An experimental examination of learned helplessness in older adolescents and young adults with long-standing asthma.

OBJECTIVE: To examine the effects of experimentally induced learned helplessness in older adolescents and young adults with long-standing asthma. METHODS: Thirty-nine participants (18-24 years of age) with histories of long-standing asthma (AS) and an age-matched healthy cohort (HC) (N = 94) received either contingent or noncontingent feedback on an experimental task. Participants' anagram-solving performance was assessed following the experimental procedure. Participants also completed a measure of depression and pretest-posttest measures of mood, expectancy, and attributions related to experimental task performance. RESULTS: The AS participants demonstrated significantly greater problem-solving deficits following response-noncontingent feedback, compared to the HC group. Further, whereas both AS and HC participants made more internal performance attributions when given response-contingent feedback, only AS participants demonstrated a pattern of increased internal attributions (i.e., self-focus) following response-noncontingent failure. In addition, 21% of AS participants met DSM-IV criteria for major depression, compared to only 5% of the HC group. CONCLUSIONS: Individuals with long-standing asthma may be at increased risk for depression and for learned helplessness deficits, specifically impaired problem solving, in response to environmental noncontingency. Results are discussed in terms of both learned helplessness theory and perseverative self-focus conceptualizations of depression. The implications for both short- and long-term management of pediatric asthma are also discussed.

Illness uncertainty, attributional style, and psychological adjustment in older adolescents and young adults with asthma.

Examined psychological adjustment in a college sample of older adolescents and young adults (n = 49) with histories of childhood asthma. A substantial number of subjects evidenced clinically significant levels of overall distress. In addition, greater perceived asthma uncertainty and increased stable attributions for negative events were significantly associated with poorer psychological adjustment after controlling for demographic and disease variables. Further analyses revealed a moderating influence of uncertainty on attribution-adjustment relationships. These findings provide initial support for a cognitive diathesis-stress view of adjustment in long-standing asthma. Results also support a growing body of evidence suggesting that the focus of efforts to enhance adjustment to asthma need to be expanded beyond childhood and early adolescence.

Screening for depression: use of patient questionnaires.

Despite the prevalence of depression, it is consistently underdiagnosed. As a result, many depressed patients fail to receive adequate treatment and may experience serious consequences, including suicide. Various screening instruments have been developed to identify depression in patients whose symptoms might go unrecognized. Despite the risks associated with screening, many benefits may result. These include increased recognition of depression, alteration of treatment plans and improved clinical outcome.