A Systematic Review of Studies Using the Brief COPE: Religious Coping in Factor Analyses

Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley

Background

As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy.

Objectives

This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence.

Methods

This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression.

Results

A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence.

Conclusion

This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.

The development of the revised COPE 68 inventory with English and Slovak versions

Introduction

Although there have been several attempts at improving the COPE Inventory, the factor structure of the instrument is still in dispute. In addition, studies have shown low reliability coefficients for some of the first-order factors, with Mental Disengagement having the lowest factor loadings. In a recent study on the external validation of the instrument, two additional first-order factors were identified in the qualitative analysis, namely Self-care and Care for Others.

Methods

Based on these arguments we created the Revised COPE 68 Inventory, changing some of the problematic items in the first order factor Mental Disengagement and adding items for the two new factors (Self-care and Care for Others). We then tested its reliability and performed factor analyses on the first and second-order factorial structure. The data were collected through social media in two languages, English and Slovak, using convenience and snowball sampling techniques. The English sample contained 834 participants with mean age 25.27  years (SD = 8.467) and the Slovak sample comprised 1,425 participants with mean age 33 years (SD = 14.59). For the statistical analyses we used Exploratory Structural Equation Model (ESEM) analyses with target rotation and WLSMV, Exploratory and second-order confirmatory factor analysis with the scores of the COPE Inventory and EFA.

Results

The Revised COPE 68 inventory had a good fit for all 17 first-order factors in both languages, including for the new factors Self-care and Care for Others. It appears that the first-order factors form a three-factor solution in both samples, consisting of active coping, social-emotional coping and avoidant coping. The revised Mental Disengagement has better psychometric properties as well.

Discussion

The Revised COPE 68 inventory was found to be a reliable multidimensional instrument for measuring various coping strategies in both the English and Slovak language versions.

Coping strategies and associated factors among people with physical disabilities for psychological distress in Ethiopia

BACKGROUND

Coping strategies are frequently used among individuals with physical disabilities when they face adversities. Low- and middle-income countries are not investigated coping styles among psychological distress persons with disabilities despite the high prevalence of psychological distress. The aim of this study was to identify coping strategies among people with physical disabilities for their psychological distress in Ethiopia has a crucial role to improve the health status of persons with physical disabilities.

METHODS

An institution-based cross-sectional study was employed among individuals living with physical disabilities at the University of Gondar staff and students from May to June 2021. All staff and students with physical disabilities were screened for psychological distress (n = 269). The census sampling technique was used to select the study participants for psychological distress. The Brief Cope with Problems Experienced (COPE-28) was used to assess coping strategies. Bivariate and multivariate linear regression analyses were used to identify factors associated with coping strategies. An odd ratio (OR) with a 95% confidence interval (CI) at P < 0.05 was computed to assess the strength of the association.

RESULTS

The emotional-focused coping strategy was the most frequently used when dealing with psychological distress among participants with physical disabilities. The most commonly used emotional-focused coping strategy was spirituality. In the multivariate analyses; urban residence (β = 3.05, 95% CI: 0.98, 5.12), and stigma (β = 3.10, 95% CI: 0.61, 2.83) were factors positively associated with emotion-focused coping strategy, and World Health Organization Quality of Life (WHO QOL) (β = 0.18, 95% CI: 0.13, 0.22), and stigma (β = 1.11, 95% CI: 0.61, 2.83) were factors significantly associated with problem-focused coping. Urban residence (β= -0.96, 95% CI: -1.69, -0.22) was negatively associated with dysfunctional coping strategy, but WHO QOL (β = 0.35, 95% CI: 0.32, 0.38) was positively correlated with dysfunctional coping.

CONCLUSION

In this study revealed that spirituality is the most frequently used coping strategy among the study participants. Urban residents, stigma, and WHO QOL significantly correlated with coping strategies among such patients. The Ministry of Health, Ministry of Education, and other concerned organizations may find the present findings useful to strengthen the coping styles to minimize psychological distress among people with physical disabilities.

