Rudolf H. Moos

The role of coping responses and social resources in attenuating the stress of life events

The nature of individual coping responses to stressful life events was explored in a representative adult community sample. Two approaches to the classification of coping strategies were operationalized. Using these measures, small but significant gender and contextual differences in coping were identified. Mood and symptom levels were related to coping responses and to quantitative and qualitative measures of social resources. Measures of coping and social resources attenuated the relationship between undesirable life events and personal functioning.

The development of a menstrual distress questionnaire.

&NA; The development of a Menstrual Distress Questionnaire (MDQ) is described. Each of 839 women rated their experience of 47 symptoms on a six‐point scale separately for the menstrual, premenstrual, and intermenstrual phases of her most recent menstrual cycle and for her worst menstrual cycle. The 47 symptoms were intercorrelated and factor analyzed separately for each phase, and eight basically replicated factors were extracted from each of these analyses. These factors, which represent separate but empirically intercorrelated clusters of symptoms, were labeled pain, concentration, behavioral change, autonomic reactions, water retention, r gative affect, arousal, and control. Scores on these eight clusters of symptoms were slightly correlated with age and parity. The scores were not affected by the specific menstrual cycle phase a woman was in when filling out the questionnaire or by the length of time since the woman had experienced the symptoms. Menstrual cycle symptom‐profiles graphically depicting a womans menstrual symptomatology were constructed and illustrated. The need for and utility of standard methods with which to measure menstrual cycle symptomatology is discussed.

Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease

CONTEXT Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown. OBJECTIVE To determine why depressive symptoms are associated with an increased risk of cardiovascular events. DESIGN AND PARTICIPANTS The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years. SETTING Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008. MAIN OUTCOME MEASURES Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators. RESULTS A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score > or = 10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16-1.95; P = .002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00-1.71; P = .04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94-1.63; P = .12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79-1.40; P = .75). CONCLUSION In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.

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.

Coping and adjustment in distressed and healthy adolescents

Abstract The way in which adolescents respond to stressors may be an important predictor of how successfully they adapt to the challenges of the teen years. In this article we examine coping responses in four groups of youth (healthy controls, adolescents with rheumatic disease, adolescents with conduct problems and depressed adolescents) using eight narrow-band scales hierarchically organized into broader-band domains of approach and avoidance coping. We then examine the association between coping responses and individual differences in adjustment. Adolescents in the four groups do not differ in their use of approach coping; however, depressed adolescents and adolescents with conduct disorder use more avoidance coping than rheumatic disease and healthy adolescents. Overall, adolescents who use more approach and less avoidance coping are better adjusted. The results suggest that efforts to change, manage, or positively reappraise a problematic situation actively, are important for good long-term adjustment. Adolescents who engage in more avoidance coping may be at greater risk for poorer adjustment to subsequent life stressors and crises.

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.

The role of predisposing and moderating factors in the stress-illness relationship

Longitudinal data on 267 married couples are used to examine the interrelationships among predisposing factors, stress, moderating factors, and subsequent functioning. A model of the stress process that considers spouse symptoms and coping was estimated separately for three functioning criteria (depressed mood, physical symptoms, and alcohol, consumption) and across gender groups. Predisposing factors such as low social status and poor initialfunctioning were related to higher levels of stress. Women were more responsive to stressors and social resources (family support) than were men. The stress-illness relationship was strengthened by the use of avoidance coping responses, particularly if both partners relied on avoidance coping. There were no stress-buffering effects offamily support. The associations between self-esteem, coping responses, and later functioning depended on the partners corresponding coping levels. These findings underscore the value of considering a significant others symptoms and behavior as salient aspects of the stress process.

Stress Generation, Avoidance Coping, and Depressive Symptoms: A 10-Year Model.

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

Children of alcoholics during the recovery process: Alcoholic and matched control families

Children of relapsed and recovered alcoholic patients were compared with children from sociodemographically matched control families on a set of indices of emotional and physical status. The children of relapsed alcoholics evidenced more symptoms of emotional disturbance than did the control children. In contrast, the children of recovered alcoholics were functioning as well as the control children. Additional analyses showed that the emotional status of children was related to the emotional, physical, and occupational functioning shown by their alcoholic and their nonalcoholic parent, as well as to family life stressors.

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.