Multidimensional investigation of the structure of coping among people with amputations

Variability and stability of coping styles among breast cancer survivors: A prospective study

OBJECTIVES

We aimed to examine: (1) the long-term association between coping styles and psychological distress, (2) if women diagnosed with breast cancer have a predominant coping style, (3) stability of coping styles, (4) predictors of changes in coping styles, (5) if maladaptive coping adversely impacts disease-free survival (DFS).

METHODS

This prospective study included women diagnosed with primary breast cancer during 2006-2009. Patients completed questionnaires for the Norwegian Mini-Mental Adjustment to Cancer scale, which includes positive attitude (PA), helplessness/hopelessness (HH), anxious preoccupation (AP), and avoidance (AV), and the Hospital Anxiety and Depression Scale at diagnosis and 1, 3, and 5 years postdiagnosis.

RESULTS

Two hundred and ninety-three of 367 women (79.8%) completed the questionnaires at all time points. Anxiety and depression were moderately to strongly correlated with HH and AP coping styles (r = 0.31 to r = 0.69) at all time points. The predominant coping style was PA (23.4-29.9%). Stability for PA and cognitive AV styles was found at the group level, but not at an individual level. Chemotherapy and comorbidity were predictors for HH, AP, and AV 5 years postdiagnosis (p < 0.05). Maladaptive coping was not associated with DFS.

CONCLUSIONS

HH and AP were associated with higher psychological distress at all times. Group level coping remained stable over time for PA and AV. Coping style stability at an individual level was not observed. Having received chemotherapy and experienced adverse events affected coping at 5 years postdiagnosis. Maladaptive coping was not associated with DFS.

Impact of coping strategies on quality of life of adolescents and young women with endometriosis

Purpose: Endometriosis is a hormone-dependent, inflammatory, painful condition affecting 1 in 10 women during their reproductive years. The symptoms of endometriosis-dysmenorrhea, dyspareunia, infertility-negatively impact the quality of life (QoL) of the affected women. Few studies have been conducted on mental health and QoL impact in a younger endometriosis patient population (adolescents and young women). This study quantitative, cross-sectional study was designed to address this gap by ascertaining whether coping strategies may impact the QoL of this patient population. Methods: After consent, participants (n = 24) completed a sociodemographic questionnaire, Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI-II), Coping Strategies Inventory (CSI), Endometriosis Health Patient-5 (EHP-5) and Visual Analogue Scale (VAS). Results: Participants reported the use of both positive and maladaptive strategies to deal with the symptomatology, which were associated with QoL levels and mental health status. Associations between QoL and maladaptive coping strategies (e.g. autocriticism, social withdrawal) were uncovered. Cognitive restructuring was identified as an adaptive coping strategy that impacts QoL positively. Conclusion: These results provide additional evidence showing that endometriosis symptoms substantially affect the psychological well-being of young patients and identify opportunities for interventions (e.g. cognitive behavioral, rational/emotive therapy) to implement coping styles leading to improved QoL.

The Coping Circumplex Model: An Integrative Model of the Structure of Coping With Stress

It seems obvious that the identification of coping structure is necessary to understand how stress affects human health and functioning. Despite numerous coping conceptualization proposals, there is no agreement as to the core coping categories. This article presents the Coping Circumplex Model (CCM), which is designed to integrate various coping distinctions, drawing inspiration from the tradition of circumplex models in psychology. The model is based on the assumption that individuals in stressful situations face two tasks: they need to solve the problem and regulate their emotions, which are reflected in two corresponding dimensions, that is, the problem coping dimension and emotion coping dimension. Problem coping and emotion coping are interpreted as bipolar dimensions. Importantly, these dimensions define a space for other coping categories. The model contains a total of eight coping styles forming a circumplex: positive emotional coping, efficiency, problem solving, preoccupation with the problem, negative emotional coping, helplessness, problem avoidance, and hedonic disengagement. The paper discusses the potential of the CCM to overcome some of the problems of stress psychology by: (a) supplementing the set of coping categories (i.e., process, strategy, style) with coping mode; (b) providing a foundation for the integration of numerous coping constructs; (c) enabling the interpretation of results obtained by means of different coping measures, thus facilitating knowledge consolidation; (d) explaining relationships between coping and adjustment after trauma, as well as explaining the mechanisms of psychological interventions (e.g., cognitive therapy, exposure therapy); (e) clarifying linkages between the effectiveness of coping strategies and situation controllability. Moreover, the CCM may elucidate the relationship between coping and emotion regulation (e.g., cognitive reappraisal and expressive suppression).

Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study

OBJECTIVE

Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation.

DESIGN

A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients.

MAIN OUTCOME MEASURES

IES-R, WOC and HADS.

RESULTS

Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment.

CONCLUSIONS

Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.

A prospective study of positive adjustment to lower limb amputation

OBJECTIVE

To examine prospectively the influence of demographic, amputation and psychosocial variables on positive psychological adjustment outcomes for lower limb amputees.

DESIGN

A quantitative questionnaire study with two time points: at the beginning of rehabilitation and at six-month follow-up. Multiple regression analyses were used to determine the contribution of demographic/amputation factors versus psychosocial factors to adjustment outcomes.

SETTING

A regional outpatient specialist mobility and rehabilitation centre in the UK.

SUBJECTS

Participants were recruited as a consecutive sample of new referrals with lower limb amputation.

MAIN MEASURES

Age, gender, level and cause of amputation were recorded. The following measures were used: Hope Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Trinity Amputation and Prosthetic Experiences Scale (TAPES) pain subscale initially and the Positive and Negative Affect Scale (PANAS) and full TAPES at six-month follow up. The measures were administered by two specialist nurses.

RESULTS

Ninety-nine patients provided data at both time points. Hope at the beginning of rehabilitation was related to positive mood (P<0.001) and hope and social support were related to general adjustment (P<0.01, P<0.001) at follow-up. Demographic and amputation factors were not related to psychological adjustment outcomes in this study.

CONCLUSIONS

The findings demonstrate prospectively the importance of psychosocial variables in the prediction of positive adjustment to lower limb amputation.

A two-year longitudinal study of social support following amputation

PURPOSE

(1) To describe one aspect of social support, social integration, longitudinally for 2 years following lower limb amputation and (2) to explore the impact of social support on depression, pain interference, life satisfaction, mobility, and occupational functioning.

METHOD

Eighty-nine adults recruited from consecutive admissions to an orthopaedic surgery service completed telephone interviews 1, 6, 12 and 24 months following amputation surgery. Dependent variables included the Social Integration (SI) sub-scale of the Craig Handicap Assessment and Reporting Technique (CHART) and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

There was a high level of SI among most persons following lower limb amputations that was relatively unchanged in the 2 years following surgery. However, mean levels of SI were lower in this group compared to a sample without disabilities. MSPSS scores were highly variable, ranging from almost no support to the maximum amount of support. MSPSS was an important concurrent predictor of pain interference, life satisfaction, and mobility, controlling for demographic and amputation-related factors. Baseline MSPSS predicted mobility and occupational functioning 6 months post-amputation, controlling for demographic and amputation-related factors.

CONCLUSIONS

Findings suggest that interventions aimed at improving the quality of social relationships after amputation may facilitate participation in activities.

Sexuality in persons with limb amputation: A meaningful discussion of re-integration

PURPOSE

Rehabilitation professionals do not appear to be sufficiently prepared to deal with the sexual issues of people with a physical disability, although they have recognized the value of discussing them during the rehabilitation process. This commentary argues that the sexuality of people with a disability should be evaluated from the two viewpoints of sexual function and sexual concern. With regard to people with a limb amputation, their sexual life has not attracted researchers' or clinicians' interest because their sexual function is usually preserved, is the same as that of able-bodied persons, and there is a perception that assistance is not required. Indeed, the number of published studies on the sexuality of this population is apparently fewer than the number of studies on the sexuality of persons with central nervous system impairment.

CONCLUSION

Investigation of the body image of people with a limb amputation and recognition of their needs are considered to be necessary for further discussion of this theme. Discussion of sexuality with some realistic statistical figures should also have great value in assisting with the re-integration of people with a limb amputation.

Transfemoral amputees' experiences of the first meeting and subsequent interactions with hospital staff

PURPOSE

To describe, by use of a phenomenological approach, how transfemoral amputees experience their first meeting and subsequent interaction with hospital staff in the acute phase, in the long term and suggestions for future care-giving.

METHOD

Eleven transfemoral amputees, median age 33.5 years, were interviewed. The amputations, performed in median 7.5 years before the interview, were caused by tumour, motorcycle accidents or work-related traumas. The participants were community dwelling and managed well indoors. All, except one, worked or studied full time. The interviews were tape-recorded and transcribed verbatim.

