The role of Magnetic Resonance Images (MRIs) in coping for patients with brain tumours and their parents: a qualitative study.

BACKGROUND: When children and young people (CYP) are diagnosed with a brain tumour, Magnetic Resonance Imaging (MRI) is key to the clinical management of this condition. This can produce hundreds, and often thousands, of Magnetic Resonance Images (MRIs). METHODS: Semi-structured interviews were undertaken with 14 families (15 parents and 8 patients), and analysed using Grounded Theory. Analysis was supported by the Framework Method. RESULTS: Although the focus of the research was whether paediatric patients and their families find viewing MRIs beneficial, all patients and parents discussed difficult times during the illness and using various strategies to cope. This article explores the identified coping strategies that involved MRIs, and the role that MRIs can play in coping. Coping strategies were classified under the aim of the strategy when used: 'Normalising'; 'Maintaining hope and a sense of the future'; 'Dealing with an uncertain future'; and 'Seeking Support'. CONCLUSIONS: Coping and finding ways to cope are clearly used by patients and their families and are something that they wish to discuss, as they were raised in conversations that were not necessarily about coping. This suggests clinicians should always allow time and space (in appointments, consultations, or impromptu conversations on the ward) for patient families to discuss ways of coping. MRIs were found to be used in various ways: to maintain or adapt normal; maintain hope and a sense of the future; deal with an uncertain future; and seek support from others. Clinicians should recognise the potential for MRIs to aid coping and if appropriate, suggest that families take copies of scans (MRIs) home. Professional coaches or counsellors may also find MRIs beneficial as a way to remind families that the child is in a more stable or 'better' place than they have been previously.

Subjective and objective demands on different types of differential stress inventory.

PURPOSE: To validate the differential stress inventory (DSI) by evaluating the objective and subjective stress differences in the five DSI types in the occupational setting. METHODS: A total of 119 German participants working as medical assistants (n = 40) or in a bank (n = 79) were recruited. They completed the Maslach Burnout Inventory-General Survey, the DSI, and wore ECG measuring devices for 24 h to measure heart rate variability. The DSI was used to group people into one of five types according to how they perceived and coped with stress: normal, overstressed, stress-resistant, low stress/high coping, or high stress/high coping. RESULTS: The overstressed type had significantly more burnout symptoms than the other types. The high stress/high coping type also had more symptoms of emotional exhaustion and total burnout compared to the other types, while the low stress/high coping and the stress-resistant types generally had the lowest levels of burnout. There were no differences on the HRV parameters among the DSI types. CONCLUSION: Categorising people into types like in the DSI can help make workers aware of unhealthy stress and coping patterns before they turn into more severe pathology. Proper application and targeted preventive measures can save the individual's health and the company's budget. While the DSI picked up on differences in burnout symptoms as a long-term consequence of stress, there is evidence that it cannot pick up on short-term stress or physical stress as measured by HRV from the 24 h recording.

Factor structure of a coping measure in the 2013 Canadian Forces Mental Health Survey.

BACKGROUND: Coping has been the subject of numerous studies over the past decades, yet significant debate remains regarding the structure of this construct. DATA AND METHODS: Exploratory and confirmatory factor analyses were conducted on 2013 Canadian Forces Mental Health Survey (CFMHS) data to examine the factor structure of coping items. A total of 6,696 Canadian Armed Forces (CAF) Regular Force members completed a coping inventory that assessed 14 coping strategies (e.g., problem solving, talking to others). RESULTS: Results indicated that coping among CAF Regular Force members was best represented by two factors: positive coping and negative coping. Coping strategies categorized as positive coping included active efforts to confront the stressor or improve one's well-being, whereas those categorized as negative coping reflected passive or avoidant efforts or behaviours that may compromise one's health. Positive coping factor scores were positively associated with perceptions of one's ability to handle difficult problems and day-to-day demands, while negative coping factor scores were negatively associated with such perceptions, suggesting that the factors had good concurrent validity. Additional analyses pointed to higher positive and negative coping scores among female Regular Force members compared with male Regular Force members. The additional analyses also showed generally less favourable coping scores among lower-ranking Regular Force members and those with a history of deployment to Afghanistan relative to their respective counterparts. Lastly, Regular Force members who received mental health training demonstrated higher positive coping scores. DISCUSSION: The report discusses implications for the use of coping indicators in future analyses involving the CFMHS.

