Drinking to cope, emotional distress and alcohol use and abuse: a ten-year model.

OBJECTIVE: This study examines the ability of baseline drinking to cope to predict drinking behavior across an ensuing 10-year period. In addition, it examines whether a propensity to consume alcohol to cope with stressors strengthens the link between emotional distress and drinking behavior. METHOD: The study uses survey data from a baseline sample of 421 adults (54% women) assessed four times over a 10-year period (i.e., baseline and 1-, 4- and 10-year follow-ups). RESULTS: Baseline drinking to cope was associated with more alcohol consumption and drinking problems at all four observations across the 10-year interval. Baseline drinking to cope also predicted increases in both alcohol consumption and drinking problems in the following year. Moreover, change in drinking to cope was positively linked to changes in both alcohol consumption and drinking problems over the interval. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger link between both anxiety and depressive symptoms and drinking outcomes. CONCLUSIONS: Findings demonstrate the power of alcohol-related coping strategies in predicting long-term drinking behavior and they illustrate one way in which such coping is linked to alcohol use and abuse. More broadly, they underscore the importance of considering individual differences in emotion-based theories of drinking behavior.

Long-term posttreatment functioning among patients with unipolar depression: an integrative model.

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources.

Resource loss, resource gain, and depressive symptoms: a 10-year model.

This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across 10 years was significantly associated with a decrease in depressive symptoms. In addition, change in the preponderance of negative over positive events across 10 years was inversely associated with change in resources during the period. Finally, in an integrative structural equation model, the association between change in life events and depressive symptoms at follow-up was completely mediated through resource change.

Being labeled as gifted, self-appraisal, and psychological well-being: a life span developmental perspective.

This study examined the relation of being labeled as intellectually gifted to a midlife appraisal of having lived up to one's abilities and to psychological well-being at age eighty. Participants in the study were 399 individuals in the Terman Study of the Gifted who were between the ages of seventy-five and eighty-four in 1992. A proxy index of Terman Study membership was derived from participants' self-report during their mid-twenties of the age at which they first learned that they were members of the Terman Study. Learning at a younger age of membership in a study of intellectual giftedness was related to less likelihood of believing that one had lived up to one's intellectual abilities at midlife and to less favorable psychological well-being at age eighty. Results are discussed in terms of the possible implications of being labeled as gifted for the formation of unrealistic expectations about achievement.

Self-appraisal, life satisfaction, and retrospective life choices across one and three decades.

This research investigated the relationship of a self-appraisal of having lived up to one's intellectual abilities at midlife (average age of 49 years) with life satisfaction and retrospective life choices 1 and 3 decades later among 383 participants in the Terman Study of the Gifted. Study 1 showed that participants who reported living up to their intellectual abilities were higher in satisfaction with occupational success, satisfaction with family life, and joy in living 11 years later. Study 2 showed that participants who reported living up to their abilities were higher in overall life satisfaction and were less likely to report that they would make different life choices in work or family life 3 decades later. In an integrative structural equation model, the relation between the midlife self-appraisal of having lived up to intellectual abilities and overall satisfaction at age 80 was mediated by life satisfaction discrepancy at age 61.

Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients.

This research broadened and refined a resources model of coping to encompass negative as well as positive aspects of social relationships and examined this expanded conceptualization in a 4-year prospective model with 183 cardiac patients (140 men and 43 women). Social support and social stressors in the family and extrafamily domains contributed significantly to a common social context latent construct. In addition, this conceptualization of social context was significantly related to depressive symptoms 4 years later. Especially important conceptually, coping strategies functioned as a mechanism through which both social support and social stressors related to subsequent depressive symptoms. Moreover, positive and negative aspects of social relationships made essentially unique contributions in predicting subsequent coping efforts.

Reassurance seeking, stress generation, and depressive symptoms: an integrative model.