RESULTS

Three themes emerged: (i) Communication/information - limitations in preparing the patient for the new situation, (ii) empathy and emotional support, and (iii) ability to meet the need of individually tailored rehabilitation. For future care-giving three categories emerged: (i) Individually tailored communication/information, (ii) rehabilitation to be prepared to adapt to one's new situation, and (iii) support in regaining control.

CONCLUSION

The participants expressed a need for both professional and emotional support in the acute phase. Over time they preferred a patient-centred approach which improved coping skills and facilitated their own ability to gain control. Increased awareness of how meeting and interacting with hospital staff influences rehabilitation processes may further improve patient satisfaction and outcomes.

Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations

OBJECTIVE

This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations (n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment.

METHOD

One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use.

RESULTS

Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score > or =8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score > or =8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment.

CONCLUSIONS

These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.

Psychosocial adaptation to spinal cord injury: a dimensional perspective

From 313 individuals who sustained spinal cord injuries self-reported responses were examined on their psychosocial adaptation to disability and perceived quality of life. A multidimensional scaling analysis yielded a 2-dimensional structure of adaptation. The first dimension indicated adaptive versus nonadaptive reactions. The second dimension was suggestive of denial versus realization of the affect related to the medical impairment.

Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations

This study examines the contribution of demographic/amputation-related variables and coping strategies to the prediction of psychosocial adaptation in veterans with acquired lower limb amputations. Multiple indicators of the psychosocial adjustment of 796 individuals in the UK aged between 26-92 years with lower limb amputations were assessed. Hierarchical linear regressions were performed to investigate relationships between demographic/amputation-related variables (i.e. age, time since amputation, amputation level and amputation aetiology), the dimensions of coping (namely problem solving, seeking social support and avoidance) and self-reported adaptation to amputation, as well as symptoms of intrusion, anxiety and depression. Results indicated that coping styles were important predictors of psychosocial adaptation. Avoidance was strongly associated with psychological distress and poor adjustment. In contrast, problem solving was negatively associated with depressive and anxious symptomatology whereas seeking social support was negatively associated with symptoms of depression and positively associated with social adaptation. These findings suggest the potential for interventions designed to promote particular coping strategies to improve psychosocial outcomes.

Psychosocial adjustment to lower-limb amputation: a review

PURPOSE

To review the existing literature on the social and psychological challenges faced by people with an amputation and to provide a detailed analysis of the literature examining psychological adjustment to these challenges across time.

METHOD

Existing papers on psychological adjustment to amputation were analysed according to their results, methodology, and conclusions.

RESULTS

Although depression and anxiety are relatively high up to 2 years post-amputation, they appear to decline thereafter to general population norms. However, social discomfort and body-image anxiety have also been found among some people with amputations, and these have been associated with increased activity restriction, depression, and anxiety. Factors associated with positive adjustment to limb loss include greater time since amputation, more social support, greater satisfaction with the prosthesis, active coping attempts, an optimistic personality disposition, a lower level of amputation in the case of lower limbs, and lower levels of phantom limb pain and stump pain.

CONCLUSION

The majority of studies on adjustment to amputation are cross-sectional in design and have used noncomparable measures. Furthermore, they have neglected to study many important areas of rehabilitation, including immediate reaction to amputation, adjustment during and shortly after the rehabilitation period, and development of a changed sense of self and identity. In order to address these concerns, more longitudinal and qualitative research is called for. We end by outlining the components of a descriptive phased model of the rehabilitation process.

Psychological aspects of mutilating hand injuries

The immediate and long-term outcome of a mutilating hand injury can be positively influenced by health care professionals adopting a biopsychosocial perspective toward treatment and management. Such an injury produces a psychological and social impact that should be openly and candidly addressed with the injured individual and with the family. The earlier and the more skillfully these issues are addressed, the more likely it is that psychological factors will not impede functional outcome.

Sexuality in persons with limb amputation

Eighty-five (85) persons with limb amputation participated in a self-report survey with the aim of describing their physical and psychological status in their sexual life. The questionnaire was organised to reveal not only the physical aspect of sexual life but also life satisfaction. The results indicated that: 1) 43.5% of the respondents talked about sexual issues with somebody in daily life; 2) 60.0% of the respondents engaged in coitus; and 3) the existence of a partner was shown to be a factor associated with satisfaction with sexual life.