Grief and coping of parents whose child has a constant life-threatening disability, hypoplastic left heart syndrome with reference to the Dual-Process Model.

This paper reports on a study that examined the grief and coping of 29 parents whose child has hypoplastic left heart syndrome using the Dual Process Model. The study employed a secondary thematic analysis of interviews at key times of treatment and recovery for the child. After the diagnosis, parents experienced intense loss (LO), but focused upon restoration-orientated tasks (RO) to support their child. Over time, most parents employed a healthy oscillation between LO coping and RO coping, with waves of grief and with some grieving suppressed. There are some specific grief and coping and gender patterns employed by parents.

Age Differences in Stress and Coping: Problem-Focused Strategies Mediate the Relationship Between Age and Positive Affect.

The present study examined the different types of stressors experienced by adults of different ages, their coping strategies, and positive/negative affect. A mediation hypothesis of coping strategies was tested on the relationships between age and positive/negative affect. One-hundred and ninety-six community-dwelling adults (age range 18-89 years) reported the most stressful situation they experienced in the past month and coping strategies. Levels of positive and negative affect in the past month were also measured. Content analysis revealed age differences in different types of stressors adults reported. Three types of coping strategies were found: problem-focused, positive emotion-focused, and negative emotion-focused coping. Older adults were less likely than younger adults to use problem-focused coping and reported lower levels of positive affect. Path analysis supported the mediation hypothesis, showing that problem-focused coping mediated the relationship between age and positive affect. Implications are discussed on the importance of promoting problem-focused coping among older adults.

Relocation experiences with unplanned admission to a nursing home: a qualitative study.

BACKGROUND: In many countries, people over 85 years of age are relocated involuntarily or unplanned to a nursing home. In Switzerland, 43% of elderly over 85 years are admitted to nursing homes after hospital discharge. This percentage is higher than in the USA with 32.5% or in Germany with only 19%. Despite those more frequent Swiss admissions, no research has been conducted exploring how unplanned admissions to nursing homes affect the adaptation. Therefore, the aim of this study was to gain an in-depth understanding into unplanned admissions to nursing homes and to explore its impact on adaptation. METHODS: The study used a qualitative interview design based on Meleis' transition model. Secondary data analysis was guided by Mayring's qualitative content analysis. Face-to-face interviews with elderly over 77 years (n = 31) were conducted from a convenience sample in Switzerland between January and March 2013. RESULTS: The following four patterns of adaptation emerged from the analysis: "being cut-off," "being restricted," "being cared for," and "moving on." The patterns evaluate the relocation into nursing homes and provide an opportunity to appraise the stages of adaption. CONCLUSIONS: This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

Navigating physical activity engagement following a diagnosis of cancer: A qualitative exploration.

This qualitative descriptive study explored cancer survivors' experiences of barriers and facilitators to undertaking physical activity to inform how services and professionals might offer better support. Purposive and theoretical sampling was used to recruit 25 people who were up to 5 years post-cancer diagnosis. Participants took part in face to face, semi-structured interviews, and transcripts were analysed using thematic analysis. The analysis identified five interrelated themes which represented cancer survivors' views: 1) You're on your own-a sense of abandonment post-treatment, and lack of sufficient and tailored information; 2) Dis-ease-disruption to self and identity, and a heightened awareness of physical self and fragility; 3) Becoming acclimatised-physical activity in the face of treatment-related side effects and residual impairment; 4) Importance of others-encouragement and support from health professionals, family and friends, and cancer-specific exercise groups; 5) Meanings people ascribed to physical activity-these were central and could help or hinder engagement. Our findings suggest being able to live well and re-engage in meaningful activities following a diagnosis of cancer is both complex and challenging. There appear to be gaps in current service provision in supporting the broader health and well-being of cancer survivors.

Coping profiles, perceived stress and health-related behaviors: a cluster analysis approach.