The purpose of this study was to examine a mechanism through which interpersonal vulnerability factors may be linked with depressive symptoms by integrating a stress-generation model with an interpersonal theory of depression. The proposed conceptual framework was tested with 267 college students in a prospective structural equation model with 3 assessments over a 5-week period. Results supported all hypotheses. Initial depressive symptoms and initial reassurance seeking style were positively associated, and initial depressive symptoms were positively related to the occurrence of subsequent minor social stressors. Finally, a reassurance-seeking style was positively related to outcome depressive symptoms indirectly through minor social stressors. As predicted, stress generation operated as a mediating mechanism linking an initial reassurance-seeking style to subsequent depressive symptoms.

Social support, coping, and depressive symptoms in a late-middle-aged sample of patients reporting cardiac illness.

This study tests a 1-year predictive model of depressive symptoms in a late-middle-aged sample of patients reporting diagnoses of cardiac illness. Results based on 325 individuals (248 men and 77 women) diagnosed with chronic cardiac illness, 71 individuals (52 men and 19 women) diagnosed with acute cardiac illness, and 219 healthy controls (129 men and 90 women) strongly supported the hypotheses. Compared with healthy persons, individuals with chronic and those with acute cardiac illness reported more depressive symptoms at follow-up. Women overall showed more depressive symptoms than did men, and women with cardiac illness were particularly vulnerable to behavioral manifestations of depressive symptoms. Integrative time-lag and prospective structural equation models indicated that, for individuals with cardiac illness, social support and adaptive coping strategies predicted fewer depressive symptoms.

Life stressors, personal and social resources, and depression: a 4-year structural model.

By extending earlier stress-resistance research with a 1-year time lag, findings with 254 adults show that adaptive personality characteristics and positive family support operate prospectively over 4 years in predicting reduced depression, even when prior depression is controlled. By strengthening knowledge about the determinants and mediational role of coping, the results demonstrate in a 2-group LISREL analysis that the pattern of predictive relations differs under high and low stressors. Under high stressors, personal and social resources relate to future psychological health indirectly, through more adaptive coping strategies. Under low stressors, these resources relate directly to psychological health. The results support the idea that such resources play a causal role in maintaining psychological health, and they suggest the potential for a general, adaptively oriented framework applicable to adjustment under both high and low stressors.

Life stressors, resistance factors, and improved psychological functioning: an extension of the stress resistance paradigm.

This study applied a set of factors previously identified as being linked with stress resistance to the prediction of both stable and improved psychological functioning over a 1-year interval with more than 400 community-resident adults. Stable psychological functioning under high stressors is predicted at the beginning of the year by personal and social resources that are linked to functioning through their influence on increased approach coping during the year. In contrast, improved psychological functioning under low stressors is predicted directly by initial resources. As predicted by crisis theory, improved functioning under high stressors is related to an increase in resources during the year. The findings are discussed in the context of an extension of the stress-resistance paradigm beyond illness prevention toward a general, adaptively oriented health framework.

Personal and contextual determinants of coping strategies.

This study examined personal and contextual predictors of active and avoidance coping strategies in a community sample of over 400 adults and in a sample of over 400 persons entering psychiatric treatment for unipolar depression. Sociodemographic factors of education and income (except for active-cognitive coping), personality dispositions of self-confidence and an easy-going manner, and contextual factors of negative life events and family support each made a significant incremental contribution to predicting active and avoidance coping. Among both healthy adults and patients, active and avoidance coping were positively associated with negative life events. Individuals who had more personal and environmental resources were more likely to rely on active coping and less likely to use avoidance coping. Moreover, for both groups, most of the predictors continued to show significant relations with active and avoidance coping strategies even after the stable component in coping was controlled in a longitudinal design. A comprehensive framework to understand the determinants of coping can be of practical value in suggesting points for therapeutic interventions aimed at fostering more adaptive coping efforts.

Self-efficacy, social support, and depression in aging: a longitudinal analysis.

This study examines the relationship of self-efficacy and social support to adjustment in aging. Fifty-two community residents participated in an initial structured interview and a follow-up interview one year later. Measures of depression and self-efficacy relating to social support were included in the initial interview, with measures of depression and actual social support included at follow-up. Results showed that initial self-efficacy was related to social support one year later. A path analysis showed that self-efficacy functions directly as well as indirectly through its effect on social support in preventing depression. A partial correlational analysis showed that the relationships between initial self-efficacy and depression one year later and between social support and depression at follow-up hold when ongoing depression is controlled.

