'Every day I worry about something': A qualitative exploration of children's experiences of stress and coping.

OBJECTIVES: Most research investigating children's experiences of stress and coping has utilized a quantitative approach. This study aimed to examine children's experiences of stress by conducting interviews with children and their parents. DESIGN: Dyadic child-parent interviews, embedded within a multiphase design. METHODS: Thirty-eight children (22 boys) aged 7-11 years and 38 parents (34 mothers) completed in-depth dyadic interviews about stressful life events, adversity, and coping, analysed using inductive thematic analysis with a phenomenological lens. RESULTS: Four themes emerged: (1) navigating the social minefield; (2) pressure to thrive in the modern world; (3) fear of the unknown; and (4) learning life's lessons. The first suggested that social relationships are a major feature of children's stress experiences; however, social support was also found to be a beneficial coping mechanism. The second theme highlighted multiple sources of pressure on young children (including school, extracurricular activities, pressure from self and others); the impact of such pressure was dependent upon children's coping resources. The third theme emphasized the difficulty of coping with novel stressors, and how awareness can help reduce this fear. The final theme highlighted important lessons that children can learn from stressful experiences and how to cope with stress. CONCLUSIONS: This study addresses the importance of the person and context-dependent nature of stress and coping in order for children to survive and thrive following stressful experiences. These findings contribute to existing knowledge that could be used to develop a toolkit for coping with stress, designed specifically for children, parents, schools, and services. Statement of contribution What is already known on this subject? Stress experienced in childhood can have a significant impact on psychological and physiological outcomes across the life course. It is known that individual differences are vital for understanding the effects of stress on health, for children as well as adults. Qualitative methods enable deeper understanding of children's experiences of stress and coping. What does the study add? Depth and breadth to understanding children's experiences of stressful events. An individual differences focus on the early stress experience that is frequently overlooked. Support for the use of a dyadic interview approach for assessing children's stress experiences.

Resilience characteristics and prior life stress determine anticipatory response to acute social stress in children aged 7-11 years.

OBJECTIVES: To assess the interplay of prior life stress and characteristics of resilience in determining how children cope with potentially stressful situations, using a two-phase study that triangulates parent-child dyadic interview data with subsequent experience of an acute laboratory stressor in 7-11-year-olds. METHODS: Participants (n = 34) were designated as being in one of four groups based on high/low levels of prior stress experience and high/low resilience ratings assessed during at-home interviews and from questionnaires measuring recent life events, hassles, and trait coping. During a subsequent laboratory stress protocol, salivary cortisol and heart rate were monitored, and a verbal subjective report was provided. RESULTS: Salivary cortisol showed a significant increase in anticipation of the stress test, heart rate increased during the test, and children self-reported the task as stressful. Males displayed higher levels of cortisol than females in the anticipatory period. We observed no increase in salivary cortisol in response to the stress testing phase. Using the stress/resilience categorization, children with a higher level of resilience were differentiated by cortisol level in anticipation of the acute stress experiment based on their level of prior life stress. Highly resilient children with greater experience of prior life stress showed a lower anticipatory cortisol response than highly resilient children with less experience of prior life stress. CONCLUSIONS: This study highlights the relevance of contextual factors, such as prior stress experience and resilience, in physiological response to the anticipation of acute stress and has implications for understanding how children cope with stressful experiences. Statement of contribution What is already known on this subject? An adaptation to the stress testing paradigm, the Bath Experimental Stress Test for Children (BEST-C) was found to reliably induce a salivary cortisol response in young children, suggesting that peer matching the audience was an effective modification to laboratory social stress testing. Recent work focusing on early life adversity has seen the emergence of prior stress experience and resilience as key factors in the examination of acute stress responses. However, much of the research regarding the impact of childhood stress is ambiguous; some research suggests that if children have experienced prior stressful life events this will enact a positive effect on stress responses and lead to resilience, and other research suggested that it will have a compounding negative effect. What does the study add? Findings provide support for the capacity of the BEST-C to induce an anticipation stress response in children. Contextual factors e.g., prior stress experience and resilience are key for understanding stress responses. Resilient children with more experience of stress show lower cortisol than those with less stress experience.

The influence of organisational climate on care of patients with schizophrenia: a qualitative analysis of health care professionals' views.

BACKGROUND: Organizational climate relates to how employees perceive and describe the characteristics of their employing organization. It has been found to have an impact on healthcare professionals' and patients' experiences of healthcare (e.g. job satisfaction, patient satisfaction), as well as organizational outcomes (e.g. employee productivity). This research used organizational theory to explore dynamics between health care professionals (pharmacists, doctors and nurses) in mental health outpatients' services for patients taking clozapine, and the perceived influence on patient care. SETTING: Seven clozapine clinics (from one NHS mental health Trust in the UK) which provided care for people with treatment resistant schizophrenia. METHODS: This study used qualitative methods to identify organizational climate factors such as deep structures, micro-climates and climates of conflict that might inhibit change and affect patient care. Using Interpretative Phenomenological Analysis, semistructured interviews were conducted with 10 healthcare professionals working in the clinics to explore their experiences of working in these clinics and the NHS mental health Trust the clinics were part of. MAIN OUTCOME MEASURE: Health Care Professionals' perceptions of the care of patients with treatment resistant schizophrenia. RESULTS: Three superordinate themes emerged from the data: philosophy of care, need for change and role ambiguity. Participants found it difficult to articulate what a philosophy of care was and in spite of expressing the need for change in the way the clinics were run, could not see how 'changing things would work'. There was considerable role ambiguity with some 'blurring of the boundaries between roles'. Factors associated with organizational climate (role conflict; job satisfaction) were inhibiting team working and preventing staff from identifying the patients' health requirements and care delivery through innovation in skill mix. There were mixed attitudes towards the pharmacist's inclusion as a team member. CONCLUSIONS: Our findings suggest deficiencies within the clinics that may be manifestations of the wider culture of the NHS. The implications for mental health outpatient clinics are that local initiatives are crucial to the implementation of recovery models; clear guidance should be provided on the skill mix required in clozapine clinics and interprofessional learning should be encouraged to reduce role conflict.