Using cluster analytical procedure, this study aimed (i) to determine whether people could be differentiated on the basis of coping profiles (or unique combinations of coping strategies); and (ii) to examine the relationships between these profiles and perceived stress and health-related behaviors. A sample of 578 French students (345 females, 233 males; M(age)= 21.78, SD(age)= 2.21) completed the Perceived Stress Scale-14 ( Bruchon-Schweitzer, 2002), the Brief COPE ( Muller and Spitz, 2003) and a series of items measuring health-related behaviors. A two-phased cluster analytic procedure (i.e. hierarchical and non-hierarchical-k-means) was employed to derive clusters of coping strategy profiles. The results yielded four distinctive coping profiles: High Copers, Adaptive Copers, Avoidant Copers and Low Copers. The results showed that clusters differed significantly in perceived stress and health-related behaviors. High Copers and Avoidant Copers displayed higher levels of perceived stress and engaged more in unhealthy behavior, compared with Adaptive Copers and Low Copers who reported lower levels of stress and engaged more in healthy behaviors. These findings suggested that individuals' relative reliance on some strategies and de-emphasis on others may be a more advantageous way of understanding the manner in which individuals cope with stress. Therefore, cluster analysis approach may provide an advantage over more traditional statistical techniques by identifying distinct coping profiles that might best benefit from interventions. Future research should consider coping profiles to provide a deeper understanding of the relationships between coping strategies and health outcomes and to identify risk groups.

Coping with stigma by association and family burden among family members of people with mental illness.

In this study, we explored stigma by association, family burden, and their impact on the family members of people with mental illness. We also studied the ways in which family members coped with these phenomena. We conducted semistructured interviews with 23 immediate family members of people with mental illness. Participants reported various experiences of stigma by association and family burden. Social exclusion, being blamed, not being taken seriously, time-consuming caregiving activities, and exhaustion appeared to be the predominant forms of stigma by association and family burden experienced by the participants. The participants used problem-focused and emotion-focused coping strategies, separately or simultaneously, to cope with the negative impact of stigma by association and family burden. The results suggest that family members should have access to services to address these problems. Social, instrumental, and emotional support should be given to family members by community members and mental health professionals.

Factors associated with grief and depression following the loss of a child: a multivariate analysis.

The present study aims to explore the factors which are associated with grief and depression outcomes in a group of bereaved parents in the first few years following the loss of a child. Sixty-four participants were recruited from bereavement support organisations, between two and 59 months post loss, mean 30 months (SD = 15). They completed a questionnaire packet which comprised standard instruments measuring grief, depression, coping styles, continuing bonds and optimism/pessimism, as well as a number of specific bereavement-related questions. Univariate analyses were conducted to establish which factors were associated with grief and depression. Those which were statistically significant were then entered into multivariate analyses to establish their relative importance. High levels of avoidance and depression and lower levels of cognitive restructuring (benefit finding) were associated with higher grief symptoms, whereas higher levels of avoidance and alcohol/substance use were associated with higher depression symptoms. The present study highlights the relative importance of different coping strategies adopted by this group of bereaved parents, compared to the relative unimportance of circumstances around the loss, e.g. sudden or violent death. The use of alcohol and other substances by bereaved parents requires urgent attention as a potentially life-threatening maladaptive coping strategy. The call for further research into risk factors for bereaved parents is emphasised.

Classification of intellectual disability using the Wechsler Intelligence Scale for Children: Full Scale IQ or General Abilities Index?

AIM: We examined the implications of using the Full Scale IQ (FSIQ) versus the General Abilities Index (GAI) for determination of intellectual disability using the Wechsler Intelligence Scales for Children, fourth edition (WISC-IV). METHOD: Children referred for neuropsychological assessment (543 males, 290 females; mean age 10y 5mo, SD 2y 9mo, range 6-16y) were administered the WISC-IV and the Adaptive Behavior Assessment System, second edition (ABAS-II). RESULTS: GAI and FSIQ were highly correlated; however, fewer children were identified as having intellectual disability using GAI (n=159) than when using FSIQ (n=196). Although the 44 children classified as having intellectual disability based upon FSIQ (but not GAI) had significantly higher adaptive functioning scores than those meeting intellectual disability criteria based upon both FSIQ and GAI, mean adaptive scores still fell within the impaired range. FSIQ and GAI were comparable in predicting impairments in adaptive functioning. INTERPRETATION: Using GAI rather than FSIQ in intellectual disability diagnostic decision-making resulted in fewer individuals being diagnosed with intellectual disability; however, the mean GAI of the disqualified individuals was at the upper end of criteria for intellectual impairment (standard score 75), and these individuals remained adaptively impaired. As GAI and FSIQ were similarly predictive of overall adaptive functioning, the use of GAI for intellectual disability diagnostic decision-making may be of limited value.

Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy.