Personality, coping, and family resources in stress resistance: a longitudinal analysis.

Earlier cross-sectional analyses have made causal inferences about stress-resistance variables problematic. This study used a longitudinal analysis where stress-resistance factors in the areas of personality, coping, and family support assessed at an initial testing were used to predict psychological and physical adjustment one year later, controlling for initial adjustment. The study involved a survey of 245 men and 248 women in randomly selected families in the San Francisco Bay area. Findings demonstrated that feelings of self-confidence, an easy-going disposition, a disinclination to use avoidance coping, and the availability of family support operate jointly to protect individuals from negative psychological consequences of life stress. For women the stress-resistance index also predicted psychosomatic complaints experienced one year after initial testing.

Life stress and health: personality, coping, and family support in stress resistance.

The purpose of this study was to extend work on factors that buffer the potentially negative health effects of life stress. Using a survey with a representative community sample, respondents were separated into a Distressed Group (high stress, high distress) and a Stress Resistant Group (high stress, low distress). Findings demonstrated that those who adapted to life stress with little physical or psychological strain were more easy-going and less inclined to use avoidance coping than individuals who became ill under stress. In addition, in the stress resistant group, men were more self-confident and women had better family support than their counterparts in the distressed group. Results are discussed in relation to earlier findings concerning "hardiness," avoidance coping, and the behavioral prescriptions of conventional sex roles.

The environmental psychology of the hospital: is the cure worse than the illness?

This paper presents a framework and summarizes evidence bearing on the role that the physical environment plays in the prevention and reduction of psychological and social problems encountered by patients in acute care and psychiatric institutions. Factors that are considered important to preventive strategies include issues such as the spatial layout and design of hospital environments, privacy problems, personal control and independence, information interventions, hospital social relationships, and levels of environmental stimulation. Two case studies are utilized to illustrate these issues within the context of both acute care and psychiatric facilities in a large municipal hospital. Greatest emphasis is placed on the use of the physical environment in the promotion of primary and secondary prevention within tertiary care settings.

Adjustment in aging: the roles of life stress, hassles, and self-efficacy.

This study examines the relationship of life stress, daily hassles, and perceived self-efficacy to adjustment in a community sample of 32 men and 32 women between ages 65 and 75. In a structured interview, negative life change events, daily hassles, self-efficacy, depression, psychosomatic symptoms, and negative well being were assessed. Both negative life events and daily hassles were related to psychological distress and physical symptoms for men, and hassles were associated with psychological distress and physical symptoms for women. An inverse relationship between self-efficacy and maladjustment was also found. Hassles showed the most powerful relationship to distress.

Social integration and mental health in a biracial community.

The study investigated the relationship between social integration and mental health, with a particular interest in social integration in a minority group context. The study involved a home interview with 33 white and 30 black women who resided in a residentially integrated working-class community in Austin, Texas. Although blacks reported significantly more psychological symptoms than whites, the race effect was explained by an underlying interaction between race and social integration. Blacks low in social integration showed more symptoms than either white respondents or blacks with a high level of integration. The Race X Social integration interaction is considered in the light of societally based prejudice and the potential social stress associated with minority group status.

Social support and adjustment: predictive benefits of social climate indices.

This study estimates the relationship between social support and physical and psychological adjustment, using measures that afford a qualitative assessment of social support. Qualitative indices of social support in family (Family Relationships Index) and work (Work Relationships Index) environments were derived from available social climate measures. Respondents were a randomly selected community sample of 267 male and 267 female adult family members. Results support hypotheses that qualitative measures of support in family and work environments predict psychosomatic complaints and depression after variance due to negative life change and quantitative measures of social support is accounted for. While the work environment is a more important source of support for men than women, the family environment provides an especially potent source of support for unemployed women.