Daily external stress, internal stress, dyadic coping, and relationship functioning of Turkish couples during the COVID-19: A daily diary study.

Stressors arising from the current COVID-19 pandemic have pernicious effects on relational functioning. However, the systemic transactional model (STM) addresses the buffering role of dyadic coping in couples' relationships. Therefore, the current study aimed to examine the possible buffering role of dyadic coping and investigate the negative consequences of external stressors related to the COVID-19 pandemic and internal stressors on relationship satisfaction and intimacy on within- and between-person levels. Data were collected from 100 couples through daily diary questions over 14 consecutive days. The mean age for females was 32.45 years (SD = 8.11), and for males, it was 34.79 years (SD = 8.79). The findings showed several significant within-person moderation effects. Specifically, simple slope analysis revealed that the associations between internal stress and relationship satisfaction, and intimacy were positive for both partners who reported particularly more dyadic coping on a given day. Conversely, interaction effect of dyadic coping with external stress has not been found significant on within-person level. Between-person effects revealed that dyadic coping buffers the negative association between external stress and relational outcomes and the negative effect of internal stress. The current study expanded the literature of the STM of dyadic coping within the context of an acute external crisis. In line with STM predictions, couples may benefit from interventions focused on enhancing coping strategies to navigate major and minor stressors, especially during significant life challenges, thereby maintaining high relationship quality.

Risk Factors of Prolonged Grief Disorder.

Prolonged Grief Disorder (PGD) is characterized by extensive yearning, which includes a strong desire, for the deceased that occurs for at least 12 months. The aim of this study was to identify risk factors that contribute to PGD including the type of loss, relationship to the deceased, and coping. The sample included 190 bereaved adults (71 unexpected or violent loss and 119 natural loss) that experienced the loss of a loved one at least 12 months prior to completing the survey used in this study. There were non-significant results for type of loss, the presence of PGD, and coping. Findings showed that dysfunctional coping including self-blame explained the presence of PGD. Closeness to the deceased prior to the loss contributed to the presence of PGD. The findings highlight the risk factors for adults that experience a presence of PGD.

Vaccine Hesitancy in the Autism Spectrum Disorder Context: Parental Vaccine Decision-Making and Coping with Stress Strategies.

BACKGROUND: Despite no scientific evidence linking vaccines to Autism Spectrum Disorder (ASD), vaccine hesitancy persists among parents of children with ASD. This study aims to compare vaccine hesitancy and behaviors among parents of children with ASD, other Neurodevelopmental Disorders (NDD), and without NDD, and to examine the relationship between stress coping mechanisms and vaccine hesitancy, including comparing coping mechanisms between diagnostic groups as well as their association with hesitancy. METHODS: In this cross-sectional study, one parent of each child with ASD, non-ASD NDD, or without NDD was included. Data were collected using a researcher-created form, the Vaccine Hesitancy Scale in Turkish, and the Coping Style Scale Brief Form. Vaccine hesitancy, parents' COVID-19 vaccination status, and vaccination status of children's younger siblings were analyzed through univariate and multivariate analyses, with a focus on correlations between vaccine hesitancy and coping styles. RESULTS: The study included one parent from each of 299 children. Parents of children with ASD showed an adjusted odds ratio of 2.66 (95% CI 1.35-5.06) for high vaccine hesitancy, 2.57 (95% CI 1.17-5.65) for not receiving the COVID-19 vaccine, and 1.40 (95% CI 0.45-4.40) for younger siblings not receiving routine vaccines. A weak but significant correlation was observed between vaccine hesitancy and the use of restraint coping style among these parents (r = 0.280; p = 0.010). CONCLUSIONS: The study underscores the importance of targeted educational efforts and personalized communication to address vaccine hesitancy among parents of children with ASD. Enhancing vaccination coverage in this community requires further research to develop interventions tailored to their specific needs.

Effects of social support on vision-related quality of life in older adults with dry eye disease: the chain mediating role of illness perception and coping style.