Psychometric Validation of the Brief-COPE Scale in a Sample of Individuals with Multiple Sclerosis: A Brief Report

People with multiple sclerosis (MS) must often cope with high levels of stress, especially during the ongoing COVID-19 pandemic. The Brief-COPE is commonly used to assess how individuals use different coping strategies to deal with stressful life situations, but its application with people who have MS has not been validated. The purpose of this study was to assess the measurement structure and psychometric properties of the Brief-COPE in a sample of community-dwelling adults with multiple sclerosis, using exploratory factor analysis. Results revealed a three-factor measurement structure: (a) flexible coping, (b) succumbing coping, and (c) substance use coping. Correlations among these three factors and external measures of related concepts provided evidence of the validity of these factors. The Brief-COPE can be incorporated in rehabilitation counseling, mental health, and health care settings to assess coping strategies, assisting people with MS with managing stressful life events during and after the pandemic. Rehabilitation and health researchers can use it to assess the effectiveness of psychosocial interventions aimed to improve coping abilities and mental health of people with MS.

Religiousness in the first year of COVID-19: A systematic review of empirical research

The COVID-19 pandemic emerged suddenly in early 2020, posing a serious health threat and creating tremendous stress and distress across the world. Religion has been shown to play important and varied roles in previous disasters and health crises, but its roles in the pandemic have yet to be outlined. We aimed to summarize the research conducted on religion and COVID-19 in the first year of the pandemic with a systematic review of studies that specifically involved individual-level religiousness and COVID-19. Searches were conducted in PubMed, Scopus, CINAHL, and PsycINFO covering a one-year period from the first published mention of the novel coronavirus (Jan. 5, 2020) through January 4, 2021. We included articles about COVID-19 that were peer-reviewed and empirical, measured and reported results on religion on an individual level, and were available in English. Our search produced 137 empirical articles that met the inclusion criteria. In the course of sorting studies by their primary focus, eight categories of empirical findings emerged: general distress and wellbeing (53 articles), COVID-19-specific stress (24 articles), beliefs in science, conspiracies, and misinformation (15 articles), COVID-19 public health behaviors (12 articles), perceived risk of COVID-19 (10 articles), perceived growth or positive changes taking place during the pandemic (nine articles), health behaviors (three articles), and consumer behavior (three articles). Findings indicated that religiousness was associated with both unique benefits and challenges and played a significant role in the pandemic. Religiousness was associated with a broad range of outcomes across geographical regions and populations during the first year of COVID-19. It was a commonly reported coping mechanism with varying levels of favorable associations with mental health and COVID-19-related behaviors.

A Comprehensive Review and Bifactor Modeling Analysis of the Brief COPE

The Brief COPE is a measure of coping strategies that contains 14 factors. The purpose of this research was twofold: (a) examine the psychometric proprieties of the Brief Cope in previous studies; and (b) perform Confirmatory Factor Analyses (CFA) with second-order model and bifactor model specifications that could be used to assess the best model that represents the 14 coping strategies inherent to the instrument. In order to meet the first objective, a bibliographic review of published peer-reviewed studies between 1997 and 2021 was conducted. Results from the review identified 50 studies, of which 21 used exploratory factor analysis, 28 CFA and one study test-retest analysis. Seventeen studies used the entire correlated 14-factor structure. However, only 11 studies conducted a CFA. For the second objective, a sample of 472 working class individuals (female = 278) with a mean work experience of 19.06 years (SD = 11,92) were recruited. We tested several model specifications, convergent and discriminant validity analysis. We found the correlated 14-factor structure of the Brief COPE to have good psychometric properties. The second-order and bifactor model specifications displayed poor fit or did not converge, respectively. The measure showed good convergent and discriminant validity, and the subscales showed adequate internal consistency. We provide further validity and reliability of the correlated 14-factor structure, evidencing that this measure can assess coping mechanisms. Second-order model specifications need further testing and empirical evidence to support such hierarchical categorization.

