being for both parents and infants in paediatric settings, including the neonatal intensive care unit (NICU). Over the past 4 years, our NICU has increasingly adopted a collaborative philosophy of care. The purpose of the study was to examine parental experiences of FCC during both the admission and discharge time points in order to examine differences in parents' experiences and identify areas for improvement. METHODS: We conducted interviews at two time points (admission and discharge) with 83 parents (mothers and fathers) of premature and medically fragile infants and analysed the data using thematic analysis. RESULTS: Three key themes (and sub-themes) were identified: disempowerment, hierarchy between parents and staff and the father's peripheral role. The themes were equally prevalent across admission and discharge. CONCLUSIONS: The challenges relating to FCC reported by parents at both admission and discharge represent some of the key barriers that parents still face in terms of being truly involved in the care of their infant in the NICU. Similar themes at both time points suggest that parents need equal amounts of support during their stay in NICU, irrespective of the level of care the infant is receiving and whether they are approaching discharge. Implications for improving FCC more generally are discussed.

Global life satisfaction predicts ambulatory affect, stress, and cortisol in daily life in working adults.

Global life satisfaction has been linked with long-term health advantages, yet how life satisfaction impacts the trajectory of long-term health is unclear. This paper examines one such possible mechanism-that greater life satisfaction confers momentary benefits in daily life that accumulate over time. A community sample of working adults (n = 115) completed a measure of life satisfaction and then three subsequent days of ecological momentary assessment surveys (6 times/day) measuring affect (i.e., emotional valence, arousal), and perceived stress, and also provided salivary cortisol samples. Multilevel models indicated that people with higher (vs. lower) levels of life satisfaction reported better momentary affect, less stress, marginally lower momentary levels and significantly altered diurnal slopes of cortisol. Findings suggest individuals with high global life satisfaction have advantageous daily experiences, providing initial evidence for potential mechanisms through which global life satisfaction may help explain long-term health benefits.

The shared experience of adolescent and young adult cancer patients and their caregivers.

OBJECTIVE: We examined the interdependent, dyadic, mental health of adolescent and young adult (AYA) cancer patients and their caregivers. Our aims were as follows: (1) to investigate the degree to which patients' and caregivers' subjective perceptions of illness severity are congruent with objective severity (i.e., medical indicators), (2) to compare patients' and caregivers' subjective perceptions of illness severity and cancer-related posttraumatic stress symptoms (PTSS), and (3) to evaluate whether subjective perceptions of illness severity are linked to patients' and caregivers' cancer-related PTSS. METHODS: The AYA cancer patients (n = 110; ages 12-24 years; 52% male) undergoing active treatment at an outpatient clinic and their caregivers (n = 110; 97% parents; ages 24-68 years; 89% female) independently reported their PTSS and subjective illness severity. RESULTS: Overall, neither patients' nor caregivers' reports of subjective illness severity were associated with objective illness severity. Caregivers reported higher PTSS than did patients and higher illness severity than younger, but not older, patients. Actor-partner interdependence model analyses indicated that AYA patients' subjective illness severity is the strongest predictor of their own PTSS and is a significant correlate of their caregivers' PTSS. Caregivers' subjective illness severity is associated with their own PTSS only. Results remained robust after controlling for demographic and illness characteristics. CONCLUSIONS: The AYA patients' and caregivers' illness perceptions are distinct from each other and from objective medical indicators of illness severity. Patients' reports of subjective illness severity may be a marker for their own and their caregivers' mental health. Patient care and efficacious psychosocial interventions may require consideration of both patients' and caregivers' subjective perceptions of illness severity.

Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus.

This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age 55.4; 80 % White/Caucasian 65 % female) with poorly controlled type 2 diabetes (HbA1c level ≥ 7.5 %) provided demographic and several self-report measures (including diabetes-related distress, diabetes self-care activities, discrimination, and attributions of discrimination), and had height, weight, and glycated hemoglobin (HbA1c) assessed by trained research staff as part of a larger research study. Individuals who attributed self-reported discrimination to weight had significantly higher HbA1c levels, higher levels of diabetes-related distress, and worse diabetes-related self-care behaviors (general diet, exercise, and glucose testing). These relationships persisted even when controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics. Results indicate that the perception of weight stigma among individuals with type 2 diabetes is strongly associated with a range of poor diabetes outcomes. Efforts to reduce exposure to and/or teach adaptive coping for weight stigma may benefit patients with type 2 diabetes.

Unique relations between post-traumatic stress disorder symptoms and patient functioning in type 2 diabetes.