Objective: This study explored the effects of social support, illness perception, coping style, and vision-related quality of life (VRQOL) in older patients with dry eye disease (DED) using a chain mediation model. Methods: A total of 407 patients with DED from a tertiary hospital in Wuxi, Jiangsu Province, China, between June and December 2023 were selected as participants. A demographic questionnaire, the Social Support Rating Scale, the Brief Illness Perception Questionnaire, the Medical Coping Modes Questionnaire, and the National Eye Institute Visual Functioning questionnaire-25 were all given to them to complete. IBM SPSS (version 27.0) was used for data analysis, and Model 6 of the PROCESS Macro was used to test the predicted chain mediation model. Results: The positive association between social support and VRQOL demonstrated the mediation role of illness perception and coping style. Social support affected VRQOL via three pathways: illness perception (effect = 0.190), confrontational coping style (effect = 0.103), and a combination of illness perception and confrontational coping style (effect = 0.067), accounted for 23.60%, 12.80%, and 8.32% of the total effect, respectively. Conclusion: Social support in older patients with DED can significantly and positively predict the VRQOL. In addition to the independent mediating effect of illness perception and confrontational coping style, a chain-mediating effect exists between social support and VRQOL. The study serves as a valuable strategy for healthcare professionals to prevent and intervene in VRQOL for older patients with DED in the future.

Patients with diabetes and obesity exhibit characteristics in eating and coping behaviors and personality traits.

Aims/introduction: In patients with diabetes, obesity is an aggravating factor for glycemic control and its vascular complications. However, the psychological and behavioral characteristics of those patients with obesity have not been fully clarified. This study investigated eating and coping behavior, personality traits, quality of life (QOL), and depression status in patients with diabetes with or without obesity. Materials and methods: Questionnaires obtained from 567 patients with diabetes at Dokkyo Medical University were analyzed. Eating behavior, coping behavior, personality traits, QOL, and depression status were evaluated by the Eating Behavior Questionnaire, Brief COPE, Japanese Ten-Item Personality Inventory, EuroQol 5 Dimensions-5 Level, and Patient Health Questionnaire-9, respectively. Participants were divided according to body mass index (BMI) into a non-obese group (BMI < 25), obese group (BMI 25-35), and high-degree obese group (BMI ≥ 35), and results were compared between groups. Results: On all items of the Eating Behavior Questionnaire, scores were higher in the obese and high-degree obese groups than non-obese group, indicating worse eating behavior. In coping behavior, significant intergroup differences were found in self-distraction, substance use, using emotional support, using instrumental support, and venting. As for personality traits, the obese group had significantly lower conscientiousness and higher emotional instability than the non-obese group. There was no significant difference in QOL or depression status. Conclusions: These results suggest that there are some characteristics in eating and coping behaviors and some personality traits between obese and non-obese patients with diabetes. Treatment based on such characteristics may be useful for patients with diabetes and obesity. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-024-00721-w.

"In God We Trust": An Exploratory Study of the Associations Between Religiosity and the Caregiving Experiences of Parents of Children with Rare Diseases in Poland.

Most children with a rare disease are cared for by their family members but parenting such a child is extremely demanding due to the complexity and severity of symptoms, with serious physical, emotional, social, and financial consequences for caregivers. Although religion may serve as a positive coping strategy, little is known about its role in helping caregivers manage the stress related to the burden of caregiving in Poland. Therefore, we surveyed 925 Polish family caregivers of children with rare diseases to understand the association between caregivers' religiosity and their caring experiences. The findings suggest that parents' religiosity is associated with a more positive caregiving experience, perceived quality of life, and experienced caregiving burden. While religious caregivers reported experiencing less distressing emotions and stressed the encouraging impact of their child's disease on their life more often, non-religious caregivers experienced role captivity and role overload more frequently. Since religion may serve as a source of strength and a protecting factor against mental health problems and the burden of caregiving, healthcare professionals should be aware of the importance of religious and spiritual care, and caregivers' religiosity should be considered an integral part of a holistic approach.

Distinct patterns of hippocampal subfield volumes predict coping strategies, emotion regulation, and impulsivity in healthy adults.