Instruments for Assessing Spiritual/Religious Coping in Multicultural Clinical Settings

ABSTRACT

A review of literature was conducted to discover and compare various instruments that could be used in daily nursing practice to assess spiritual and religious coping in a variety of multicultural clinical settings. Fifteen spiritual and religious (S/R) instruments were identified, used in 31 studies in multiple countries. These S/R coping tools may be useful to nurses in assessment and for planning interventions.

Predictors of Psychosocial Adaptation and Mental Well-Being Among People With Chronic Illnesses and Disabilities in Hong Kong

Psychosocial adaptation to chronic illness and disability (CID) involves a complex interplay of the client’s background factors with resilience and coping. To date, there have been few studies on psychosocial adaptation to CID in the Chinese context. To examine the predictors of psychosocial adaptation, we surveyed people with CID from community-rehabilitation settings and self-help groups ( N = 224). The research questionnaire collected information on demographics, health-related factors, social support, resilience, coping strategies, psychosocial adaptation, and mental well-being. Resilience, coping strategies, health-related factors, and sex were found to be important predictors of psychosocial adaptation. Using structural equation modeling (SEM), we tested a conceptual model on how social support and health-related factors predict adjustment variables (resilience and coping strategies), which further affect psychosocial adaptation and mental well-being. All the variables are closely linked and the path coefficients are all significant. An overall fair model fit (comparative fit index [CFI] = 0.89; root mean square error of approximation [RMSEA] = 0.089) was obtained. The results provide support for the conceptual model we proposed based on health-related coping and the phase model of psychosocial adaptation. The key predictors of psychosocial adaptation and mental well-being in Chinese people with CID in Hong Kong are similar to those identified in non-Chinese studies.

Predicting Parental Mental Health During COVID-19: Economic Pressure, COVID-19 Stress, and Coping Strategies

As the COVID-19 pandemic continues, understanding connections between economic pressures and mental health experiences is critical in comprehending how stressful global events can affect families. Although economic pressures and stress can negatively impact mental health, approach coping strategies may provide reductions in negative mental health experiences for parents compared to avoidant coping strategies. Despite recent work showing that stress resulting from the pandemic can have negative implications for the mental health of parents with young children, there is little known about the mental health of parents with adolescents. This study utilized a longitudinal sample of 198 parents (194 biological parents; 103 Fathers, and 91 Mothers) of adolescents and examined the mediating impact of COVID-19 stress on the relationship between economic pressure and subsequent depressive and anxious symptoms. Additionally, approach and avoidant coping strategies were examined as potential moderators between COVID-19 stress and later mental health. Results indicated that parents who experienced economic pressure reported worsening mental health across the school semester, with COVID-19 stress mediating this pathway. Further, approach coping strategies moderated the association between COVID-19 stress and later anxiety symptoms such that higher levels of coping associated with greater rates of later anxiety symptoms, while lower levels of coping associated with less anxiety symptoms later. Avoidant coping strategies also moderated these associations, such that greater use associated with greater depressive and anxious symptomology later. These findings emphasize that parents are experiencing worsening mental health following the onset of the pandemic and that there is an urgent need for increased mental health services to assist families during this time.

Mental health service utilisation among transgender women sex workers who are at risk of mental health problems in Shenyang, China: An application of minority stress theory

Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut-off for probable depression or probable anxiety or had suicidal ideation (N = 126); subsample 2: perceived needs for mental health services (N = 109)]. A cross-sectional survey was conducted among TGSW in Shenyang, China during 2017-2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non-affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations.

The Impact of US Nurses' Personal Religious and Spiritual Beliefs on Their Mental Well-Being and Burnout: A Path Analysis

This study addresses the gap in the literature regarding the impact of nurses' personal religious and spiritual beliefs on their mental well-being and burnout. A model of the association between these factors was tested based on surveys of 207 nurses located in southeastern USA and analyzed to determine the association between religion/spirituality, mental well-being, and burnout. A path analysis supported a model in which, through its positive impact on mental well-being, religion/spirituality was negatively associated with emotional exhaustion and depersonalization and positively associated with personal accomplishment.