This study assessed the combined effects of coping style and intra-procedural information on indices of distress (physiological measures, observed distress, self-report measures of anxiety and affect) among a group of patients undergoing colposcopy. High and low monitors were exposed to one of three interventions: high information (live video feed of colposcopy); low information (complete audiovisual distraction); and control. Results revealed a 2 (monitoring style) × 3 (information level) × 2 (time) interaction for systolic blood pressure (SBP), F(2, 111) = 3.55, p = .032. Among low monitors, patients in the low-information group exhibited significant SBP reductions during colposcopy, while those in the high-information group exhibited SBP increases. Among high monitors, patients in the high-information and control groups exhibited SBP reductions. Further, significant differences in observed signs of distress were found between groups with high monitors in the low-information group faring best overall, F(2, 111) = 4.41, p = .014. These findings indicate that tailoring information to suit individual coping style may maximize the apparent efficacy of interventions aimed at reducing stress during medical examinations.

[Psychologic, pedagogical and hygienic analysis of educational difficulties in students].

Educational difficulties in students are studied. Classification of the difficulties is suggested. Causes of the difficulties (outer and inner factors) are shown. Psychologic portrait of a student facing educational difficulties is presented.

Coping flexibility and complicated grief: a comparison of American and Chinese samples.

BACKGROUND: The ability to process a death and the ability to remain optimistic and look beyond the loss are both thought to be effective means of coping with loss and other aversive events. Recently, these seemingly contrary dimensions have been integrated into the idea of coping flexibility. METHODS: In this study, we assessed the ability of married and bereaved individuals in the United States and Hong Kong to use both coping approaches as operationalized by the trauma-focused and forward-focused coping scales of a previously validated questionnaire. We also calculated a single flexibility score. RESULTS: Bereaved participants reported greater trauma-focused coping ability than did married participants. However, bereaved participants meeting criteria for complicated grief (CG) reported less forward-focused coping than both asymptomatic bereaved and married participants. The CG group also showed less overall coping flexibility than the asymptomatic bereaved and married groups. Country was not a factor. CONCLUSION: Findings suggest that deficits in coping flexibility are indicative of pathology in bereaved individuals, and that this relationship extends across cultures. Limitations of the study and directions for future research are discussed.

A controlled trial of problem-solving counseling for war-affected adults in Aceh, Indonesia.

PURPOSE: War and conflict have consequences on the mental health of individuals and entire communities and the communities in Aceh, Indonesia, having experienced more than 30 years of armed conflict, are no exception. This study presents results from an evaluation of a non-specific mental health group counseling program among adults affected by conflict. Interventions such as these need to be evaluated to further the limited empirical evidence base for efficacious community-based treatments for improving the mental health and psychosocial problems in humanitarian settings. METHODS: A total of 589 adults were screened using a locally validated measure of mental health and functioning. Of all, 420 (71%) met the study inclusion criteria of elevated symptom levels and functional impairment: 214 and 206 in three intervention and three control villages, respectively. Intervention participants met weekly for eight sessions in groups of eight to ten adults. Following completion of treatment, 175 (85%) controls and 158 (74%) intervention participants were re-assessed. Regression analyses compared pre- and post-intervention scale scores. RESULTS: We did not find an intervention effect for reducing the burden of depression and anxiety symptoms when compared with the control sample. Impact on functioning was mixed and there was an increase in use of positive coping strategies. CONCLUSIONS: The lack of mental health impact may be because the mental health problems and dysfunction were not due to disorder, but were normal responses to struggles of daily living experienced by this community and not addressed by the intervention.

An ICF-CY-based content analysis of the Vineland Adaptive Behavior Scales-II.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF), and its version for children and youth (ICF-CY), has been increasingly adopted as a system to describe function and disability. A content analysis of the Vineland Adaptive Behavior Scales-II (VABS-II) was conducted to examine congruence with the functioning and disability component of this framework. METHOD: The 383 VABS-II items contained a total of 1,231 concepts. Established linking rules were used to map these concepts to ICF-CY codes. RESULTS: Overall the VABS-II concepts were well represented in the ICF-CY. Most of the concepts mapped to activity codes; however, about 30% of concepts were coded as body function. Most concepts represented relatively discrete activities, with more limited coverage of broader categories often included in measures of participation. CONCLUSIONS: The VABS-II content maps well to the ICF-CY activity/participation codes. Although VABS-II items ask about typical performance, item requirements often imply specific means of performance.

