STRESS

Original Articles

Trauma-Informed Care for Children: A Scoping Review: Kyung-Sook Bang, Ji-Hye Choe, Sinyoung Choi, Yeseul Jeong, Sungjae Kim; STRESS. 2024;32(2):94-103. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.94

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Abstract PDF: Background
Trauma-informed care involves providing services to traumatized patients with an understanding of and sensitivity to their experiences. This scoping review examines the literature concerning trauma-informed care for children.
Methods
We conducted a comprehensive literature search across domestic (RISS, NDSL, KISS, and DBpia) and international (PubMed, Embase, CINAHL, and PsycINFO) databases. The search terms were “trauma,” “PTSD,” “trauma-informed,” “trauma-focused,” “trauma-sensitive,” “newborn,” “neonate,” “premature infant,” “infant,” “child,” “adolescent,” “teen,” “juvenile,” “adolescence,” “pediatric,” and “nursing”. The final selection comprised 18 documents that were analyzed for general characteristics (publication year, study country, academic sector, research design, and data collection method), population demographics, variables, and measurement tools.
Results
Literature on this topic considerably increased since 2017, with the United States being the predominant research hub (50.0%) and nursing representing the primary academic sector (55.6%). The research designs were mainly quantitative (33.3%) and mixed-method studies (33.3%). Quantitative studies predominantly utilized surveys, while qualitative research employed observations, in-depth interviews, and focus group discussions. Most of the participants were nurses, doctors, and allied health professionals. As a result of analyzing the main variables measured in the literature through WordCloud, variables such as “stress,” “care,” and “knowledge” had the highest frequency. Three studies incorporated or adapted tools to assess trauma-informed care.
Conclusions
The findings of this review serve as foundational data for proposing future research trajectories in trauma-informed care and for enhancing awareness and strategic planning in clinical practice.

Influence of the Negative Life Changes Experienced after Becoming Single Mothers on Parenting Stress: Focusing on the Moderated Mediation Effect of Depression by Low-Income Status: RaeHyuck Lee; STRESS. 2024;32(2):85-93. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.85

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Abstract PDF: Background
This study examines the influence of negative life changes experienced after becoming single mothers and their influence on parenting stress, focusing on the moderated mediation effect of depression influenced by low-income status.
Methods
The research questions were tested by using raw data from the Survey of Single-parent Families and applying the PROCESS macro method.
Results
First, the negative life changes experienced after becoming single mothers were found to positively and significantly influence parenting stress. Second, a partial mediation effect was observed: The levels of negative life changes increased the levels of depression, which, in turn, increased the levels of parenting stress. Third, the mediating effect of depression on the relationship between single mothers’ negative life changes and parenting stress was more pronounced for those with low income compared to those with medium and high income.
Conclusions
This study suggests strategies to address single mothers’ parenting stress.

Stress and Coping of Self-Quarantined People Focusing on Negative Cases of the Coronavirus Disease: A Qualitative Study: Kyung Im Kang, Chanhee Kim, Min Hye Lee; STRESS. 2024;32(2):74-84. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.74

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Abstract PDF: Background
In South Korea, many people have experienced self-quarantine due to coronavirus disease (COVID-19). This study explored stress, coping, and post-quarantine changes among people who were self-quarantined because of close contact but tested negative for COVID-19 in the early days of the pandemic.
Methods
Qualitative interviews were conducted with four focus groups, each comprising five people. Data were analyzed using inductive content analysis.
Results
Three categories of stress and coping during self-quarantine and post-quarantine changes emerged. First, the category of content related to stress comprised “problems that are difficult to handle alone.” The subcategories were “painful body and mind,” “the experience of being in a jail without bars,” and “repeated internal and external conflicts.” Second, the category for various stress-coping methods was labeled “struggling my way,” and the subcategories were “coping methods that helped me overcome” and “coping methods that added difficulty.” Finally, the category for changes after self-quarantine was labeled “more mature me.” The subcategories involved “thorough observation of infection prevention measures in daily life,” “living together,” and “a new realization of life.”
Conclusions
Our findings contribute toward developing online or offline health programs to help individuals who self-quarantined but tested negative for infectious diseases, allowing them to feel confident to self-quarantine in good health.

Academic Mental Health and Stress Mindset among High School Students: Job Demands-Resources Model: Ji-Eon Kim, Hyo-Shim Cho, Tae-Hyung Kwon, Eun-Young Kim, Ochir Erdenezaya Tsogt, Soohyun Cho; STRESS. 2024;32(2):66-73. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.66

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Abstract PDF: Background
This study aimed to identify stress mindset as an intervention factor for academic stress management within the framework of the Job Demands-Resources Model. We investigated the role of a stress mindset in the relationship between academic demands, resources, burnout, engagement as academic mental health.
Methods
From the perspective of academic interpersonal perceptions, 391 first- and second-year high school students were analyzed using a structural equation model consisting of observed variables with demands and resources from parents, teachers, and peers.
Results
The low-stress mindset group showed a significant pathway from academic demands to academic burnout. The high-stress mindset group demonstrated pathways from academic resources to academic burnout and engagement.
Conclusions
These findings highlight the significance of a stress mindset in enhancing the academic mental health of high school students.