Coping Strategies and Life Satisfaction among Romanian Emerging Adults during the COVID-19 Pandemic

The aim of the present study was to understand coping mechanisms among Romanian youth in their response to institutional COVID-19 pandemic restrictions. Data were collected from emerging adults (N = 214), aged 18–29, enrolled in various fields of study throughout a public university in Romania. Adopted versions of the Coping Orientation for Problem Experiences Scale (Brief-COPE, Carver, 1997) and Satisfaction with Life Scales (SLWS, Diener et al., 1985) were administered to explore the impact of the specific social distancing and isolation enforced pandemic restrictions. Findings elucidate the response styles, impact of coping skills, and strategies employed by students toward their well-being during stay-at-home courses. Results indicated that Romanian emerging-adults tend to use diverse strategies, but they use more disengagement, problem-focused coping, humor, socially supportive coping or religion, rather than denial, avoidant-focused coping or substance use, when faced with unprecedented situations during the COVID-19 pandemic. We discuss these findings framed in resilience as it relates to the positive youth psychology framework.

Associations between coping strategies and mental health outcomes in autistic adults

Compared to the general population, mental health difficulties are commonly reported in autistic adults. However, the ways in which coping strategies are associated with mental health and well-being in this population remain unknown. Further, we do not know if, and if so, how these associations might differ to that of non-autistic adults. In this study, we hypothesized that in both our autistic (N = 255) and non-autistic (N = 165) adult samples, disengagement coping strategies (e.g., denial) would relate to poorer mental health and well-being, while engagement coping strategies (e.g., problem solving) would relate to better mental health and well-being. Regression analyses revealed that higher use of disengagement coping strategies was significantly associated with higher levels of anxiety and depression, and lower levels of well-being in both samples. In contrast, increased use of engagement coping strategies was associated with better well-being, but only in the autistic sample. Our results contribute to the characterization of negative and positive mental health outcomes in autistic adults from a coping perspective, with potential to offer novel information regarding coping strategies to consider when addressing support options for mental health difficulties in the autistic adult population.

Validation of the Brief RCOPE in Portuguese Family Caregivers of Adults with Health Conditions

Background: Coping is a multifactorial and individual process related to responding to stressful situations, such as being a caregiver of a relative with health conditions. Spiritual/religious coping is an important internal resource used by individuals enduring stressful situations. The 14-item Brief RCOPE is a widely used instrument but not available in European Portuguese. Objective: To translate, adapt and validate the 14-item Brief RCOPE in Portuguese caregivers of an adult relative with a health condition. Method: The methodological guideline provided by Sousa and Rojjanasrirat was used to examine the psychometric properties of the Brief RCOPE. Results: The linguistic and conceptual equivalence of the scale was determined. The internal consistency was acceptable (Cronbach’s α = 0.86). The Principal Axis Factor (PAF) analysis with varimax rotation identified two factors made up of 13 items, and one item was excluded from the scale. Conclusion: The European Portuguese version of the Brief RCOPE is a reliable and valid measure for assessing religious coping of family caregivers of adults with health conditions.

Nurses' and Physicians' Distress, Burnout, and Coping Strategies During COVID-19: Stress and Impact on Perceived Performance and Intentions to Quit

INTRODUCTION

Health care providers (HCPs) have experienced more stress and burnout during COVID-19 than before. We compared sources and levels of stress, distress, and approaches to coping between nurses and physicians, and examined whether coping strategies helped mitigate the negative impact of stress and intentions to quit.

METHODS

Using a cross-sectional study design, burnout was measured with the Maslach Burnout Inventory. Psychological distress was measured using the Depression, Anxiety, and Stress Scale. A self-reported survey was used to evaluate stressors, impact on perceived performance, and intentions to quit. The data were analyzed using t-tests and linear regression models.

RESULTS

Responses of 119 HCPs were analyzed. Findings suggest that (1) compared to physicians, nurses experienced a higher level of distress and burnout, and used more maladaptive coping strategies. (2) Both nurses and physicians experienced more distress and burnout during COVID-19 than before. (3) Adaptive coping strategies moderated the negative impact of stress on work performance (4) Adaptive coping strategies moderated the negative effect of stress on burnout, which in turn reduced intentions to quit. Stress negatively impacted work performance and burnout only for those with low, but not high, levels of adaptive coping strategies.