BACKGROUND: Recent studies have suggested that the hippocampus (HC) is involved in cognitive and behavioral functions beyond memory. We aimed to investigate how the volume of each subfield of the HC is associated with distinct patterns of coping strategies, emotion regulation, and impulsivity in a healthy population. METHODS: We studied a total of 218 healthy subjects using the Leipzig mind-brain-body dataset. Participants were assessed for coping strategies, emotion regulation, and impulsivity using the Cognitive Emotion Regulation Questionnaire (CERQ), Coping Orientations to Problems Experienced (COPE), Impulsive Behavior Scale (UPPS), and Behavioral Activation and Inhibition System (BAS/BIS). The associations between HC subfield volumes including CA1, CA2/3, CA4/DG, SR-SL-SM, and subiculum, and behavioral scores were examined using multiple linear regression models adjusted for possible confounders, including age, sex, years of education, handedness, total intracranial volume (ICV), and HC volume. RESULTS: The use of emotional support, venting, and positive reframing coping strategies were significantly and positively correlated with total, total right, and total left HC volumes. Venting was significantly associated with CA1 after adjusting for age, sex, handedness, and education (P=0.001, B = 0.265, P-FDR = 0.005). No significant association was observed between CERQ subscales and HC subfield volumes after controlling for confounders and multiple analyses. However, sensation-seeking subscale of the UPPS-P was positively correlated with total and right CA2-CA3 volumes after adjustments for age, sex, handedness, ICV, and HC volumes (P=0.002, B = 0.266, P-FDR = 0.035). BAS and BIS subscales did not show significant relationship with HC subfield volumes. CONCLUSION: Patterns of HC subfields volumes are associated with coping strategies, impulsivity, and emotion regulation. In particular, using emotional support, positive reframing, venting, and sensation seeking are significantly associated with certain HC subfield volumes. These findings suggest that the hippocampus may play a crucial role in modulating emotional responses and behavioral adaptations, offering potential targets for therapeutic interventions.

"I Felt Dirty in a Way a Shower Wouldn't Fix": A Qualitative Examination of Sexual Trauma-Related Mental Contamination.

Trauma-related mental contamination (MC) is a distressing sense of dirtiness that arises absent a contaminant following a traumatic event. Existing work has linked MC to more severe posttraumatic stress disorder symptoms among individuals with sexual trauma histories and has begun to characterize some aspects of the experience of trauma-related MC. However, a more nuanced understanding of how individuals experience and respond to trauma-related MC is lacking. The present study explored lived experiences of trauma-related MC among a sample of 34 women with sexual trauma histories using semi-structured qualitative interviews. Women were asked about MC across several domains, including somatic locations where trauma-related MC is experienced; triggers for trauma-related MC; and engagement in MC-related coping strategies, including washing behaviors. Women reported experiencing trauma-related MC in various bodily locations (internal, external, and both). Both overtly trauma-related triggers (e.g., trauma-relevant people or words, sexual contact) and non-trauma-related triggers (e.g., sweating, being around other people) were mentioned. Women also reported experiencing a variety of emotions alongside trauma-related MC (e.g., disgust, shame, anger) and using a range of strategies to cope with trauma-related MC, including washing behaviors, distraction, and substance use. Findings suggest that triggers for and responses to trauma-related MC are heterogeneous. Future work should explore the role of context in individuals' experiences of and responses to trauma-related MC, as well as whether experiences of trauma-related MC may differ by gender or across settings. Increased understanding of trauma-related MC may inform efforts to more readily and effectively identify and target MC in clinical practice.

Irresponsibility Stereotypes Exacerbate Effects of Sexual Violence on Cisgender Bisexual Women's Coping Drinking Motives.

OBJECTIVE: Bisexual women experience disparities in alcohol use outcomes compared to both lesbian and heterosexual women. Bisexual women also experience higher rates of sexual violence (SV) and alcohol use following SV. We examined whether coping drinking motives mediate the link between adult SV severity and alcohol use and whether dimensions of binegativity (i.e., hostility, instability, irresponsibility) moderate the effects of SV. METHOD: The sample consisted of 355 young (ages 18-35) cisgender bisexual women drinkers (Mage=25.8, 84.2% White) recruited via MTurk. Measures included: Sexual Experiences Survey-Short Form Victimization (Koss et al., 2007), Anti-Bisexual Experiences Scale (Brewster & Moradi, 2010), Modified Drinking Motives Questionnaire-Revised (Grant et al., 2007), and Alcohol Use Disorders Identification Test Consumption subscale (Babor et al., 2001). The PROCESS macro for SPSS was used. RESULTS: There was an interaction between SV severity and irresponsibility stereotypes in predicting coping motives. SV severity related to greater coping motives at mean and high, but not low, levels of irresponsibility stereotypes. Indirect effects of SV severity on alcohol use via coping motives were significant at mean and high, but not low, levels of irresponsibility stereotypes. Hostility and instability dimensions of binegativity did not interact with SV severity in predicting coping motives. CONCLUSIONS: Results identified SV severity and irresponsibility stereotypes as compounding experiences that may explain greater alcohol use. Bisexual women exposed to this dimension of binegativity may be particularly vulnerable to drink alcohol to cope with distress following SV. Interventions for alcohol use may be enhanced by helping bisexual women cope with SV-related distress and irresponsibility stereotypes.

