Health-related quality of life in adults with cystic fibrosis: the role of coping

OBJECTIVE: This study examined the role of coping in explaining health-related quality of life (HRQoL) in cystic fibrosis (CF). METHODS: Coping, quality of life, and clinical variables were assessed. The CF Coping Scale measures four ways of coping: optimistic acceptance, hopefulness, distraction, and avoidance. The Cystic Fibrosis Quality of Life Questionnaire (CFQoL) comprises 9 domains: physical, social, treatment, chest symptoms, emotional, body image, relationships, career, and future. Step-wise multiple regression and path analysis were used to model the associations between coping and CFQoL domains, taking into account important demographic and clinical factors. RESULTS: One hundred and sixteen people with CF were recruited to the study. Their mean FEV(1)% predicted and BMI were 59.3% and 21.2 kg/m(2), respectively. Mean scores were highest for optimism and lowest for distraction coping. Coping had an inequitable influence across the CFQoL domains: it had negligible influence on domains that incorporate symptoms and aspects of physical functioning but considerable influence on psychosocial domains. Optimism and distraction were strongly associated with emotional responses, social functioning, and interpersonal relationships. A high level of optimism was associated with a better HRQoL and high levels of distraction with a poorer HRQoL. For some domains, optimism and distraction had a counterbalancing effect so the difference between them could be an important predictor of HRQoL. CONCLUSION: Coping has emerged as an important factor in explaining some quality-of-life domains but not others. This has important implications especially when employing HRQoL as an outcome measure in clinical trials.     

精神分裂症患者应对方式的结构

背景 精神分裂症患者面临着许多压力,但他们不恰当的应对方式往往影响着疾病的预后.国外的应对方式问卷由于文化背景差异不完全适用于我国人群;而国内的应对方式量表是在精神病人以外的人群中建立的,是否适合精神病人仍不清楚.本研究旨在探索精神分裂症患者和正常人的应对方式结构是否相同,如存在差异,则应另编制适合患者的问卷.方法 通过文献复习收集了91个应对方式项目.7例精神分裂症患者完成模拟测查,根据反馈意见修改部分项目并补充了1个项目.经专家评阅后修改编辑成92个项目的应对方式问卷初稿.分别在符合入选条件的315名正常人和208例精神分裂症患者中测试.患者的入选条件①≥16岁;②符合中国精神障碍分类与诊断标准第3版(CCMD-3)精神分裂症诊断标准;③住院接受药物治疗1个月或以上;④临床总体印象评定的病情严重程度为"中度有病"或更轻,且阳性和阴性症状量表(PANSS)中"注意障碍"项目得分不超过3分;⑤能够理解题意独立完成问卷并知情同意.正常组入选条件①≥16岁;②无精神病史;③能理解题意独立完成问卷并知情同意.对测试结果采用探索性因子分析比较两组的应对方式结构.经过因子分析删除了共通性或载荷量低的项目,两组总共保留了73个项目.根据研究对象的反馈意见再次修改及合并有关项目,编辑成65个项目的应对方式问卷修改稿.而后在符合同样入选条件的另外287名正常人和219例精神分裂症患者中进行验证,采用验证性因子分析分别确定各自的应对方式结构.同时收集患者的病程、诊断亚型资料,并由3名经过一致性培训的主治医师以上的精神科医师对其中205名患者进行了PANSS评定,分析患者的临床特点与应对方式因子得分之间的关系.结果 正常组的应对方式包括"问题解决指向"、"回避"、"认知调整"、"情绪调节"、"寻找专业支持"和"否认"6个因子;而患者组只有前四个因子,后两个因子的相应项目分散到这四个因子中,没有形成独立的因子.验证性因子分析的结果验证了上述结构.研究对象的年龄、性别以及受教育程度对因子结构均无明显的影响.模型比较的结果说明4因子结构对分裂症患者优于6因子结构.偏执型患者"回避"因子分高于未分型患者;偏执型及未分型患者的"问题解决"和"认知调整"因子分高于其他患者.总病程与"情绪调节"因子分呈正相关;PANSS阳性症状分与"回避"因子分呈正相关.结论 精神分裂症患者应对方式的结构与正常人不同,患者的应对方式缺乏必要的选择性.在此基础上编制适合精神分裂症患者特点的应对方式问卷是必要的.     

