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Insufficient Coping Behavior Under Chronic Stress and Vulnerability to Psychiatric Disorders

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Insufficient Coping Behavior Under Chronic Stress and Vulnerability to Psychiatric Disorders Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2014 Insufficient Coping Behavior under Chronic Stress and Vulnerability to Psychiatric Disorders Mohr, Christine ; Braun, Silke ; Bridler, René ; Chmetz, Florian ; Delfino, Juan P ; Kluckner, Viktoria J ; Lott, Petra ; Schrag, Yann ; Seifritz, Erich ; Stassen, Hans H DOI: https://doi.org/10.1159/000356398 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-91461 Journal Article Published Version Originally published at: Mohr, Christine; Braun, Silke; Bridler, René; Chmetz, Florian; Delfino, Juan P; Kluckner, Viktoria J; Lott, Petra; Schrag, Yann; Seifritz, Erich; Stassen, Hans H (2014). Insufficient Coping Behavior under Chronic Stress and Vulnerability to Psychiatric Disorders. Psychopathology, 47(4):235-243. DOI: https://doi.org/10.1159/000356398 Original Paper Psychopathology 2014;47:235–243 Received: April 15, 2013 DOI: 10.1159/000356398 Accepted after revision: October 18, 2013 Published online: January 9, 2014 Insufficient Coping Behavior under Chronic Stress and Vulnerability to Psychiatric Disorders a b b a Christine Mohr Silke Braun René Bridler Florian Chmetz b b d a Juan P. Delfino Viktoria J. Kluckner Petra Lott Yann Schrag c b Erich Seifritz Hans H. Stassen a b Institute of Psychology, University of Lausanne, Lausanne , and Institute for Response-Genetics, University of c Zurich, and Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, d Zurich , Switzerland; Languages Division, Pasadena City College, Pasadena, Calif. , USA Key Words means of a neural network approach. We found 2 highly sta- Chronic stress · Insufficient coping skills · Affective ble and reproducible COPE scales that explained the ob- disorders · Early detection · Students served interindividual variation in coping behavior sufficient- ly well and in a socioculturally independent way. The scales reflected basic coping behavior in terms of ‘activity-passivity’ Abstract and ‘defeatism-resilience’, and in the sense of stable, sociocul- Background: Epidemiological data indicate that 75% of sub- turally independent personality traits. Results: Correlation jects with major psychiatric disorders have their onset of ill- analyses carried out for external validation revealed a close ness in the age range of 17–24 years. An estimated 35–50% of relationship between high scores on the defeatism scale and college and university students drop out prematurely due to impaired physical and mental health. This underlined the role insufficient coping skills under chronic stress, while 85% of of insufficient coping behavior as a risk factor for physical and students receiving a psychiatric diagnosis withdraw from col- mental health problems. Conclusion: The combined COPE lege/university prior to the completion of their education. and ZHQ instruments appear to constitute powerful screen- In this study, we aimed at developing standardized means ing tools for insufficient coping skills under chronic stress and of identifying students with insufficient coping skills under for risks of mental health problems. © 2014 S. Karger AG, Basel chronic stress and at risk for mental health problems. Sam- pling and Methods: A sample of 1,217 college students from 3 different sites in the USA and Switzerland completed 2 self- report questionnaires: the Coping Strategies Inventory (COPE) Introduction and the Zurich Health Questionnaire (ZHQ), which assesses ‘regular exercises’, ‘consumption behavior’, ‘impaired physi- Epidemiological data indicate that 75% of subjects cal health’, ‘psychosomatic disturbances’ and ‘impaired men- suffering from major psychiatric disorders or with a pre- tal health’. The data were subjected to structure analyses by vious history of psychiatric disorders had their onset of © 2014 S. Karger AG, Basel Hans H. Stassen 0254–4962/14/0474–0235$39.50/0 Institute for Response-Genetics University of Zurich E-Mail [email protected] CH–8032 Zurich (Switzerland) www.karger.com/psp E-Mail k454910 @ bli.uzh.ch Downloaded by: Universität Zürich, Zentralbibliothek Zürich 130.60.47.22 - 6/3/2016 2:48:31 PM illness between 17 and 24 years of age [1] . This is exact- ventions before psychiatric symptoms develop and may ly the time when college and university students receive reach clinically relevant thresholds [15, 16] . Specifically, their higher education, thereby experiencing significant our study addressed the following questions: (1) the inter- levels of chronic stress over several years. Chronic stress, relationship of coping behavior and the factors ‘regular however, can lead to serious health problems