Development and Preliminary Efficacy of a Mindfulness-Based Counseling Program as Part of Comprehensive Cardiac Rehabilitation: A Pilot Study: Ji Young Jung, Min Jung Kim, Sol Bin Yoon, Hyo Jin Kim, Jin A Yoo, Mi Kyung Lee, Sang Hee Shin, Justin Y. Jeon, Sung Nim Han, Jung Eun Lee, Chan Joo Lee, Jong Young Lee, Ick-Mo Chung, Jong Nam Kim; STRESS. 2024;32(2):53-65. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.53

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Abstract PDF: Background
While psychological intervention is recognized as a core component of cardiac rehabilitation (CR), its application in CR remains limited. This study aimed to develop a psychological counseling program (the Mindfulness-Based Counseling Program [MBCP]) as a component of comprehensive CR for the patients with cardiovascular disease and to explore its preliminary efficacy.
Methods
We developed a psychological counseling program (MBCP) as part of comprehensive CR. The MBCP consisted of six-week psychological counseling and mindfulness practice. Through this program, we aimed to promote health maintenance behaviors and stress management. Thirteen subjects with either acute myocardial infarction or congestive heart failure with reduced EF (≤40%) participated, randomized into either comprehensive CR including MBCP (n=7) or exercise-based CR (n=6). Psychological-status assessments included life satisfaction (DSQ), health-related quality of life (HRQoL), depression (PHQ-9), anxiety (GAD-7), type D personality, and stress (PSS).
Results
The comprehensive CR group (n=7) experienced a significant decrease in anxiety and improvements in general health and mental aspects of HRQoL. The exercise CR group (n=6) experienced reduced depression and significantly increased mental aspects of HRQoL. Additionally, the overall satisfaction and participation rate for MBCP was high.
Conclusions
The MBCP developed in this study showed preliminary efficacy for CR and is anticipated to enhance psychological wellbeing and the quality of life among cardiac patients.

Effect of Emotional Regulation Strategies on Psychological Distress in Obsessive-Compulsive Tendency: Woo-Jin Cha, Myoung-Ho Hyun; STRESS. 2024;32(2):104-110. Published online June 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.2.104

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Abstract PDF: Background
This study examined the effects of emotion regulation strategies on psychological distress in individuals with obsessive-compulsive tendencies.
Methods
A total of 339 adults completed online and offline surveys administered to determine the level of obsessive-compulsive symptoms. Among them, 56 were categorized into the obsessive-compulsive tendency group and randomly assigned to the reappraisal, acceptance, and suppression groups, where each participated in emotion regulation strategy training. Their psychological distress was assessed before and after the training.
Results
The results of the repeated-measures analysis of variance (ANOVA) showed that the main effects of neither group nor time were significant, but the interaction between group and time was significant. The acceptance group showed a significant decrease in psychological distress post-training, whereas the suppression group showed a significant increase. The reappraisal group showed no significant changes in psychological distress before and after the training.
Conclusions
This study demonstrated that the acceptance strategy was especially effective and adaptive in reducing psychological distress. These findings expand our understanding of emotion regulation strategies and have therapeutic implications. Finally, the implications and limitations of this study are discussed, presenting directions for future research.

Relationship between Childhood Trauma and Depression in Youths in the Transition to Independent Living: The Mediating Effect of Disconnection-Rejection Schemas Moderated by Out-of-Home Care Types: Shin Young Park, Myoung-Ho Hyun, Min Jin Jin; STRESS. 2024;32(1):9-18. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.9

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Abstract PDF: Background
This study explored the relationship between childhood trauma, disconnection-rejection schemas, and depression among youths in the transition to independent living. Additionally, this study examined whether the impact of childhood trauma on depression, mediated by disconnection-rejection schemas, was moderated by the type of out-of-home care (residential care centers, group homes, and foster homes).
Methods
A survey questionnaire measuring childhood trauma, disconnection-rejection schemas, and depression was administered to 201 participants.
Results
Mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. In all types of out-of-home care, both the mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. There were no significant differences in mediating effects based on the type of out-of-home care.
Conclusions
The findings of this study can be applied to the treatment of depression during the transition to independent living in individuals who have experienced childhood trauma.