Coping strategies and behavioral/emotional problems among Chinese adolescents

This study was carried out to describe strategies used to cope with stress and to explore the association between coping strategies and behavioral/emotional problems in a community sample of adolescents from Mainland China. Participants completed a self-administered questionnaire incorporating the Chinese Trait Coping Style Questionnaire, the Chinese version of the Youth Self-Report of Child Behavior Checklist, and a number of demographic questions. Results indicated that Chinese adolescents often used multiple coping strategies when faced with stress. Principal factor analysis followed by oblique rotation revealed two dimensions of coping strategies in Chinese adolescents: active coping and avoidant coping. A series of logistic regression analyses showed that avoidant coping was significantly associated with increased risk for internalizing and externalizing problems, but active coping was associated with reduced risk, after adjustment for child's age and sex and father's occupation. These findings provide evidence of the association between coping and mental health problems in Chinese adolescents.     

Factor structure in the Camberwell Assessment of Need–Patient Version: The correlations with dimensions of illness,personality and quality of life of schizophrenia patients

Aim: To investigate the factor structure underlying the Camberwell Assessment of Need–Patient Version (CANSAS‐P) items in schizophrenia and schizoaffective disorder. Method: Factor, correlation and regression analyses were performed for dimensions of CANSAS‐P, illness, personality and quality of life (QOL) related variables in 95 stabilized patients with chronic schizophrenia and schizoaffective disorder. Results: Exploratory factor analysis revealed a four‐factor model that explains 50.4% of the total variance of the 20 CANSAS‐P items. The factors ‘Social disability’, ‘Information processing disability’, ‘Emotional processing disability’, and ‘Coping disability’ showed acceptable internal consistency (Cronbach's α coefficient 0.67–0.77). The CANSAS‐P subscale scores positively correlated with severity of symptoms, distress (r ranged from 0.34 to 0.45), while negatively associated with general functioning (r = ?0.34), friend (r = ?0.46) and family support (r = ?0.41), satisfaction with medicine (r = ?0.35), general activities (r = ?0.40), and general QOL (r = ?0.35) (all P < 0.001). Severity of illness, symptoms, emotional distress and emotion‐oriented coping were positive predictors; friend support, QOL general activities, life satisfaction and satisfaction with medicine were negative predictors of the CANSAS‐P subscale scores. The effect size (f²) for these predictors ranged from medium to quite large (f² = 0.28–1.13), and they explain from 23% to 46% of the variability in CANSAS‐P subscales. Conclusions: A four‐factor structure mode, including social and cognitive functioning, emotion responsivity and coping with daily challenges, appears to fit CANSAS‐P items. These subscales may contribute to research and improve treatment of psychiatric patients.     

Adolescent coping: the different ways in which boys and girls cope

In order to investigate the ways in which boys and girls cope with their concerns, 650 Year 11 and Year 12 students from seven post-primary schools in Melbourne, Australia were asked to describe how they cope with the main concerns in their lives. In addition to elicitation of spontaneous responses, a modified form of the Ways of Coping Checklist (Folkman and Lazarus, 1980; 1985b) was also administered to obtain an assessment of students coping strategies. Clear differences were found between the ways in which boys and girls cope. Girls seek more social support and generally are more likely than boys to focus on relationships. They also employ more strategies related to hoping for the best and wishful thinking. The question of how boys and girls can develop their coping repertoire so as to increase the adaptability of their responses in difficult situations is also addressed.     