and can exercises’, ‘consumption behavior’, ‘impaired physical affect nearly every system of the human body, as sug- health’, ‘psychosomatic disturbances’ and ‘impaired gested by physical, cognitive, affective and behavioral mental health’; (2) how to draw a line between risk and symptoms. Indeed, in a certain percentage of the gen- nonrisk cases; (3) the extent to which insufficient coping eral population, chronic stress raises the blood pressure, skills are influenced by sociocultural factors, and (4) the increases the risk of heart attack and stroke [2] , sup- extent to which premature dropping out among students presses the immune system [3] and increases the vulner- is related to insufficient coping skills. ability to psychiatric disorders such as anxiety, depres- sion or schizophrenia [4–6] . Results from general health surveys of college students M a t e r i a l s differ quantitatively in a variety of ways (sample sizes, es- timated rates), a fact likely to originate from selection bi- Power analyses based on the available data suggested a sample size of 400 subjects to cover 90% of the expected empirical vari- ases due to low survey response rates in the range of 20% ance (1,500 subjects for 95%). Accordingly, our study comprised [7–12] . The resulting overall picture is nonetheless very (1) a ‘learning sample’ of 407 college students from Pasadena, Cal- similar across study sites: typically, 50% of students re- if., USA; (2) a second ‘learning sample’ of 404 university students port psychological distress (compared with only 11% of from Lausanne (French-speaking part of Switzerland), and (3) a age-matched controls from the general population), and ‘test sample’ of 406 university students from Zurich (German- speaking part of Switzerland). The 3 study sites were chosen in some 30% say that chronic stress significantly affects their such a way that sociocultural differences of clinical relevance academic performance. Among those reporting reduced could be detected. Our basic assumption was that most college academic performance, the stress-induced burden ap- and university students experience significant levels of chronic peared to be closely related to a pronounced lack of cop- stress over several years due to tight schedules and frequent ex- ing skills, which can obviously lead to things escalating in aminations. Students were recruited for this project via 2 different approaches. A ‘classroom approach’ was used in Pasadena, where the long run [13] . all students of a classroom were informed about the principal As a consequence, almost 50% of these students show goals of our project and invited to participate in the study. By con- elevated alcohol consumption, 12% report suicidal trast, in Lausanne and Zurich we used a ‘random sampling ap- thoughts, and 11% have already been treated for mental proach’: after a short university-wide advertising campaign, infor- health problems. As to physical activity, nearly half of mation stands were established in central, highly frequented cam- pus areas, where study administrators sought to enroll 400 those students do not meet the American Heart Associa- students. tion Recommendations for Physical Activity in Adults All students were asked to fill out the 28-item Coping Strategies with respect to moderate-intensity cardio or aerobic ex- Inventory (COPE)1 [17] (available in standardized form in 6 lan- ercise. Given these facts, it is not really surprising that (1) guages on http://www.bli.uzh.ch/Left07b.php) along with the 63- 35–50% of dropout cases among students appear to be item Zurich Health Questionnaire (ZHQ), which assesses the fac- tors ‘regular exercises’, ‘consumption behavior’, ‘impaired physi- related to insufficient coping skills, and (2) 85% of stu- cal health’, ‘psychosomatic disturbances’ and ‘impaired mental dents who receive a diagnosis of major psychiatric disor- health’ [18] (available in 6 languages on the website mentioned der withdraw from college/university prior to completion above). As to the question of significant fluctuations in student of their education [14] . dropout rates over time, we analyzed the academic performance In this study, the focus was placed on college/univer- statistics of students at the University of Zurich (UZH) for the years 1995–2010 to determine, as a function of time, the propor- sity students at early stages of their academic education. tion of freshmen who later on graduated from UZH with a master’s We aimed at developing standardized means of ‘early’ degree. This project was approved by the ethics committee of the identification of freshman students with insufficient cop- Canton of Zurich. ing skills under chronic stress and at risk for mental health problems. These students might benefit from early inter- M e t h o d s 1 Dispositional version,
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