DISCUSSION

The current findings of HCPs' challenges, risks, and protective factors provide valuable information (1) on COVID-19's impact on HCPs, (2) to guide the distribution of institutional supportive efforts and recommend adaptive coping strategies, and (3) to inform medical education, such as resilience training, focusing on adaptive coping approaches.

Exploring the Structure and Interrelations of Time-Stable Psychological Resilience, Psychological Vulnerability, and Social Cohesion

The current study explores the relationship between three constructs of high relevance in the context of adversities which have, however, not yet been systematically linked on the level of psychological dispositions: psychological vulnerability, psychological resilience, and social cohesion. Based on previous theoretical and empirical frameworks, a collection of trait questionnaires was assessed in a Berlin sample of 3,522 subjects between 18 and 65 years of age. Using a confirmatory factor analytical approach, we found no support for a simple three-factor structure. Results from exploratory structural analyses suggest that instead of psychological resilience and psychological vulnerability constituting two separate factors, respective indicators load on one bipolar latent factor. Interestingly, some psychological resilience indicators contributed to an additional specific latent factor, which may be interpreted as adaptive capacities, that is, abilities to adapt to changes or adjust to consequences of adversities. Furthermore, instead of evidence for one single social cohesion factor on the psychological level, indicators of perceived social support and loneliness formed another specific factor of social belonging, while indicators of prosocial competencies were found to form yet another distinct factor, which was positively associated to the other social factors, adaptive capacities and social belonging. Our results suggest that social cohesion is composed of different independent psychological components, such as trust, social belonging, and social skills. Furthermore, our findings highlight the importance of social capacities and belonging for psychological resilience and suggest that decreasing loneliness and increasing social skills should therefore represent a valuable intervention strategy to foster adaptive capacities.

Depression and Anxiety in Times of COVID-19: How Coping Strategies and Loneliness Relate to Mental Health Outcomes and Academic Performance

The link between depression, anxiety, and loneliness has been well established in the literature. Yet, the performance consequences of these negative mental health outcomes and the role of coping behaviors, as well as behavioral consequences such as procrastination as mediators have received far less research attention. Due to the COVID-19 social isolation restrictions, people are at risk of falling into a negative mental health spiral that can also affect their performance over time. The purpose of this longitudinal study among 881 first-year bachelor students is to explore the mechanisms by which loneliness, coping strategies in the context of COVID-19, mental health outcomes and procrastination sequentially mediate the relationship depression and anxiety on the one hand, and academic performance on the other hand. We measured mental health variables several times during the COVID-19 crisis and assessed how this translates into academic performance at the end of the academic year. By performing exploratory and confirmatory factor analyses, three high-order factors for the coping strategies in the context of the COVID-19 crisis were identified, namely maladaptive coping, adaptive coping, and supportive coping. Structural equation modeling was used to test the sequential mediational model. The results showed that maladaptive coping strategies employed at T2 during the lockdown, but not adaptive or supportive coping partially mediate the trajectories of depression (T1) and anxiety (T1). Loneliness (T2) partially mediated the trajectory of depression and anxiety (T1), and procrastination fully mediated the impact of depression (T3) on academic performance (T4). These results help understand the mechanisms that influence mental health and academic performance outcomes in response to the COVID-19 crisis. Based on the study outcomes, educational researchers can test strategies to reduce the adverse effects of stressful situations in learning environments by targeting maladaptive coping behaviors and procrastination.

Risk of Depression Among MMT Patients: Does Coping Strategies and Perceived Social Support Play a Role?

INTRODUCTION

Patients receiving methadone maintenance therapy (MMT) experience higher level of stress and are at greater risk of developing mental health problems such as depression which could potentially affect both quality of life and treatment outcomes. This cross-sectional study is aimed at understanding the relationship between psychosocial factors such as social support, coping, and depression among patients receiving MMT in a Malaysian Hospital.