Influential Factors for Self-Management Among Patients with Diabetic Retinopathy: A Structural Equation Model Analysis.

Purpose: To investigate the influencing factors of self-management of diabetic retinopathy (DR) by constructing a structural equation model (SEM) to analyze the relationships among self-management behavior, perceived social support, and trait coping style as well as to determine the influencing path in order to provide a theoretical reference for exploring a multipath health management model that can be used to improve the quality of life of DR patients. Patients and Methods: A total of 388 patients with DR were enrolled in this cross-sectional study conducted from January 2020 to January 2023. All subjects completed a general questionnaire and were assessed by the Self-management Scale for Patients with Diabetic Retinopathy, the Perceived Social Support Scale, and the Trait Coping Style Scale. Structural equation modeling was employed to examine the relationship between self-management and its influencing factors. The bootstrap method was used to examine the path relationships among self-management, perceived social support, and trait coping styles in DR patients. Results: A total of 346 valid questionnaires were collected in this study, with a response rate of 89% (346/388). The average score of self-management of DR patients was 69.50±18.32, and it was significantly positively correlated with perceived social support and positive coping (r=0.624, r=0.578, both P<0.01). The total effect of perceived social support on DR self-management was 1.439, with a direct effect of 1.056 and an indirect effect of 0.384. Positive coping played a mediating role in perceived social support and self-management. Conclusion: The self-management of DR was at an intermediate level. Perceived social support and trait coping styles were important influencing factors for self-management behavior in DR patients. Therefore, improving perceived social support and trait coping styles can promote the self-management behavior of DR patients, reduce their psychological burden, and improve their compliance and quality of life.

Psychometric Testing of the Brief Coping Orientation to Problems Experienced Inventory Among Diverse Women From a Rural Community in Hawai'i.

The Brief COPE (Coping Orientation to Problems Experienced) Inventory is a standardized and widely used scale that enables researchers to measure coping responses of persons in relation to stressors. The psychometric properties of this scale, however, have not been assessed for communities in Hawai'i. This study investigated the psychometric properties of the Brief COPE for diverse women from a rural community on the island of O'ahu in Hawai'i. This study was conducted in a federally qualified health center (FQHC) with 161 women who were of a childbearing age between the ages of 18 to 38 years. Contrary to previous research, the factor structure of the final model suggested six factors: Behavioral Disengagement, Denial, Venting, and Self-Blame; Action Coping, Positive Reframing, Acceptance, and Planning; Humor; Substance Use; Social Support; and Religion. The final model demonstrated good model fit with an RMSEA of .07 and CFI of .95. The reduced factor structure may be a more robust measure of coping strategies, which may allow for better resources and interventions that adequately address the way women of childbearing ages from rural communities respond to stressful situations. Exploring coping mechanisms of diverse women will better our understanding of the way people respond to stress and develop strengths and mechanisms that mediate stressors including those that are linked to social and cultural determinants of health. Findings from this study may also inform future research and policy that aim to foster coping, and thus, resiliency of diverse women, particularly in rural settings.

A review of the impact of sensory processing sensitivity on mental health in university students.