This study examined reported post-traumatic stress disorder symptoms in adults with poorly controlled type 2 diabetes who had no history of psychiatric diagnosis or treatment (n = 184, MHbA1c = 9.13%, standard deviation = 1.68). Participants reported moderate to severe intensity of post-traumatic stress disorder symptoms (M = 19.17, SD = 17.58). Together, depressive and post-traumatic stress disorder symptoms accounted for 10-40 percent of the variance in type 2 diabetes outcomes; post-traumatic stress disorder symptoms were associated with elevated diabetes distress and more frequent exercise and self-blood glucose testing (unique R2 ~ 3%). Post-traumatic stress disorder symptoms may be overlooked in type 2 diabetes among patients without formal psychiatric diagnoses, and warrant increased attention.

Support and conflict in relationships and psychological health in adolescents and young adults with cancer.

Perceived support and conflict between adolescents and young adults with cancer and their primary caregivers, other family, close friends, and medical staff were examined in relation to adolescents and young adults' psychological health. Adolescents and young adults ( n = 115, 51% male, ages 12-24 years, M (standard deviation) = 16.07 (2.29)) in outpatient cancer treatment perceived more support and conflict within familial relationships than other relationships. Among familial relationships, perceived support and conflict were associated with psychological health; within other relationships, only support was associated with psychological health. Interactions among family were most strongly correlated with psychological distress; interactions with friends were stronger correlates of posttraumatic stress symptoms, positive affect, and posttraumatic growth.

How do you feel? Self-esteem predicts affect, stress, social interaction, and symptom severity during daily life in patients with chronic illness.

Self-esteem has been demonstrated to predict health and well-being in a number of samples and domains using retrospective reports, but little is known about the effect of self-esteem in daily life. A community sample with asthma (n = 97) or rheumatoid arthritis (n = 31) completed a self-esteem measure and collected Ecological Momentary Assessment (EMA) data 5x/day for one week using a palmtop computer. Low self-esteem predicted more negative affect, less positive affect, greater stress severity, and greater symptom severity in daily life. Naturalistic exploration of mechanisms relating self-esteem to physiological and/or psychological components in illness may clarify causal relationships and inform theoretical models of self-care, well-being, and disease management.

Assessing acute psychological distress in the immediate aftermath of stroke.

BACKGROUND AND PURPOSE: High acute stress may presage the development of subsequent cardiovascular ailments. Understanding how best to assess acute stress may inform early interventions seeking to prevent long-term morbidity/mortality following stroke. A mixed methods approach examined early post-stroke acute stress symptoms using the post-traumatic stress disorder checklist-5 (PCL-5) and the acute stress disorder scale (ASDS). METHODS: A focus group of stroke survivors and/or their caregivers ( N=8) evaluated PCL-5/ASDS feasibility, and 20 patients hospitalized for acute stroke were interviewed 2-10 days post-stroke onset, using either the PCL-5 or the ASDS. RESULTS: Acute stress symptoms were present and measurable during acute stroke recovery. Assessment of acute stress in hospitalized patients with stroke is feasible; a briefer modified ASDS has advantages over the PCL-5. CONCLUSIONS: The ASDS is a viable and useful measure for assessing psychological distress during the acute post-stroke aftermath. Findings suggest that acute stress symptoms are present among patients with stroke, warranting greater attention to psychological responses in the early post-stroke period. Given that acute stress has serious potential long-term health consequences, additional research on stroke-related acute stress may prove useful for understanding post-stroke morbidity/mortality.

Genetics as a molecular window into recovery, its treatment, and stress responses after stroke.

Stroke remains a major source of adult disability in the USA and worldwide. Most patients show some recovery during the weeks to months following a stroke, but this is generally incomplete. An emerging branch of therapeutics targets the processes underlying this behavioral recovery from stroke toward the goal of reducing long-term disability. A key factor hampering these efforts is the very large degree of variability between stroke survivors. Available data suggest that genetic differences could explain an important fraction of the differences between subjects. The current review considers this from several angles, including genetic differences in relation to drugs that promote recovery. Genetic factors related to physiological and psychological stress responses may also be critically important to understanding recovery after stroke and its treatment. The studies reviewed provide insights into recovery and suggest directions for further research to improve clinical decision-making in this setting. Genetic differences between patients might be used to help clinical trials select specific patient subgroups, on a biological basis, in order to sharpen the precision with which new treatments are evaluated. Pharmacogenomic factors might also provide insights into inter-subject differences in treatment side effects for pharmacological prescriptions, and behavioral interventions, and others. These efforts must be conducted with the strictest ethical standards given the highly sensitive nature of genetic data. Understanding the effect of selected genetic measures could improve a clinician's ability to predict the risk and efficacy of a restorative therapy and to make maximally informed decisions, and in so doing, facilitate individual patient care.

Feasibility Study of a Mobile Health Intervention for Older Adults on Oral Anticoagulation Therapy.

Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre-post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up (Mbase = 12.5 ± 5.51, Mfollow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults' knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.

Social Constraints are Associated with Negative Psychological and Physical Adjustment in Bereavement.

