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      Stress, coping, and quality of life in the United States during the COVID-19 pandemic

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          Abstract

          While research has widely explored stress, coping, and quality of life (QOL) individually and the potential links between them, a critical dearth exists in the literature regarding these constructs in the context of the COVID-19 pandemic. Our study aims to identify the salient stressors experienced, describe the coping strategies used, and examine the relationships between stressors, coping, and QOL among individuals during the pandemic. Data are from a sample of 1,004 respondents who completed an online survey. Key measures included stressful life events (SLEs), coping strategies, and the physical and psychological health domains of QOL. Staged multivariate linear regression analyses examined the relationships between SLEs and the two QOL domains, controlling for sociodemographic and pre-existing health conditions and testing for the effects of coping strategies on these relationships. The most common SLEs experienced during the pandemic were a decrease in financial status, personal injury or illness, and change in living conditions. Problem-focused coping (β = 0.42, σ = 0.13, p < 0.001 for physical QOL; β = 0.57, σ = 0.12, p < 0.001 for psychological QOL) and emotion-focused coping (β = 0.86, σ = 0.13, p < 0.001 for psychological QOL) were significantly related to higher levels of QOL, whereas avoidant coping (β = –0.93, σ = 0.13, p < 0.001 for physical QOL; β = -1.33, σ = 0.12, p < 0.001 for psychological QOL) was associated with lower QOL. Avoidant coping partially mediated the relationships between experiencing SLEs and lower physical and psychological QOL. Our study informs clinical interventions to help individuals adopt healthy behaviors to effectively manage stressors, especially large-scale, stressful events like the pandemic. Our findings also call for public health and clinical interventions to address the long-term impacts of the most prevalent stressors experienced during the pandemic among vulnerable groups.

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          You want to measure coping but your protocol's too long: consider the brief COPE.

          Studies of coping in applied settings often confront the need to minimize time demands on participants. The problem of participant response burden is exacerbated further by the fact that these studies typically are designed to test multiple hypotheses with the same sample, a strategy that entails the use of many time-consuming measures. Such research would benefit from a brief measure of coping assessing several responses known to be relevant to effective and ineffective coping. This article presents such a brief form of a previously published measure called the COPE inventory (Carver, Scheier, & Weintraub, 1989), which has proven to be useful in health-related research. The Brief COPE omits two scales of the full COPE, reduces others to two items per scale, and adds one scale. Psychometric properties of the Brief COPE are reported, derived from a sample of adults participating in a study of the process of recovery after Hurricane Andrew.
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            TARGET ARTICLE: "Posttraumatic Growth: Conceptual Foundations and Empirical Evidence"

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              Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

              Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis. Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys. Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. When they do so, the resultant risk for cardiac events is often substantially elevated, equaling that associated with previously established risk factors for CAD, such as hypertension and hypercholesterolemia.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 May 2023
                2023
                10 May 2023
                : 18
                : 5
                : e0277741
                Affiliations
                [001] Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
                University of Colorado Denver, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-9471-9347
                Article
                PONE-D-22-30131
                10.1371/journal.pone.0277741
                10171688
                5d4cc9e2-f55c-4c07-a000-437adaa041b3
                © 2023 Wakeel et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 November 2022
                : 6 April 2023
                Page count
                Figures: 2, Tables: 4, Pages: 18
                Funding
                Funded by: Lehigh University Office of the Vice Provost for Research
                Award Recipient :
                This study was funded by a grant (PI: FW) from the Lehigh University Office of the Vice Provost for Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. URL of funder: https://research.cc.lehigh.edu/Contact-OVPR.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Biology and Life Sciences
                Psychology
                Social Psychology
                Social Sciences
                Psychology
                Social Psychology
                Medicine and Health Sciences
                Health Care
                Quality of Life
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Custom metadata
                The data that support the findings of this study are openly available in the Open Science Framework at https://osf.io/htazm.
                COVID-19

                Uncategorized
                Uncategorized

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