Denial in patients with advanced cancer is a common yet poorly understood phenomenon. This case report aims to illustrate the complexity of apparent denial in a psycho-oncology setting and to use it as a clinical anchor to review the concept of denial through multiple theoretical and practical lenses, highlighting key considerations for clinicians.

We present the case of a woman in her forties, originally from Africa, diagnosed with advanced metastatic gastric cancer. The case is examined through a narrative review of the existing literature on denial, encompassing psychological, psychiatric, neurocognitive, cultural, and systemic perspectives.

The patient demonstrated behaviors initially interpreted as denial by the treating service, including behaviors such as declining prognostic discussions, refusing to inform her family, and avoiding opioid analgesia, yet she explicitly acknowledged her diagnosis and its severity. Psycho-oncology consultation helped reframe her responses as coherent, value-driven choices rooted in her role as a mother and her cultural background, rather than as impaired insight or maladaptive coping. On the final day of her life, she accepted palliative care and consented to family notification, illustrating the fluid and evolving nature of apparent denial.

This case underscores the importance of individualized assessment and offering care before pathologizing patient disengagement. We discuss how palliative or psycho-oncology practitioners could distinguish adaptive coping from maladaptive denial, identify underlying psychiatric conditions, and screen for neurocognitive impairment if relevant. A multidisciplinary, empathic approach that respects patient autonomy is essential in navigating such complex encounters.

This study aimed to examine religious and post-Christian spiritual orientations, types of spiritual and ritual activities, coping strategies of patients with advanced illness and explore associations between spiritual needs, practices, well-being, quality of life, and coping styles.

One hundred and two patients completed validated instruments: Post-Christian Spirituality Scale, Spiritual Needs Questionnaire, Spiritual Practices Questionnaire, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale, Global Quality of Life Scale, and Brief-COPE Questionnaire. Descriptive statistics summarized participant characteristics and scale distributions. Spearman correlations (Bonferroni-adjusted) examined associations between spiritual needs, practices, and coping modes. Multivariate regression analyses assessed whether ritual practices predicted spiritual needs.

Inner peace (median, 1.4; IQR, 1, 2) and humanistic/prosocial practices (median, 66.6; IQR, 44.4, 83.2) were prominent spiritual needs and frequently used rituals, respectively. Strong correlations were observed between religious needs and religious rituals (rho = 0.87). Existential, inner peace, and giving/generativity needs correlated moderately with existentialistic practices (rho = 0.56–0.69). Humanistic/prosocial spiritual practices were moderately associated with giving/generativity (rho = 0.52) and inner peace needs (rho = 0.42). Emotion-focused coping, particularly acceptance and emotional support, was most consistently associated with spiritual needs and practices, reinforcing the centrality of relational and embodied forms of spirituality at the end of life. Regression analyses confirmed existentialistic practices predicted existential and inner peace needs, while humanistic practices predicted generativity needs.

Findings demonstrate strong alignment between spiritual needs and ritual activity, supporting development of personalized, ritual-based spiritual care frameworks. Determining individual orientations toward embodied, relational, and humanistic practices may offer an adaptable means of addressing spiritual suffering.

The Family Adaptation study, ancillary to the Single Ventricle Reconstruction Trial, examined the prevalence of anxiety and its associations with stress, psychosocial factors, and quality of life measures in parents of infants who underwent the Norwood procedure.

Two hundred and fifteen parents (143 mothers and 72 fathers) of 146 infants completed state anxiety (State Anxiety Inventory), stress, psychosocial, and quality of life measures post-Norwood, post-Stage II, and at a final visit (median child age: 14 months).

A substantial proportion of parents reported severe anxiety symptoms following the Norwood surgery, with 61% of mothers and 43% of fathers affected, decreasing over time to 46% and 33% by the final visit, respectively. Mothers’ average STAI-S scores were significantly higher than fathers’ post-Norwood (47.7 ± 13.2 versus 43.5 ± 11.8, p = 0.03), declining to 42.1 ± 13.0 versus 39.0 ± 9.6 (p = 0.14) at the final visit. Stress related to parenting a child with a serious illness was a stronger and more consistent predictor of mothers’ anxiety over time (highest R2 = 0.49 for emotional distress), whereas insufficient coping and fewer protective factors were greater and more consistent predictors for fathers (highest R2 = 0.40 for mastery and health). Quality of life was a consistent predictor of state anxiety for both mothers and fathers.

Anxiety is elevated in parents of infants who underwent the Norwood procedure and is influenced by a complex interplay of stress, psychosocial factors, and quality of life. Addressing these factors is crucial for improving parents’ mental health, which in turn promotes the well-being of the entire family.

Non-suicidal self-injury (NSSI) displays an alarmingly high prevalence rate among university students, placing them at high risk for adverse long-term outcomes, including suicide.

This study aimed to achieve a better understanding of factors contributing to NSSI in university student populations by examining reasons for NSSI and histories of stressful events and coping strategies.

A total of 185 university students with a lifetime history of NSSI were assessed for depressive symptoms and NSSI characteristics. They completed three questionnaires on NSSI reasons, stressful events and coping strategies during childhood and adolescence. Each questionnaire included an ‘others’ option combined with an open-ended response box. After descriptive analysis of the closed questions, these open-ended responses were qualitatively categorised and analysed as predictors of depression severity and NSSI continuation from adolescence into adulthood.