Losing a loved one is a normative life event, yet there is great variability in subsequent interpersonal experiences and adjustment. The Social-Cognitive Processing (SCP) model suggests that social constraints (i.e. limited opportunities to disclose thoughts and feelings in a supportive context) impede emotional and cognitive processing of stressful life events, which may lead to maladjustment. This study investigates personal and loss-related correlates of social constraints during bereavement, the links between social constraints and post-loss adjustment, and whether social constraints moderate the relations between loss-related intrusive thoughts and adjustment. A community sample of bereaved individuals (n = 238) provided demographic and loss-related information and reported on their social constraints, loss-related intrusions, and psychological and physical adjustment. Women, younger people, and those with greater financial concerns reported more social constraints. Social constraints were significantly associated with more depressive symptoms, perceived stress, somatic symptoms, and worse global health. Individuals with high social constraints and high loss-related intrusions had the highest depressive symptoms and perceived life stress. Consistent with the SCP model, loss-related social constraints are associated with poorer adjustment, especially psychological adjustment. In particular, experiencing social constraints in conjunction with loss-related intrusions may heighten the risk for poor psychological health.

Understanding the utility of emotional approach coping: evidence from a laboratory stressor and daily life.

BACKGROUND: Dispositional emotional approach coping (EAC) marks an adaptive tendency to process and express emotions. EAC's association with cognitions, affect, and intra- and interindividual characteristics that may account for its utility was examined in response to an acute stressor and in daily life. DESIGN: This study included a laboratory stress task and ecological momentary assessment. METHODS: Healthy undergraduate students (n = 124; mean age: 20; women: 56%) completed a laboratory component (baseline survey, speech stress task, pre- and posttask measures) and five subsequent days of surveys via palm pilot (six surveys/day). RESULTS: Controlling for sex, neuroticism, and social support, greater EAC was associated with more positive cognitive appraisals, personal resources, and positive affect and less-negative affect during the lab stressor, and with more perceived control and positive affect in daily life. Significant EAC × sex interactions were found for poststressor affect: men with high EAC reported more positive affect and women with high EAC reported less negative affect. CONCLUSIONS: Findings provide support that EAC's utility may be independent of intra- and interindividual characteristics, and that men and women may benefit from EAC in different ways in regards to affect. The proclivity to use EAC may come with a resiliency that protects against stress and promotes general well-being.

Post-Disaster Mental Health Among Parent-Child Dyads After a Major Earthquake in Indonesia.

The interdependent adjustment of children and their parents following disasters has been well documented. We used the Actor-Partner Interdependence Model (APIM) to provide an appropriate analytical framework for examining how family members may contribute to each other's post-disaster mental health. Independent self-reports were collected from parent-child dyads (n = 397) residing in a rural community in Indonesia that was devastated by a major earthquake. Elementary school children (M = 10 years; 51 % female) and one of their parents (M = 41 years; 73 % female) each reported on their disaster exposure, posttraumatic stress (PTS) symptoms, and general distress. The APIM was used to examine mental health within dyads and moderation by gender across dyads. Children reported lower disaster exposure and fewer PTS symptoms, but similar general distress levels, as their parents. Children's and parents' disaster-specific PTS symptoms were the strongest predictor of their own general distress. Parents' PTS symptoms were associated with children's general distress (b = 0.14, p < 0.001), but children's PTS symptoms were not associated with parents' general distress (b = -0.02, p > 0.05). Findings were not moderated by parents' or children's gender. Although children and parents may respond differently to natural disasters, they may be best understood as a dyad. APIM analyses provide new evidence suggesting a unidirectional path of influence from parents' disaster-related symptomatology to children's general mental health. Dyadic approaches to understanding mental health and treating symptoms of distress among disaster survivors and their families following trauma are encouraged.

A national study of health care service utilization and substance use after the 2010 Chilean earthquake.

OBJECTIVE: A national epidemiological survey in Chile assessed adaptive (health care utilization) and maladaptive (substance use) postearthquake behaviors. METHODS: Three months after the 8.8-magnitude 2010 Bio-Bio earthquake, face-to-face interviews were conducted with a representative sample of 2,108 adults. Logistic regression analyses examined predictors of health care service utilization and substance use. RESULTS: Few participants utilized available government- and community-based psychosocial resources (16.6%). A minority reported increased substance use (13.2%). Lower self-efficacy was correlated with increased health care utilization (odds ratio [OR]=.92, 95% confidence interval [CI]=.88-.96) and use of tranquilizers, illicit and psychotropic drugs, and alcohol (OR=.95, CI=.91-.99); this pattern was not limited to residents of areas with the heaviest impacts. CONCLUSIONS: Self-efficacy beliefs elucidate variability in survivors' behaviors postdisaster and may provide an avenue to encourage salubrious responses. Postdisaster interventions should broadly target the population; those less heavily affected may need, and be as likely to use, available resources.