Introduction: The concept of sensory processing sensitivity (SPS) was first introduced by Aron and Aron (1996) as an innate trait characterized by heightened processing of sensory, emotional, and physical stimuli. Since the concept's introduction in 1996, high SPS has been shown to be associated with poor physical and mental health. It is possible that this is especially true in university students, who are frequently faced with numerous stressors, such as intense workloads and test anxiety. Methods: This article is a systematic literature review conducted through EBSCOHost using the following databases: Academic Search Complete, APA PsycArticles, APA PsycInfo, Education Research Complete, ERIC, MEDLINE Complete, and SocINDEX. Search terms included terms regarding high sensory processing sensitivity, university or professional students, and mental health. Results: A total of 6 studies were included. University students with high SPS experienced heightened reactions to sensory, emotional, and physical stimuli. The studies demonstrate correlations of high SPS with outcomes such as depressive tendencies and difficulty adjusting to college. Discussion: These findings highlight that SPS is associated with poor mental health outcomes. The results underscore the importance of developing support methods for students with high SPS. Future studies should further explore SPS in university students to develop targeted support methods and programs.

Mental toughness and choking susceptibility in athletes.

Choking susceptibility refers to the propensity of an athlete to choke under pressure. Mesagno has operationalized choking susceptibility as a combination of scores on self-consciousness, anxiety and coping. Despite the potential of Mesagno's protocol, there is currently limited support for its validity. Secondly, although mental toughness (MT) has a relationship with sport performance, there is limited research on its relationship to choking under pressure, specifically. The current study investigated the relationship between choking susceptibility and mental toughness. It was hypothesized that choking susceptible athletes will have significantly lower levels of mental toughness than those who are not choking susceptible. Data from a heterogeneous sample of athletes (N = 415) was obtained through a Qualtrics research panel. Results of a Mann-Whitney U showed that self-reported mental toughness was not significantly different in athletes categorized as choking susceptible and non-choking susceptible. Correlational analyses also highlighted differences between mental toughness and the composite scores of choking susceptibility, which provide researchers with avenues for future research in this area alongside a need for each construct to be examined in relation to choking behavior in sport.

Coping style as a risk factor for future alcohol use disorder: A 16-year longitudinal study in a Canadian military sample.

BACKGROUND: Coping strategies used in response to stress have the potential to influence the development of mental health disorders, including alcohol use disorders. The current study investigated whether coping strategies placed an individual at greater likelihood for developing a future alcohol use disorder. METHODS: This study used data from the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey; a nationally representative 16-year follow-up survey, with initial data collected in the 2002 Canadian Community Health Survey - Canadian Forces Supplement. The total sample from the two datasets included 2941 individuals who were Regular Force members in 2002. Coping styles included problem-focused, avoidant, and self-medication. Adjusted logistic regression analyses examined relationships between coping style (in 2002) and alcohol use disorders (developed between 2002 and 2018). RESULTS: Self-medication coping in 2002 was associated with any alcohol disorder since last interview (i.e., 2002-2018) (AOR 1.26; 95 % CI, 1.02-1.57) and during the past year (adjusted odds ratios [AOR 1.26; 95 % CI, 1.08-1.47]), as well as past-year binge drinking (AOR 1.19; 95 % CI, 1.09-1.29). Problem-focused coping was protective against past-year alcohol abuse (AOR 0.84; 95 % CI, 0.71-1.00) and any alcohol use disorder (AOR 0.87; 95 % CI 0.76-1.00). CONCLUSION: Coping styles were strongly associated with future alcohol use disorders. Notably, results show the risk extended over a 16-year period. Findings suggest the use of self-medicating coping strategies places an individual at increased risk of developing alcohol use disorders, while problem-focused coping may decrease future risk of alcohol use disorders.

Empowering mind-body wellness: effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy.

BACKGROUND: Being diagnosed with Breast Cancer (BC) is a crisis that throws the patient's life out of balance. Cancer-related fatigue is a debilitating sign experienced by women during and after BC treatment. Regular physical exercise may help mitigate patients' fatigue, enhance coping abilities, improve their quality of life, and overall well-being. In parallel, psychological interventions are geared toward normalizing the lived painful experiences among oncology patients. OBJECTIVE: to examine the effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy. METHODS: A quasi-experimental study was conducted in the Oncology Surgical Department and chemotherapy unit at the Alexandria Main University Hospital, Egypt. A total of 60 women were randomly allocated to either to the study or the control groups. Women in the study group practiced seated exercises and psychological rehabilitation interventions, including mindfulness breathing, problem-solving training, cognitive reframing technique, and thought stopping while the control group received the routine care. RESULTS: The study revealed a significant decline in the fatigue mean scores among participants in the intervention group from 136.10 ± 27.76 to 98.43 ± 25.99 (p < 0.001). Similarly, there was a significant decrease in the patients' mean scores of maladaptive coping, helplessness/ hopelessness (p = 0.014), and anxious preoccupation (p = 0.008). In contrast, there is a noticeable increment in the scores of adaptive coping, such as fighting spirit (p = 0.012), cognitive avoidance (p = 0.002), and fatalism (p = 0.009). CONCLUSION: Bundling seated exercises and psychological rehabilitation interventions using the teach-back approach have been proven to be simple and inexpensive non-pharmacological methods of reducing cancer-related fatigue and improving coping skills among women post-mastectomy. TRIAL REGISTRATION NUMBER: NCT06360276, ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT06360276 .