Qualitative analysis identified eight, five and ten categories from the open-ended responses for NSSI reasons, stressful events and coping strategies, respectively, with substantial to almost perfect interrater reliability. Two qualitative reason categories, one stressful event category and two coping strategy categories significantly predicted depression severity (β = 0.21–0.23). Participants reporting events in the stressful events category ‘Traumatisation and experiences of violence’ were three times more likely to continue NSSI into adulthood (f 2 = 0.07).

This study demonstrates the value of mixed-methods approaches. Stable qualitative categories highlight the need to capture individual variations in NSSI-related factors. It emphasises trauma-related stressors due to their influence on depression severity and persistence of NSSI into adulthood.

Cognitive and behavioral factors contribute to the mitigation of stress-related health outcomes in later life. Given that stress management interventions for older adults are an important target for healthcare, there is a need for a relatively short and standardized assessment tool to comprehensively measure stress and coping in later adulthood while minimizing the burden on participants. The Stress Assessment Inventory (SAI), a 123-item measure designed to assess stress and coping resources in younger adults.

The objective of this study was to examine the psychometric properties of the SAI in 294 older adults.

The SAI was evaluated on its dimensionality, reliability, and validity.

A shortened SAI is proposed for older adults, with good internal consistency and criterion validity. The Revised SAI was found to have a three-factor model that captures Adaptive Cognitive Resources, Maladaptive Behavioral and Cognitive Habits, and Adaptive Health Habits.

The current study supports the use of the Revised SAI in community-dwelling older adult populations as a comprehensive tool to assess stress and coping for use by researchers and healthcare professionals.

Traumatic experiences can trigger post-traumatic stress disorder (PTSD) and influence one’s future perspective, which can change over time with the sense of control.

We measured changes in predictions about the future among individuals who experienced a traumatic event, with or without PTSD, according to their sense of control, and its relationship with post-traumatic change (post-traumatic stress symptom severity, well-being and coping strategies).

Eighty-one exposed individuals (who experienced the 2015 Paris terrorist attacks), some with PTSD, and 71 non-exposed controls (who had not experienced the attacks) were asked to estimate the probable future occurrence of 20 controllable and 20 uncontrollable events, 7–18 and 31–43 months after the attacks. Repeated-measures analysis of variance and correlations were performed to measure inter-group differences in outcomes and relationships with post-traumatic change.

Exposed participants with PTSD and without PTSD estimated uncontrollable future events to be more likely over time. Uncontrollable predictions were related to increases in post-traumatic stress symptom severity for individuals without PTSD. Uncontrollable predictions were not correlated with well-being or coping in exposed individuals.

Over time, exposed individuals provide increasingly high probability ratings for the future occurrence of uncontrollable events, a tendency associated with an increase in post-traumatic stress symptom severity in exposed individuals without PTSD. This may reflect potential delayed PTSD symptoms over time in individuals who did not initially develop PTSD following the attacks. The range of the measurements and the use of a self-constructed questionnaire limit the internal validity of the results.

Research on grief among family caregivers of individuals with dementia has seen a notable increase. Our objective was to synthesize the relationship between coping factors and pre-death grief (PDG).

(Prospero protocol: CRD42024560208) We conducted a systematic review of literature from PubMed, Web of Science, Scopus, PsycInfo, and Medline up to July 2024. Included studies encompassed quantitative, qualitative, and mixed methods approaches. During the study selection process, we excluded data on intervention effectiveness and studies not published in English. The quality of the studies was evaluated using the Mixed Methods Appraisal Tool. Evidence was summarized narratively.

Participants in this study are family caregivers who take care of dementia patients.

We included data from 12 studies in our analysis. The majority of these investigations were carried out in Western countries. The research primarily involved spousal or adult child caregivers and centered on PDG. We included validated measures of PDG in each study.

Among the reviewed studies, five reported on coping strategies, while seven addressed coping resources. Overall, the findings indicated that the application of coping strategies, specifically positive coping strategies, is effective in alleviating PDG and mitigating the effects of caregiving burden on PDG. Coping resources – including self-efficacy, sense of coherence, and support from friends and family – appear to have a beneficial impact in reducing PDG. Additionally, the quality of relationships with friends and family members was found to be a significant factor. Moreover, spiritual and religious beliefs, along with community faith, have been identified as crucial elements in alleviating grief experienced by caregivers.

Knowing what coping strategies and resources are beneficial to decrease PDG experiences among dementia caregivers.

Exposure to COVID-19 messaging that conflates older age with risk/infirmity has been suggested to have negative effects on older people’s sense of personal agency (i.e., sense of capacity to exercise control over one’s life).

This qualitative study sought to determine how older adults perceived this vulnerability narrative within early COVID-19 public messaging and how this may have influenced their personal agency.

Semi-structured interviews with 15 community-dwelling older adults in Manitoba were completed and analysed using inductive thematic analysis.

Study findings suggest that early COVID-19 public health messaging created associations between vulnerability and older age that increased the participants’ sense of age-related risk. As a response, many participants described engaging in certain actions (e.g., lifestyle behaviours, following public health protocols, coping mechanisms) to potentially increase their feelings of personal agency.

This study suggests that creators of public messaging pertaining to older age must be mindful of the ways that it may fuel a vulnerability narrative.