Coping styles in prodromes of bipolar mania

OBJECTIVES: Psychological studies have identified that different coping strategies affect outcome in bipolar disorder (BD), with the possibility of preventing mania by effective coping with prodromes. This study seeks to examine coping mechanisms using a recently developed scale to clarify the relationship of coping styles to clinical and demographic characteristics, and to identify coping differences between bipolar I and II subjects. METHODS: The Coping Inventory for Prodromes of Mania (CIPM) was completed by 203 bipolar patients, along with other diagnostic and clinical measures. The CIPM is organized into four factors of coping including: stimulation reduction (SR), problem-oriented coping (PR), seeking professional help (SPH), denial and blame (DB). CIPM psychometric properties and its relationship to demographic and clinical factors, dysfunctional attitudes, and mood symptoms were examined. Coping profiles were generated by BD subtype (I versus II). RESULTS: The CIPM displayed psychometric properties consistent with the single previous study with this instrument. Neither demographic/clinical characteristics nor mood symptoms showed any particular relationship with the CIPM. Clear differences in coping also emerged between BD I and BD II subjects. BD I tended to use a wider range of coping strategies and scored highly on the SPH factor as compared to BD II subjects. BD II participants preferred to use DB and PR, but were less likely to use SPH and SR. CONCLUSIONS: The CIPM appears to be a valid measure of coping. Coping style preferences appear to differ according to bipolar subtype.     

Coping behavior in patients with panic disorder

The purpose of the present paper was to investigate the role of coping behavior in patients with panic disorder (PD). This was done by evaluating three items of coping behavior (seeking of social support, wishful thinking and avoidance) in the Ways of Coping Checklist. The subjects consisted of 30 patients with PD (26 with agoraphobia). Coping behavior and the severity of PD was investigated at baseline and at 24 months (the final outcome). At baseline there were no gender differences in coping behavior. The severity of panic attacks significantly correlated with that of agoraphobia. The baseline severity of PD (panic attacks and agoraphobia) did not correlate with coping behavior. At the outcome assessment there was no significant correlation between the severity of panic attack and coping behavior. The severity of agoraphobia at final outcome and the coping behavior (seeking of social support) at baseline were significantly correlated. In the group that had remission in agoraphobia (the good outcome group), the severity of agoraphobia at baseline was significantly lower and the seeking of social support coping behavior was significantly higher than that of the poor outcome group. No significant difference in panic attack severity was noted between the good and poor outcome groups. Discriminant analysis revealed that seeking of social support coping behavior was a significant discriminant factor of agoraphobia. Although these are preliminary data, special coping behavior might be related to improvement of agoraphobia in patients with PD.     

Five-factor model of schizophrenic psychopathology: how valid is it?

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing--in a decreasing order of relative importance--the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.     

Coping strategies and its effects on depression among caregivers of impaired elders in Japan

The purpose of this study was to explore the coping strategies of Japanese family caregivers and to investigate relationships between coping strategies, caregiving stressors,and family caregivers' mental health. We conducted a survey by mail among family members who provided care for physically or mentally impaired elderly. In this study, we used 166 responses from family caregivers for analysis. Results of exploratory and confirmatory factor analysis indicated three factors,categorized 'Resignation,' 'Consulting and complaining' and 'Distancing'. In addition, results of structure equation modelling suggested a significant effect of 'Resignation' on the mental health of caregivers. Although the factor structure of coping strategies was similar to other studies conducted in Western countries, the effects of coping strategies were quite different. In conclusion, the effects of coping strategies on caregivers' mental health were confirmed in this study, but different types of coping strategies from those of Western countries were found to be associated with mental health of Japanese family caregivers.     

抑郁症患者应对效能在中庸思维和心理健康间的中介作用

目的探讨抑郁症患者应对效能在中庸思维和心理健康间的中介作用。方法运用中庸思维量表、应对效能问卷(CEQ)、症状自评量表(SCL-90)对在广州市民政局精神病院就诊的270例符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断的患者进行测评。结果 1中庸思维各维度与应对效能各维度之间评分均呈正相关(r=0.217~0.442,P0.01),SCL-90总评分与中庸思维及应对效能各维度呈负相关(r=-0.324~-0.161,P0.05或0.01)。2路径分析表明中庸思维各维度对应对效能和心理健康有直接效应(β=-0.34~0.69,P0.01),应对效能对SCL-90总评分有直接效应(β=-0.36,P0.01),中庸思维间接影响心理健康。结论应对效能在中庸思维和心理健康之间起着重要的中介作用,中庸思维能够改善个体的应对效能从而促进心理健康。