Nancy Nicolson

The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0–40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

Prior trauma, current stress, and poor social support contribute to youth mental health problems. As daily stressors often increase in the aftermath of traumatic events, trauma could plausibly impact psychopathology not only directly but also indirectly via ongoing stress. In this study, we examined the relative roles of trauma and daily stressors in mental health outcomes in 753 Sri Lankan adolescents residing in areas impacted by the 2004 tsunami. In 2008, participants completed measures of trauma exposure, daily stressors, social support, posttraumatic stress symptoms (PTSS), emotional and behavioral problems (EBP), and functional impairment; a subsample (n = 89) repeated these assessments 16 months later. Regression models revealed positive associations between cumulative trauma and all three mental health measures. Significant variance in these associations could be explained indirectly, via daily stressors. For PTSS, the indirect effect accounted for 26.1% of the total effect of trauma, unstandardized coefficient ab = 0. 739, 95% CI [0.459, 1.122]. For EBP this percentage was 42.4%, ab = 0.287, 95% CI [0.189, 0. 404], and for functional impairment 70.0%, ab = 0.072, 95% CI [0.049, 0.121]. Indirect effects on impairment were strongest when perceived social support was low. Although we also present evidence that pathways between stressors and psychopathology may have been bidirectional, findings support the notion that adolescents' daily stressors are important transmitters of the impact of traumatic events and highlight the need for interventions focused not only on trauma processing but also on reducing current stress and improving social support.

Background: Little is known about how daily life mood reactivity to minor stressors (stress reactivity) might change following major depressive disorder (MDD) treatment. We investigate whether (i) mood states and appraisals of daily stressors change after treatment; (ii) stress reactivity to event, activity, or social stress differs; (iii) stress reactivity depends on severity of residual depressive symptoms; and (iv) stress reactivity in individuals with remitted or non-remitted depression differ from that of never-depressed individuals.Methods: Thirty depressed individuals participated in an experience sampling study before and after a treatment period of 18 months; 39 healthy individuals formed a comparison group. Reactivity of positive affect (PA) and negative affect (NA) to daily stressors were measured.Results: More residual symptoms were associated with larger NA responses to stress. Compared to healthy controls, participants with non-remitted MDD showed higher NA-reactivity to all stressors. In contrast, stress reactivity to event and activity stressors was normalized in remitted patients. However, they still showed heightened NA-reactivity to social stress.Conclusions: Greater stress reactivity to event and activity stress appears to be state-dependent. The heightened social stress reactivity in remitted patients suggests that sensitivity to social stress may reflect an underlying vulnerability in MDD.

The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

Positive affect (PA) is closely linked to prevention of, and recovery from, depression. Previous studies have investigated PA reactivity to pleasant situations with respect to its protective properties in relation to mood disorder. The purpose of this study was to examine, and replicate, whether moment-to-moment transfer of PA in daily life (PA persistence) is relevant to the prediction of future course of depression. Individuals from three different studies (one general population sample (n=540), and two patient samples (n=43 and n=50) with matching controls (n=39 and n=21, respectively)) participated in an Experience Sampling Method (ESM) study. Time-lagged multilevel analyses were used to assess the degree of transfer (or persistence) of momentary positive affective states over time, in relation to naturalistic outcome (study 1) or treatment outcome (studies 2 and 3). Depressive symptoms were measured using the Symptom Checklist (SCL-90R) in sample 1 and the Hamilton Depression Rating Scale (HDRS) in samples 2 and 3. In study 1, participants with greater momentary PA persistence were less likely to show depressive symptoms at follow-up. In study 2, patients were more likely to respond to treatment if they displayed greater momentary PA persistence, particularly in those with recurrent depression. In study 3, patients with greater momentary PA persistence were similarly more likely to respond to treatment, especially when treated with imipramine rather than placebo. The ability to transfer PA from one moment to the next is an important factor in the prevention of and recovery from depressive symptoms. Patients with recurrent depression and those who receive antidepressants rather than placebo may benefit most from this effect. The results suggest that treatment-induced improvement in depression is mediated by increased levels of momentary transfer of PA in daily life, acquisition of which may be contingent on duration of exposure to depressive experience.