Cognitive vulnerabilities, negative life events, and depressive symptoms in young adolescents.

Negative patterns of thinking, termed cognitive vulnerabilities, have been identified as risk factors for the development of depressive symptoms when adolescents experience negative life events. This study evaluated the associations among three cognitive vulnerabilities (i.e., dysfunctional attitudes, negative inferential style, and ruminative response style) and negative life events with depressive symptoms in a sample of young adolescents. All three cognitive vulnerabilities were found to be significantly associated with depressive symptoms. Furthermore, ruminative response style was found to have a significant unique contribution to the number of depressive symptoms. Findings suggest that cognitive vulnerabilities, particularly rumination, may be instrumental in explaining the development of depressive symptoms in young adolescents.

Existential well-being predicts perceived control in adults with heart failure.

This study examined the relationship between spiritual well-being (SWB) and perceived control (PC) in adult patients with heart failure (HF). The sample included 75 adults ranging in age from 27 to 82 years. Participants verbally completed study questionnaires in a clinic room selected for privacy. Multiple linear regression results indicated that increased existential spiritual well-being (a subscale of SWB) predicted increased PC. Thus, patients with HF who adjust to personal changes and who also connect with others may develop meaning and purpose in life and may perceive increased control over their heart disease.

Parents' self-identified stressors and coping strategies during adolescents' spinal surgery experiences.

Spinal fusion surgery for idiopathic scoliosis during adolescence is a tremendous stressor for parents. This study investigated parents' pre- and postoperative stressors and their coping strategies. Ninety-two parents identified their predominant stressor and completed the Ways of Coping Questionnaire during their adolescent's preoperative clinic visit and 77 completed this procedure 4 days postoperatively. Results showed that primary stressors were parental role loss (28.26%), possibility of poor surgical outcomes (28.26%), and uncertainty about successful recovery (27.17%) preoperatively, and concerns about pain (32.47%) and parental role loss (32.47%) postoperatively. The greatest increase from pre- to postoperative periods occurred in concerns about pain. Parents used both emotion-focused and problem-focused coping strategies with significant increases postoperatively in confrontive coping, planful problem solving, and positive reappraisal and significant decreases in self-control and seeking social support. Providers should target interventions to alleviate stress and bolster coping for parents.

Parental grief responses and personal growth following the death of a child.

Conceptualizing parental grief as a psychosocial transition, this cross-sectional study of bereaved mothers (N = 35) examined the relationship of dispositional factors, grief reactions, and personal growth. More optimistic mothers reported less intense grief reactions and less distress indicative of complicated grief. Additionally, mothers who usually coped actively had less intense grief reactions. Mothers who habitually coped using positive reframing had less intense grief reactions and less complicated grief. Personal growth, a positive dimension of grief, was associated with all three coping dispositions; mothers' active coping, support seeking, and positive reframing suggesting more personal growth occurred in mothers exhibiting more of these coping dispositions. These findings increase understanding of dispositional factors associated with bereaved mothers' grief responses and expand knowledge concerning personal growth as an outcome of bereavement.

Coping and depressive symptoms in adults living with heart failure.

BACKGROUND AND RESEARCH OBJECTIVE: This study used process coping theory as the basis for investigating how coping strategies are associated with depressive symptoms in individuals living with heart failure (HF). Demographic factors also were examined as correlates of depressive symptoms. SUBJECTS AND METHODS: The convenience sample of adults living with HF (n = 75) who participated in this study ranged in age from 27 to 82 years (M = 55). Sixty-nine percent of the participants were men, 59% were married or partnered, with the majority being Caucasian and from the middle class. Subjects were recruited from a comprehensive HF program located within an academic health science center in the southeastern United States. A single wave of data collection occurred. All study questionnaires were verbally administered in a clinic room selected for privacy during a routine HF clinic visit. RESULTS AND CONCLUSION: Individuals who used more planful problem-solving and social support seeking coping strategies had fewer depressive symptoms, whereas individuals who used more escape-avoidance coping (eg, wishful thinking) had more depressive symptoms. When demographic factors also were included in a regression analysis assessing depressive symptoms, marital status, functional impairment, and the coping strategies of planful problem-solving and escape-avoidance were all statistically significant predictors of depression. Single individuals, those who used more escape-avoidance, less planful problem-solving coping, and more functional impairment had more depressive symptoms. These results suggest that psychosocial factors, in addition to physical parameters, and the ways individuals cope with the stressors of living with heart failure may be important predictors of depressive symptoms.

