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Shift-and-persist strategies as a potential protective factor against symptoms of psychological distress among young adults in Puerto Rico

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Abstract

Objective

Residents of Puerto Rico are disproportionately exposed to social and environmental stressors (e.g., Hurricane María and the 2020 sequence of tremors) known to be associated with psychological distress. Shift-and-persist (SP), or the ability to adapt the self to stressors while preserving focus on the future, has been linked with lower psychological distress, but no study has evaluated this in Puerto Rico. This study examined the association between SP and psychological distress (including that from natural disasters) in a sample of young adults in Puerto Rico.

Methods

Data from the Puerto Rico-OUTLOOK study (18–29 y) were used. Participants (n = 1497) completed assessments between September 2020 and September 2022. SP was measured with the Chen scale and categorized into quartiles (SPQ1–SPQ4). Psychological distress included symptoms of depression (CESD-10), anxiety (STAI-10), post-traumatic stress disorder (Civilian Abbreviated Scale PTSD checklist), and ataque de nervios (an idiom of distress used by Latinx groups). Outcomes were dichotomized according to clinical cutoffs when available, otherwise used sample-based cutoffs. Two additional items assessed the perceived mental health impact of Hurricane María and the 2020 sequence of tremors (categorized as no/little impact vs. some/a lot). Adjusted prevalence ratios (PR) and their 95% confidence intervals (CI) were estimated.

Results

The most commonly reported psychological distress outcome was PTSD (77%). In adjusted models, compared to SP Q1, persons in SP Q2–Q4 were less likely to have elevated symptoms of depression (PR Q2 = 0.79, 95% CI = 0.72–0.85; PR Q3 = 0.65, 95% CI = 0.58–0.73; and PR Q4 = 0.41, 95% CI = 0.35–0.48), PTSD (PR Q2 = 0.92, 95% CI = 0.87–0.98; PR Q3 = 0.86, 95% CI = 0.80–0.93; and PR Q4 = 0.76, 95% CI = 0.70–0.83), anxiety (PR Q2 = 0.39, 95% CI = 0.31–0.48; PR Q3 = 0.27, 95% CI = 0.20–0.37; and PR Q4 = 0.11, 95% CI = 0.07–0.17) and experiences of ataque de nervios (PR Q2 = 0.85, 95% CI = 0.76–0.94; PR Q3 = 0.79, 95% CI = 0.70–0.90; and PR Q4 = 0.68, 95% CI = 0.60–0.78). Compared to persons in SP Q1, persons in SP Q3–Q4 were less likely to report adverse mental health impacts from Hurricane María (PR Q3 = 0.66, 95% CI = 0.55–0.79; and PR Q4 = 0.53, 95% CI = 0.44–0.65) and the 2020 sequence of tremors (PR Q3 = 0.77, 95% CI = 0.61–0.98; and PR Q4 = 0.74, 95% CI = 0.59–0.94).

Conclusion

SP was associated with lower psychological distress. Studies are needed to confirm our findings and evaluate potential mechanisms of action.

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Data availability

Data will be made available upon request to CMP or MCR.

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Acknowledgements

Dr. López-Cepero is funded by the Building Interdisciplinary Research Careers in Women’s Health of the NIH under Award Number 8K12AR084234. Puerto Rico-OUTLOOK is funded by NIH-NHLBI under award number 5R01HL149119-04.

Funding

This article is funded by NIH BIRCWH, 8K12AR084234, National Heart, Lung, and Blood Institute, 5R01HL149119-04, 5R01HL149119-04.

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Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    Andrea A. López-Cepero, Shakira F. Suglia, Tené T. Lewis & Natalia Mazzitelli

  2. Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA

    Tanya Spruill

  3. Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico

    Cynthia M. Pérez

  4. Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA

    Milagros C. Rosal

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  1. Andrea A. López-Cepero
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Contributions

All authors have contributed to the scientific aspects of this manuscript. ALC: designed statistical analysis and conceptual model, conducted statistical analyses, data interpretation, and wrote the manuscript. TS, SS, and TL: helped to design the conceptual model, contributed to data interpretation, and revised the manuscript critically for important intellectual content. NM: conducted literature review and drafted the introduction of the manuscript. CP and MCR: acquired the data and revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript.

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Correspondence to Andrea A. López-Cepero.

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López-Cepero, A.A., Spruill, T., Suglia, S.F. et al. Shift-and-persist strategies as a potential protective factor against symptoms of psychological distress among young adults in Puerto Rico. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02601-1

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