Comparative analysis of stress level and coping strategies due to COVID-19 pandemics among dental students in Indonesia and Vietnam.

Objective: This study investigated and compared the perceived stress levels and coping strategies of dental students in Indonesia and Vietnam during the COVID-19 pandemic. Materials and methods: A cross-sectional survey was conducted online in 2022 for dental students from the University of Indonesia and Can Tho University, Vietnam (n = 304). Perceived stress levels and coping strategies were assessed using a self-administered questionnaire about student sociodemographic factors, learning experiences, coping strategies, stress-related factors, and stress levels. Data were analyzed using Mann-Whitney, Kruskal Wallis, and Spearman correlation tests. Results: This study showed the overall mean stress level was 23.9 (SD = 5.63), with a significant difference observed between Indonesian (24.44, SD = 5.14) and Vietnamese students (23.32, SD = 6.13) (p = 0.016), indicating potential variations in stress experiences. Key findings include a correlation between living arrangements and stress, as students living independently report higher stress (23.96, SD = 6.24) compared to those living with family (23.95, SD = 5.29) (p = 0.018). Fifth-year students exhibit lower stress levels (21.17, SD = 6.12) than other grades (p = 0.026). Multiple training sessions about COVID-19 are associated with better coping strategies (9.95, SD = 0.91, p < 0.001). The study also revealed different perceptions of COVID-19 learning experiences among dental students in Indonesian and Vietnamese dental students, with significant correlations observed between stress levels, coping strategies, and specific concerns such as graduation time and COVID-19-induced changes (p < 0.05). Conclusion: This study shows students experience moderate stress levels, but the significant differences in stress experiences and coping strategies between the two countries highlighted the need for tailored approaches. Providing social support from faculty, family, friends, and peer dental students was one of the students' strategies to cope and minimize stress levels.

Analysis of factors influencing cardiovascular surgical nurses' emergency response capabilities, self-efficacy, and coping strategies.

OBJECTIVES: To investigate the emergency response capabilities of cardiovascular surgical nurses, analyze their correlation with self-efficacy and coping styles, and summarize targeted intervention measures. METHODS: A total of 243 cardiovascular surgical nurses from comprehensive tertiary Grade A hospitals in Jiangsu Province were selected using convenience sampling from October to November 2023. Participants were surveyed using a general information questionnaire, an emergency response capability assessment scale for operating room nurses, a general self-efficacy scale, and a simplified coping style scale. RESULTS: The total scores were 114.77±12.39 for emergency response capability, 2.69±0.58 for self-efficacy, 2.02±0.54 for positive coping style, and 1.16±0.53 for negative coping style. Pearson correlation analysis showed that emergency response capability was positively correlated with self-efficacy and positive coping styles and negatively correlated with negative coping styles (all P<0.05). Optimal scaling regression analysis indicated seven factors; age, years of work, professional level, title, self-efficacy, positive coping style, and negative coping style, which could explain 39.0% of the variation in emergency response capability (all P<0.05). CONCLUSIONS: The emergency response capabilities of cardiovascular surgical nurses are moderately high and closely related to their self-efficacy and coping styles. Emergency rescue training for cardiovascular surgical nurses should aim at enhancing self-efficacy and positive coping styles by, for example, setting clear training goals, focusing on individual differences, fostering of active learning, and stimulating their intrinsic motivation to enhance their emergency response capabilities. These changes will lead to more organized and efficient cardiovascular surgical emergency work.