Adolescent scoliosis: effects of corrective surgery, cognitive-behavioral interventions, and age on activity outcomes.

The effects of spinal fusion surgery and cognitive-behavioral interventions on 88 adolescents' (11-18 years) activity outcomes were examined using a randomized trial with three intervention groups (information only, coping only, coping plus information) and a control group. The effects included a significant drop from baseline (preoperative) in usual activities and social activities at 1 month postsurgery for all groups, indicating that initially postsurgical recovery is particularly disruptive to patients' lives. At 3 months after surgery, all groups showed increased usual activities and social activities. Between the 3- and 6-month assessments, all groups had increases in social activities. Furthermore, the information only group had a significant increase in usual activities from 3 to 6 months. Younger adolescents (ages 11-14) in the combined information plus coping group and the control group had higher social scores over the postsurgery recovery period compared with those in the coping-only group. No differences were found on academic performance. The adolescents did not return to their baseline social activity levels during the 9-month recovery period (typically when long-term recovery is completed), indicating that the surgery itself has a long-term negative effect on patients' social life.

Adolescents' coping with surgery for scoliosis: effects on recovery outcomes over time.

Surgery for adolescent idiopathic scoliosis is painful and stressful and has a long and demanding recovery. The purpose of this study was to examine pre- and postoperative avoidant/vigilant coping and long-term activity outcomes through 9 months postsurgery for adolescents (11-18 years, N = 113) undergoing scoliosis surgery. Generally, more vigilant copers (preoperatively and 1 month postoperatively) participated in more activities (usual, new, and social) and had higher academic performance during recovery. Several moderation effects indicated these relationships were stronger for older adolescents and those more internal in locus of control. Adolescents were more vigilant in the hospital, became more avoidant 1 month after surgery, and remained at these levels 6 months postsurgery. Understanding coping processes and individual factors is necessary to develop interventions to help adolescents cope successfully with recovery demands.

Optimism, anxiety, and coping in parents of children hospitalized for spinal surgery.

Optimistic expectations about outcomes have significant implications for behaviors. Knowing the role that dispositional optimism plays in parents' anxiety and coping responses during their child's surgical experience is essential to aid professionals in bolstering parents' coping and providing support. Parental optimism, anxiety and coping, and whether optimism moderated (changed) the anxiety-coping relationship preoperatively and postoperatively were the factors evaluated in this study. Parents (N = 60) primarily white of middle and upper middle class, were administered the Life Orientation Test to assess optimism, Spielberger's State Anxiety Scale and the Ways of Coping Questionnaire. Parental anxiety decreased significantly from preoperative to postoperative levels but remained high, indicating that parents continue to be emotionally distressed during their child's recovery. Reappraising the situation more positively (positive reappraisal) was the most often used emotion-focused coping strategy and seeking social support was the most often used problem-focused coping strategy. The preoperative and postoperative anxiety-coping relationships also depended on parents' levels of optimism. The use of emotion-focused coping strategies was not effective for reducing anxiety in highly optimistic parents. Recommendations include continually assessing the parents' need for reassurance and support throughout the surgical experience. Professionals can bolster parental coping by stressing the benefits of surgery and encouraging parents to be actively involved in the child's care and progress.

Cognitive-behavioral intervention effects on adolescents' anxiety and pain following spinal fusion surgery.

BACKGROUND: Cognitive-behavioral interventions, typically effective in reducing anxiety and pain, have not been applied to adolescents undergoing major orthopaedic surgery. OBJECTIVES: To determine the effectiveness of three cognitive-behavioral interventions for reducing adolescents' postoperative anxiety and pain following spinal fusion surgery for scoliosis, and whether effectiveness depended on preoperative anxiety and age. METHODS: A randomized controlled trial with four groups receiving a videotape intervention (information only, coping only, information plus coping, or control) used a convenience sample of 109 adolescents (88 female, 93 White), 11-18 years of age (M = 14). Speilberger's (1983) State Anxiety scale assessed anxiety preoperatively and postoperatively on Day 2. A visual analogue scale assessed pain postoperatively on Days 2 and 4. RESULTS: Information plus coping was most effective for reducing postoperative anxiety in adolescents with high preoperative anxiety. Coping instruction led to less postoperative anxiety and pain for adolescents ages 13 and younger. The control group reported the highest levels of pain on Day 4. CONCLUSIONS: Cognitive-behavioral interventions designed to prepare adolescents for surgery should be tailored to individual factors and developmental needs, especially the adolescents' preoperative anxiety level and age.