Frances Cohen

Active Coping Processes, Coping Dispositions, and Recovery from Surgery

&NA; Surgical patients with similar medical problems differ greatly in their rate of postoperative recovery. This study investigated the relationship between the mode of coping with preoperative stress and recovery from surgery. Sixty‐one preoperative surgical patients were interviewed and classified into three groups based on whether they showed avoidance vigilance, or both kinds of coping behavior, concerning their surgical problem. Coping dispositions referring to the same dimension, preoperative anxiety, and previous life stress were also measured. The five recovery variables included days in hospital, number of pain medications, minor medical complications, negative psychological reactions, and the sum of these. Results showed that the vigilant group had the most complicated postoperative recovery, although only two recovery variables (days in hospital and minor complications) were statistically significant. Coping dispositions, anxiety, and life stress showed no clear or consistent relationships with recovery. Ways in which mode of coping may have influenced recovery are discussed.

Psychobiologic reactivity to stress and childhood respiratory illnesses: results of two prospective studies.

Psychological stress is thought to undermine host resistance to infection through neuroendocrine-mediated changes in immune competence. Associations between stress and infection have been modest in magnitude, however, suggesting individual variability in stress response. We therefore studied environmental stressors, psychobiologic reactivity to stress, and respiratory illness incidence in two studies of 236 preschool children. In Study 1, 137 3- to 5-year-old children from four childcare centers underwent a laboratory-based assessment of cardiovascular reactivity (changes in heart rate and mean arterial pressure) during a series of developmentally challenging tasks. Environmental stress was evaluated with two measures of stressors in the childcare setting. The incidence of respiratory illnesses was ascertained over 6 months using weekly respiratory tract examinations by a nurse. In Study 2, 99 5-year-old children were assessed for immune reactivity (changes in CD4+, CD8+, and CD19+ cell numbers, lymphocyte mitogenesis, and antibody response to pneumococcal vaccine) during the normative stressor of entering school. Blood for immune measures was sampled 1 week before and after kindergarten entry. Environmental stress was indexed with parent reports of family stressors, and a 12-week respiratory illness incidence was measured with biweekly, parent-completed symptom checklists. The two studies produced remarkably similar findings. Although environmental stress was not independently associated with respiratory illnesses in either study, the incidence of illness was related to an interaction between childcare stress and mean arterial pressure reactivity (beta =.35, p <.05) in Study 1 and to an interaction between stressful life events and CD19+ reactivity (beta =.51, p <.05) in Study 2. In both studies, reactive children sustained higher illness rates under high-stress conditions, but lower rates in low-stress conditions, compared with less reactive peers. Stress was associated with increased rates of illnesses, but only among psychobiologically reactive children. Less reactive children experienced no escalation in illness incidence under stressful conditions, suggesting that only a subset of individuals may be susceptible to the health-altering effects of stressors and adversity.

Psychological and immunological predictors of genital herpes recurrence

&NA; The relationships among stressful life experience, mood, helper‐inducer (CD4+) and suppressor‐cytotoxic (CD8+) T cells and genital herpes simplex virus (HSV) recurrence were investigated prospectively in 36 patients with recurrent HSV. The following factors were measured monthly for six months: stressful life experience (including current acute and ongoing stressors, residual effects of previous stressors, and anticipation of future stressors), negative mood, health behaviors, other possible HSV triggers, HSV recurrences, and the proportion of CD4+ and CD8+ cells (in half the sample). Results averaging monthly scores over the six‐month study period indicated that: 1) subjects with high levels of stressful experience had a lower proportion of both CD4+ and CD8+ cells, 2) subjects with high levels of depressive mood, anxiety, or hostility had a lower proportion of CD8+ cells, and 3) subjects with high levels of depressive mood who did not report many symptoms of other infections had a higher rate of HSV recurrence. A model is proposed linking depressive mood, CD8+ cells, and HSV recurrence.

the Impact of Denial and Repressive Style on Information Gain and Rehabilitation Outcomes in Myocardial Infarction Patients

&NA; The impact of denial, repressive style, and social desirability on information gained during hospitalization and their effects on recovery were studied in 30 patients with documented myocardial infarction (MI). Using three scores of cardiac knowledge as dependent variables, three significant findings emerged: 1) patients who denied more gained less information about heart anatomy and physiology; 2) patients who scored high on social desirability gained less information about symptoms indicating heart problems and activities appropriate for recovery; and 3) patients who were repressors gained less information about heart disease risk factors. Twenty‐four of the 30 patients completed a survey of functioning 6 months after discharge. Dividing patients into four groups representing a match or mismatch between repressive style and information level, it was found that 1) repressors with high risk factor information reported more complications and poorer psychomedical functioning, and 2) sensitizers with low risk factor information reported poorer social functioning.

Adrenocortical and Behavioral Predictors of Immune Responses to Starting School

ABSTRACT: Associations between major psychologic stressors and immune function have been documented in previous research, but few studies have investigated immune changes attending minor, normative stressors. This study examined adrenocortical and behavioral predictors of immune responses to starting kindergarten in 39 five-year-old children, who completed laboratory visits for venipunctures 1 wk before (time 1) and 1 wk after (time 2) school entry. At time 1, children were also immunized with pneumococcal vaccine. Immune responses were measured as change scores for T (CD4+ and CD8+) cells, B (CD19+) cells, lymphoproliferative responses to pokeweed mitogen (PWM), and type-specific pneumococcal antibody responses (ABR). Adrenocortical response was assessed as the change in salivary cortisol level, and behavioral difficulty with school adjustment was scored using parental ratings of behavior problems, stress due to changes in routines, and degree of adaptive challenge. Salivary cortisol rose after kindergarten entry (means = 0.39 ± 0.28 to 0.49 ± 0.36 μg/dL, p = 0.03) and was unrelated to behavioral difficulties. CD4+ cells increased in number, whereas PWM declined, and CD19+ cells showed a borderline increase. Change in salivary cortisol was positively associated with change in CD19+ (ΔCD19+) and inversely related to ABR. Scores for behavioral difficulty were inversely associated with ΔCD4+ and ΔCD19+. These data suggest that: 1) school entry is a stressor capable of evoking elevations in cortisol and behavior problems, accompanied by shifts in functional and enumerative measures of immune status; and 2) children with greater adrenocortical reactivity have increases in B cell numbers and less effective B cell-mediated antibody production, whereas children with more behavioral difficulties show declines in all T and B cell subsets.

