Coping as a Mechanism Linking Stressful Life Events and Mental Health Problems in Adolescents

Objective Although stressful life events represent an etiologic factor of mental health problems in adolescents, few studies have been conducted to address mechanisms linking the stress-psychopathology relation. The present study was designed to examine coping as a mediate factor on the relationship between stressful life events and symptoms of anxiety and depression. Methods The participants were 13 512 students from eight cities of China, who participated in a school-based survey. Data were collected by a questionnaire comprising coping, stressful life events, anxiety, and depressive symptoms. As a model, a series of regression equations were used to examine whether coping mediated the association between stressful life events and symptoms of anxiety and depression. Results Each dimension of stressful life events showed significant correlation with anxiety, depression and coping （all P〈0.001）. In the model to analyze mediate effects, all standardized coefficients （β） were significant （all P〈0.01）, indicating marked mediator effects. Furthermore, negative coping might account for more mediate effects than positive coping on this relationship. Conclusion Coping partially mediated the relationship between stressful life events and mental health during adolescence. This study highlighted an important public health priority for preventive interventions targeting stress-related psychopathology, and for further promoting adolescents＇ mental health.

Psychological impact of chronic hepatitis C:Comparison with other stressful life events and chronic diseases

AIM： To examine the psychological impact of chronic hepatitis C （CHC） diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications. METHODS： One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale （VAS）, the degree of stress caused by the learning of CHC diagnosis and the perceived severity of their disease. Diagnosis-related stress was compared to four other stressful life events and perceived CHC severity was compared to four other common chronic diseases. RESULTS： Learning of CHC diagnosis was considered a major stressful event （mean ± SD scores： 72±25）, significantly less than death of a loved-one （89±13, P〈0.0001） and divorce （78 ± 23, P〈0.007）, but more than job dismissal （68 ± 30, P〈 0.04） and home removal （26±24, P〈 0.0001）. CHC was considered a severe disease （74± 19）, after AIDS （94±08, P〈 0.001） and cancer （91± 11, P〈 0.001）, but before diabetes （66±23, P〈0.001） and hypertension （62±20, P〈0.001）. Perceived CHC severity was not related to the actual severity of liver disease, assessed according to Metavir fibrosis score. In multivariate analysis, diagnosisrelated stress was related to perceived disease severity （P〈0.001）, trait anxiety （P〈 0.001） and infection through blood transfusion （P〈 0.001）. CONCLUSION： Our results show the considerable psychological and emotional burden that a diagnosis of CHC represents, even in the absence of significant liver disease. They should be taken into account when announcing a diagnosis of CHC in order to reduce its negative effects.

Stressful life events,psychosocial health and general health in preschool children before age 4

Background The impact of stressful life events(SLEs)in early childhood is often ignored.We aimed to examine longitudinal associations between SLEs and psychosocial and general health in preschool children.Methods Twelve SLEs occurring before the age of 24 months were assessed and categorized by frequency(no events,1-2 SLEs,and>2 SLEs)and overall tension(no events,low,and high)(n=1431).Psychosocial and general health were meas-ured three times at the age of 24,36 and 45 months.The associations were examined by logistic regression models using generalized estimating equations to handle repeated measurements.Results Half(48.4%)of the families experienced SLEs,and 23.8%perceived high-tension SLEs before the children were aged 24 months.Gender differences were observed in the association between SLEs and psychosocial health.Compared to girls without SLEs,girls who experienced>2 SLEs[OR=3.31,95%confidence interval(CI)2.05-5.35]or high-tension SLEs(OR=3.01,95%CI 2.07-4.39)had higher odds of psychosocial problems from 24 to 45 months.The odds ratios in boys were 2.10(95%CI 1.36-3.24)and 1.47(95%CI 1.06-2.03),respectively.Moreover,only girls'risk of psychosocial problems increased after experiencing 1-2 SLEs(OR=2.15,95%CI 1.54-3.00)or low-tension SLEs(OR=1.90,95%CI 1.31-2.74).Regarding general health,children who experienced>2 SLEs(OR=1.96,95%CI 1.21-3.18)and high-tension SLEs(OR=1.60,95%CI 1.12-2.28)had higher odds of poor general health from 24 to 45 months.Conclusions The findings emphasized that young children's psychosocial and general health can be impacted by experienc-ing SLEs in early childhood.Attention and adequate support for families experiencing SLEs are needed to minimize the potential negative effect of SLEs on child health,particularly in girls.

Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus:A narrative review

Type 1 diabetes(T1D)is one of the most common chronic diseases in children and adolescents worldwide.Its etiopathogenesis results from the interplay of genetic and environmental variables.Among the latter,psychological stress has been implicated in disease onset as well as disease management.Various studies,including large population-based studies,have highlighted the role of stressful life events in the etiopathogenesis of T1D.In this article,we also emphasize the importance of attachment in the early child-caregiver relationship,which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation.It serves as a model for all subsequent relationships in one’s life.We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management.T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications.In addition to psychological stress,psychological factors such as family functioning,developmental adjustment,autonomy,mental health problems and other factors have been found to relate to metabolic control.Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi-or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.

Gene×environment interaction in major depressive disorder

Major depressive disorder(MDD)is a multifactorial disorder,where multiple susceptibility genes interact with environmental factors,predisposing individuals to the development of the illness.In this article,we reviewed different gene×environment interaction(G×E)studies shifting from a candidate gene to a genome-wide approach.Among environmental factors,childhood adversities and stressful life events have been suggested to exert crucial impacts on MDD.Importantly,the diathesis-stress conceptualization of G×E has been challenged by the differential susceptibility theory.Finally,we summarized several limitations of G×E studies and suggested how future G×E studies might reveal complex interactions between genes and environments in MDD.

Childhood Adversities Associated with Eating Disorders Reported by Adults

Background: It has been suggested that childhood events increase the risk of suffering from an eating disorder (ED) in adolescence or young adulthood. Our study here aimed at investigating whether there was an association between stressful childhood events and eating disorders later in life. Methods: Our population-based study was a part of the HeSSup (The Health and Social Support) postal survey in 2003, a follow-up survey with a random sample of working-aged subjects drawn from the Finnish Population Register in 1998. Participants in this study reported having been suffering from ED (N = 374), while controls (N = 18,639) reported no history of eating disorder in the questionnaire both in 1998 and 2003. The questionnaire included six questions related to childhood adversities. Results: Each childhood stressor increased the risk of developing ED cumulatively (one adversity OR 1.7 versus all six OR 8.3). Intrafamiliar conflicts (OR 2.0), being afraid of a family member (OR 1.5) or long-term illnesses in the family (OR 1.4) increased the ED-risk statistical significantly. Conclusion: Children exposed to stress are more likely to suffer from eating disorders as adults than those not exposed.