Does it need an app? - Differences between app-guided breathing and natural relaxation in adolescents after acute stress.

A key component of stress management and biofeedback training is the use of relaxation exercises, such as slow/deep breathing (6 breaths/minute) in heart coherence exercises (HCEs). Breathing exercises are also increasingly being integrated into smartphones as part of health apps, though their effectiveness in adolescents after acute stress has rarely been validated scientifically. The aim of the current study was to investigate the effectiveness of an app-guided HCE (n = 36) after an acute stress situation (Trier Social Stress Test) compared with natural relaxation (n = 37), among healthy adolescents (aged 11-17 years). Endocrine, autonomic, and psychological stress parameters (cortisol, alpha-amylase, heart rate, heart rate variability, mood) were examined in 73 adolescents (46 female, 27 male; Mage = 13.86, SDage = 1.87). Significant group differences were found in heart rate variability, with higher values in the low frequency band and low-to-high frequency ratio for the HCE condition, possibly indicating improved physiological functions through the stimulation of vagal tone and baroreflex. The use of a general breathing technique (natural and app-guided) also resulted in stronger relaxation reactions in cortisol when controlling for the previous stronger stress reactivity. On the other hand, app-guided slow breathing without a long training may be experienced as more uncomfortable during relaxation. The integration of breathing exercises in health apps for adolescents appears to be useful, offering a helpful and low-threshold coping/relaxation strategy during acute stress situations. Further studies should examine the benefits of app-guided breathing exercises in both psychiatric samples and the general population across a wide age range.

Affect regulation and allostatic load over time.

OBJECTIVE: Emerging work suggests that affect regulation strategies (e.g., active coping, anger expression) predict disease and mortality risk, with sometimes divergent estimates by sex or education levels. However, few studies have examined potential underlying biological mechanisms. This study assessed the longitudinal association of affect regulation with future allostatic load. METHOD: In 2004-2006, 574 participants from the Midlife in the United States study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). As a proxy for how flexibly participants regulate their affect, variability in the use of regulatory strategies was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater variability) to assess non-linear effects. Participants also provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, blood pressure). In 2017-2021, these biomarkers were again collected. Linear regressions modeled betas (ß) and 95 % confidence intervals (CI) examining associations of affect regulatory constructs with future allostatic load. RESULTS: In fully-adjusted models including initial allostatic load, general regulatory strategies were unrelated to future allostatic load. Yet, greater versus moderate affect regulation variability levels predicted lower allostatic load (ß=-0.14; 95 %CI: -0.27, -0.01). Only among more educated participants, greater use of anger expression predicted lower allostatic load, while the reverse was noted with anger control (ßexpression=-0.12; 95 %CI: -0.20, -0.05; ßcontrol=0.14; 95 %CI: 0.05, 0.24). CONCLUSIONS: While general regulatory strategies appeared unrelated to allostatic load, greater variability in their use and anger-related strategies showed predictive value. Subsequent studies should examine these associations in larger, more diverse samples.

Mental health and coping strategies of caregivers of people with intellectual and developmental disabilities: the initial impact of the COVID-19 pandemic in Brazil.

Studies on the COVID-19 pandemic highlight detrimental effects of social distancing on mental health. These effects were also observed among caregivers of people with intellectual and developmental disabilities (IDD), who undergo particular challenges in this context. This study aimed to identify the coping strategies adopted by caregivers of people with IDD in the period of social isolation during the COVID-19 pandemic and their relationship to signs of mental illness. Forty-eight caregivers of people with IDD who were users of a non-governmental organization for the assistance of people with IDD and their families in southeastern Brazil undertook an on-line survey. Data analysis included descriptive statistics, Pearson's correlation, multiple regression, and the word cloud technique. Results indicate that most caregivers employed healthy coping strategies and used negative words to describe their feelings towards the pandemic. Confrontation, withdrawal, self-control, social support, acceptance, and escape correlated with psychological symptoms (stress, depression, or loneliness). Those symptoms were more prevalent among participants using escape as a coping strategy. These findings indicate that caregivers of people with National Deworming Day (NDD) used mostly positive coping strategies to face the COVID-19 pandemic, which may have contributed to the low prevalence of psychological burden in this population.