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

BackgroundCognitive-behavioral interventions, typically effective in reducing anxiety and pain, have not been applied to adolescents undergoing major orthopaedic surgery. ObjectivesTo 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. MethodsA 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. ResultsInformation 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. ConclusionsCognitive-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.

Immune function declines with unemployment and recovers after stressor termination.

Objective: To examine the effect of unemployment on natural killer cell cytotoxicity (NKCC) and, in a subsample of persons who become re-employed, to determine if, after termination of the stressor, immune values recover to levels similar to matched controls. Methods: One hundred unemployed and 100 matched employed healthy men and women, aged 29 to 45 years, were followed for 4 months with monthly blood samples taken to measure NKCC, the ability of NK cells to kill target cells. Twenty-five participants obtained employment before the end of the study, leaving 75 unemployed (and 75 employed) participants in the main sample. For unemployed participants who obtained employment before the end of the study, subsample analyses compared NKCC levels before and after obtaining a new job. Results: The persistently unemployed sample had significantly lower NKCC levels for all three effector:target ratios (100:1, p = .0004; 50:1, p = .002; and 25:1, p = .02) when compared with the matched employed sample. There were no significant gender effects. In the subsample analyses, NKCC was significantly higher after the participants became employed, compared with their unemployed period, with substantial “recovery” of immune function (44%–72%) compared with values from the steadily employed group. Conclusions: Chronic stress is associated with persistent NKCC impairment. When the chronic stressor is terminated, however, the immune cell functional capacity quickly begins to recover. We believe this is the first study in humans to document immune function recovery after the definable end of a chronic stressor. NK = natural killer; NKCC = natural killer cell cytotoxicity.

Children's Preoperative Coping and Its Effects on Postoperative Anxiety and Return to Normal Activity

A model was tested to assess childrens preoperative coping with major orthopedic surgery and how coping is related to two different postoperative outcomes, anxiety and return to normal activities. Ninety children, ages 8 to 17, participated. Data were collected the day before surgery, the second postoperative day, and at 3-, 6-, and 9-month recovery periods. A respecified model was not significantly different from the data (p = .90), indicating a good fit. Children who were older, more anxious, and more internal in locus of control exhibited more vigilant coping. Avoidant coping was associated with less anxiety 2 days postoperatively, and vigilant coping was associated with return to normal activities over the course of recovery.

Effects of coping instruction in reducing young adolescents' pain after major spinal surgery.

Background Enduring pain following major orthopaedic surgery is a major challenge for adolescents. Purpose To evaluate the effects of coping instruction and concrete-objective information on adolescents’ postoperative pain and focus on potential applications of these interventions for orthopaedic nursing practice. Design/Method A randomized controlled trial of 66 young adolescents (age 11–14) undergoing major spinal surgery for idiopathic scoliosis. Results The intervention that focused only on coping instruction was the most effective intervention on postoperative Day 2. On postoperative Day 4, adolescents receiving coping instruction (coping alone or coping plus information) reported less pain than those not receiving coping instruction. Discussion Interventions that direct adolescent patients’ attention to learning coping strategies they can use during recovery to lessen pain may be more efficacious than others following major spinal surgery.

Immunologic changes occurring at kindergarten entry predict respiratory illnesses after the Loma Prieta earthquake.

Previous studies in adult populations have demonstrated alterations in immune function after psychologically stressful events, and pediatric research has shown significant associations between stress and various childhood morbidities. However, no previous work has examined stress-related immune changes in children and subsequent illness experience. Twenty children were enrolled in a study on immunologic changes after kindergarten entry and their prospective relationship to respiratory illness (Rl) experience. Midway through a 12-week Rl data collection period, the October 17, 1989 Loma Prieta earthquake occurred. The timing of this event created a natural experiment enabling us to study possible associations between immunologic changes at kindergarten entry, the intensity of earthquake-related stress for children and parents, and changes in Rl incidence over the 6 weeks after the earthquake. Immunologic changes were measured using helper (CD4+)-suppressor (CD8+) cell ratios, lymphocyte responses to pokeweed mitogen, and type-specific antibody responses to Pneumovax, in blood sampled 1 week before and 1 week after school entry. Rl incidence was assessed using home health diaries and telephone interviews completed every 2 weeks. Rls per child varied from none to six. Six children showed an increase in Rl incidence after the earthquake; five experienced a decline. Changes in helper-suppressor cell ratios and pokeweed mitogen response predicted changes in Rl incidence in the postearthquake period (r = .43, .46; p < .05). Children showing upregulation of immune parameters at school entry sustained a significant increase in Rl incidence after the earthquake. These findings suggest that individual differences in immune reactivity to a minor normative stressor may be related to the rate of infection after a major stressful event. J Dev Behav Pediatr 14:296–303, 1993. Index terms: stress, respiratory infection, psychoneuroimmunology.