Academic effects of the Prestige oil spill disaster.

The effect of a large scale oil spill disaster on the academic achievement and classroom behavior of children and adolescents who lived on the Galician coast (Spain) is studied from an ecological perspective. 430 participants divided into three age groups of 5, 10, and 15 years of age, were studied. The participants came from three areas differently affected by the disaster. Dependent variables were academic achievement and classroom behavior of the participants after the Prestige disaster. Degree of exposure and other protective or risk factors were investigated as well. Repeated measures ANOVA to assess the main effects of the oil spill and hierarchical regression analyses to assess the contribution of the protective/vulnerability factors were performed. The results indicate that the effects of the disaster were relatively scarce. Some protective factors accounted for a certain degree of variance of different schoolroom behaviors. These results point to the intervention of protective factors in the adaptation to the disaster.

Resilience following child maltreatment: a review of protective factors.

OBJECTIVE: Child maltreatment is linked with numerous adverse outcomes that can continue throughout the lifespan. However, variability of impairment has been noted following child maltreatment, making it seem that some people are more resilient. Our review includes a brief discussion of how resilience is measured in child maltreatment research; a summary of the evidence for protective factors associated with resilience based on those studies of highest quality; a discussion of how knowledge of protective factors can be applied to promote resilience among people exposed to child maltreatment; and finally, directions for future research. METHOD: The databases MEDLINE and PsycINFO were searched for relevant citations up to July 2010 to identify key studies and evidence syntheses. RESULTS: Although comparability across studies is limited, family-level factors of stable family environment and supportive relationships appear to be consistently linked with resilience across studies. There was also evidence for some individual-level factors, such as personality traits, although proxies of intellect were not as strongly related to resilience following child maltreatment. CONCLUSIONS: Findings from resilience research needs to be applied to determine effective strategies and specific interventions to promote resilience and foster well-being among maltreated children.

What is resilience?

OBJECTIVE: While everyone-including front-line clinicians-should strive to prevent the maltreatment and other severe stresses experienced by many children and adults in everyday life, psychiatrists and other health professionals also need to consider how best to support, throughout the lifespan, those people affected by severe adversity. The first step in achieving this is a clear understanding of the definitions and concepts in the rapidly growing study of resilience. Our paper reviews the definitions of resilience and the range of factors understood as contributing to it, and considers some of the implications for clinical care and public health. METHOD: This narrative review took a major Canadian report published in 2006 as its starting point. The databases, MEDLINE and PsycINFO, were searched for new relevant citations from 2006 up to July 2010 to identify key papers considering the definitions of resilience and related concepts. RESULTS: Definitions have evolved over time but fundamentally resilience is understood as referring to positive adaptation, or the ability to maintain or regain mental health, despite experiencing adversity. The personal, biological, and environmental or systemic sources of resilience and their interaction are considered. An interactive model of resilience illustrates the factors that enhance or reduce homeostasis or resilience. CONCLUSIONS: The 2 key concepts for clinical and public health work are: the dynamic nature of resilience throughout the lifespan; and the interaction of resilience in different ways with major domains of life function, including intimate relationships and attachments.

Development and validation of the paediatric cancer coping scale.

AIM: The purpose of this study was to develop and test the psychometric properties of the paediatric cancer coping scale in children with cancer. BACKGROUND: Coping is a mediator between stressful events and adaptation. However, existing tools cannot be used to assess and understand coping strategies in children with cancer in Taiwan. METHODS: A total of 229 children with cancer were recruited from three medical centres in Taiwan in 2008-2009. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and intra-class correlation coefficient respectively. The factor structure was determined by exploratory factor analysis and confirmatory factor analysis. Pearson's correlation coefficient was employed to test the convergent and discriminate validity. RESULTS: The paediatric cancer coping scale demonstrated internal consistency (α = 0·91) and a 2-week test-retest reliability (intra-class correlation coefficient = 0·86). Its construct validity was confirmed by factor analysis, which extracted and defined three categories of coping strategies: cognitive coping, problem-oriented coping and defensive coping; these three factors explained 40% of the total variance with factor loadings ranging from 0·31 to 0·71. Convergent and discriminate validities were demonstrated by significant correlations among the coping, resilience and anxiety subscales. CONCLUSIONS: The paediatric cancer coping scale is a reliable and valid scale to measure and examine coping strategies in children with cancer.