Association between Suicidal Ideation and Blood Cadmium Levels Based on the 3rd to 7th Korea National Health and Nutrition Examination Surveys: Sunmi Kim; STRESS. 2024;32(1):46-52. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.46

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Abstract PDF: Background
This study aimed to determine the association between blood cadmium levels and suicidal ideation.
Methods
Using data from the 3rd to 7th Korea National Health and Nutrition Examination Surveys, the geometric mean of blood cadmium levels according to suicidal ideation was compared using multiple linear regression analyses in male and female adults. The frequency of suicidal ideation according to the blood cadmium levels was also compared using multiple logistic regression models.
Results
In total, 6,877 men and 6,698 women were included in the study. When adjusting for all potential confounding factors, the geometric mean of blood cadmium levels was significantly higher in participants with suicidal ideation than in those without suicidal ideation in both men (0.92 ng/ml [95% confidence interval 0.87∼0.97 ng/ml] vs. 0.86 ng/ml [0.84∼0.88 ng/ml]; p=.026) and women (1.05 ng/ml [95% confidence interval 1.01∼1.10 ng/ml] vs. 0.99 ng/ml [0.98∼1.02 ng/ml]; p=.006). After adjusting for potential confounders, the frequency of suicidal ideation significantly increased as blood cadmium levels increased in men (p for trend=.014) and women (p for trend=.034).
Conclusions
Results revealed an association between blood cadmium levels and suicidal ideation in Korean adults.

Effect of Cognitive Processing Style on Attentional Blink during Analogue Trauma: Ye Ji Son, Yun-Kyeung Choi; STRESS. 2024;32(1):38-45. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.38

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Abstract PDF: Background
This study attempted to examine the impact of each cognitive processing style (bottom-up, top-down) on attention patterns following a traumatic experience by measuring attentional blink (AB).
Methods
Participants were 37 university students with no direct experience of traffic accidents. They were randomly assigned to either a single-task (bottom-up processing) group or a dual-task (top-down processing) group, who performed the Rapid Serial Visual Presentation (RSVP) after watching an analogue trauma video. The correct response rate to target stimuli was then compared between groups based on stimulus type and stimulus presentation interval.
Results
In the dual-task group, no significant differences were found. However, in the single-task group, a trend towards a decrease in the correct response rate to the target stimulus was observed 200 ms after the presentation of the traumatic stimulus (i.e., AB).
Conclusions
This tendency can be explained by the phenomenon of automatic attentional capture by traumatic stimuli, suggesting a relationship between bottom-up processing and attentional bias.

The Relationship between Level of Therapist Support and Efficacy and Adherence in Internet-Based Cognitive Behavioral Therapy for Disordered Eating Behaviors: Seyeom Kim, Eun-Jung Shim; STRESS. 2024;32(1):29-37. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.29

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Abstract PDF: Background
Therapist support is an important intervention design factor in internet-delivered psychotherapy. However, the relationship between therapist support and intervention outcomes is not well established. This study examined the relationship between therapist support, efficacy, and adherence to Internet-based Cognitive Behavioral Therapy (I-CBT) for disordered eating behaviors.
Methods
Thirty-six women with disordered eating behaviors were recruited and randomly assigned to three groups: low, medium, and high levels of therapist support. The participants received eight sessions of I-CBT, twice a week, with varying levels of therapist support.
Results
While all three groups showed a reduction in eating disorder risk factors (i.e., body image disturbance, disordered eating behaviors, depression, and anxiety), there were no significant differences in these improvements by therapist support level. However, there were significant differences in intervention completion rates by therapist support level, with higher levels of support associated with increased intervention completion rates.
Conclusions
Therapist support can potentially improve adherence to internet-based interventions.

Relationship between Mindfulness and Stress Response in High School Students: Mediating Effect of Self-Regulation Ability: Yoonjung Choi, Mihee Lee, Jeongik Choi; STRESS. 2024;32(1):19-28. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.19

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Abstract PDF: Background
This study explored the applicability of mindfulness meditation as an intervention approach in school counseling for managing daily stress in high school students. The study investigated the mediating effect of self-regulation ability on the relationship between mindfulness and stress response.
Methods
Data from 244 high school students (119 men and 125 women) were used to examine the mediating effect, controlling for academic variables using Hayes’ (2013) Process Macro Model 4.
Results
There was a positive correlation between mindfulness and self-regulation abilities, and mindfulness and self-regulation abilities were negatively correlated with stress response. Moreover, for students who perceived higher academic achievement levels, self-regulation abilities were positively correlated, and stress response were negatively correlated. Results showed a full mediating effect of self-regulation ability on the adverse relationship between mindfulness and stress response. The mediating effects of self-regulation modes were differentially observed in the adverse relationship between mindful consciousness and attitude dimensions of stress response.
Conclusions
These findings suggest that when applying mindfulness meditation as a daily stress management strategy for high school students, enhancing their self-regulation ability should be the focus of intervention.

Effect of Daily Stress on School Adjustment among Children at Community Child Centers: Mediating Roles of Inattention and Social Withdrawal: RaeHyuck Lee; STRESS. 2024;32(1):1-8. Published online March 28, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.1.1

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Abstract PDF

Background
This study verifies the influence of daily stress on school adjustment through inattention and social withdrawal among children at community child centers.
Methods
Analyses were performed on data collected from the Child Panel Survey of the Community Child Centers, followed by a series of regression analyses.
Results
First, daily stress had a negative and significant influence on school adjustment. Second, both inattention and social withdrawal among children mediated the influence of daily stress on school adjustment. Finally, the influence of daily stress on school adjustment was serially dual-mediated through inattention and social withdrawal.
Conclusions
This study presents evidence-based strategies that could help the school adjustment of children at community child centers.

Citations

Citations to this article as recorded by

A Phenomenological Study on Breast Cancer Survivors' Experiences of Mind Subtraction Meditation
Mi Ra Yun
Asian Oncology Nursing.2016; 16(3): 158. CrossRef

Efficacy of a Serious Game for Individuals with Interpersonal Trauma: Hyae Young Yoon, Sang-Hyun Cho, Yun-Kyeung Choi; STRESS. 2023;31(4):205-219. Published online December 28, 2023; DOI: https://doi.org/10.17547/kjsr.2023.31.4.205

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Abstract PDF: Background
This study aimed to develop a serious game for college students with interpersonal trauma to practice adopting an alternative perspective mentoring a game character with similar experiences.
Methods
We recruited 44 college students with high levels of distress after experiencing interpersonal trauma. They were assigned to either the serious game+relaxation training (SG+RX, n=22) or the virtual reality+relaxation training condition (VR+RX, n=22). Cognitive, emotional, and self-efficacy aspects related to trauma were compared in both groups before and after treatment. In addition, interpersonal perceptions of "warmth, dominance, trust, and accessibility" for facial expressions of happiness, anger, and neutrality were compared in both groups before and after treatment.
Results
Both groups showed positive changes in relaxation, post-traumatic cognition, and post-traumatic emotion after treatment. The SG+RX group showed greater increases in behavioral competence and confidence in the future and rated accessibility to angry/happy facial expressions higher than the VR+RX group.
Conclusions
These findings suggest that an interactive serious game promoting empathy, coping skills, and an alternative perspective effects positive changes for individuals with interpersonal trauma.

The Moderating Role of Perceived Social Support in the Relation between Type D Personality and PTSD Symptoms among ICU and ER Nurses: Sohyeon Kim, Myung-Ho Hyun; STRESS. 2023;31(4):197-204. Published online December 28, 2023; DOI: https://doi.org/10.17547/kjsr.2023.31.4.197

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Abstract PDF: Background
This study examined the moderating effects of four types of perceived social support on the relation between type D personality and post-traumatic stress disorder (PTSD) symptoms among ICU and ER nurses.
Methods
Data were collected from 223 ICU and ER nurses in university or general hospitals located in Seoul. A questionnaire survey method was used for data collection and SPSS Windows 28.0 and PROCESS Macro Program were used for data analysis.
Results
The results showed that only the moderating effect of senior support was statistically significant, while perceived support from family, friends, and coworkers were not. Specifically, the effect of type D personality on post-traumatic stress disorder (PTSD) symptoms was weaker in ICU and ER nurses who perceived higher social support from senior nurses.
Conclusions
The study highlighted the significance of senior support in protecting the psychological health of ICU and ER nurses. Additionally, it addressed the major considerations in developing practical interventions in hospital settings.

Developing Smoking Cessation Program for Female Smokers and Assessment of Its Impacts: Kyung Hyun Suh; STRESS. 2023;31(4):189-196. Published online December 28, 2023; DOI: https://doi.org/10.17547/kjsr.2023.31.4.189

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Abstract PDF: Background
Female smokers find it challenging to quit smoking. The number of female smokers in Korea has not seen any decline. This study developed a smoking cessation program tailored for female smokers and evaluated its effectiveness.
Methods
The treatment group, which was subjected to the smoking cessation program, was composed of seven adult female smokers and five female college students who smoked. The control group comprised 7 adult female smokers and 5 female college students who wanted to quit smoking.
Results
Of the 12 participants in the control group, only 1 (8.3%) reported that she had maintained abstinence for 4 months and 1 week, while 5 (41.7%; 3 adults and 2 students) out of the 12 in the treatment group managed to abstain. For female smokers in this group, the motivation and empowerment to quit smoking increased significantly after participating in the program, and these positive effects were sustained for up to 3 months after the completion of the program.
Conclusions
Female smokers who participated in the program that was developed as part of this study exhibited a significant abstinence rate, and their motivation and empowerment to quit smoking improved. These results indicate that this smoking cessation program can be clinically useful in helping female smokers quit smoking.

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