METHODS

One hundred and ninety-six patients attending MMT program were recruited. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression, Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess participants' perceived social support, and the Brief COPE questionnaire was used to assess coping strategies. The diagnosis of depression was made using Mini-International Neuropsychiatric Interview (MINI).

RESULTS

About 13.8% of our sample were diagnosed with depression. From our analysis, it was found that having higher levels of perceived social support (OR = 0.462, 95% CI 0.238-0.899, P < .05), the use of active and emotion focused coping mechanism (OR = 0.231, 95% CI 0.095-0.565, P < .005), and support seeking and self-distraction coping mechanism (OR = 0.196, 95% CI 0.074-0.521, P < .001) was associated with lower likelihood of depression. On the contrary, the use of dysfunctional coping strategies such as denial, behavioral disengagement, and self-blame was associated with increased likelihood of depression (OR = 9.384, 95% CI 3.081-28.581, P < .001).

CONCLUSION

Active and emotion focused along with support and self-distraction coping strategies, and higher levels of perceived social support may serve as a buffer against depression in patients receiving MMT.

Prevalence and correlates of psychological distress amongst healthcare workers during the COVID-19 pandemic: An online survey

Background

Understanding the mental health needs of healthcare workers during coronavirus disease 2019 (COVID-19) pandemic with a view of mitigating its impact on occupational functioning is vital.

Aim

To determine the prevalence and correlates of psychological distress amongst healthcare workers.

Setting

The study was carried out in Nigeria during COVID-19 pandemic.

Methods

A cross-sectional quantitative study using a convenience sample was conducted amongst healthcare workers. The survey comprised of two Google formatted self-report questionnaires, a 12-item General Health Questionnaire and a questionnaire containing socio-demographic, work related and knowledge of COVID-19 variables. Questionnaires were distributed via closed professional WhatsApp platforms. Data were analysed using descriptive statistics, chi-square test and logistic regression.

Results

There were 313 respondents and prevalence of psychological distress was 47.0%. Females were almost twice as likely to have psychological distress as males (OR = 1.92, 95% CI: 1.21-3.04, p = 0.006). Healthcare workers who had no contact with COVID-19 positive patients had an 87% reduced risk of psychological distress (OR = 0.13, 95%CI: 0.23-0.25, p = 0.018) compared with those who had contact with COVID-19 positive patients. Healthcare workers with poor knowledge of COVID-19 had a 44% reduced risk of psychological distress compared with those with good knowledge (OR = 0.56, 95% CI: 0.34-0.93, p = 0.025).

Conclusion

Findings revealed that healthcare workers in Nigeria reported psychological distress during COVID-19 pandemic. Greater risk was amongst females and those who had contact with COVID-19 positive patients whilst poor knowledge was protective.

Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men

We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.

Psychometric properties of Brief Coping Orientation to Problems Experienced in patients with multiple chronic conditions: A preliminary study

BACKGROUND

Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping-oriented interventions.

PURPOSE

The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE-CN) inventory in patients with MCCs.

METHOD

This study adopted a cross-sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE-CN, sociodemographic characteristics and clinical data were collected using a self-reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed.

RESULTS

The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE-CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from .65 to .85 for the five subscales.

CONCLUSIONS

The psychometric properties of the Brief COPE-CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health-care professionals understand patients' coping and develop coping-based interventions to promote coping in this population.

The Factor Structure of the Brief Cope: A Systematic Review

The Brief COPE is a widely used measure of coping that contains 28 items on 14 factors. Researchers have shortened the inventory, but the factor structure remains debated. A systematic review of peer-reviewed studies published in English between 1997 and 2021 was conducted to determine if a more parsimonious number of factors could be identified. Cumulative Index for Nursing and Allied Health, PsycINFO, PsycARTICLES, Medline, PubMed, and Scopus databases were searched using keywords "Brief COPE" and "factor, valid*, or psychometric.*" Searching yielded 573 articles; cited references added 38; 85 articles met inclusion criteria. Principal components analysis and confirmatory factor analysis were major analytic strategies used (28% and 27%, respectively). Only eight studies analyzed the original 14-factor structure. Factors identified ranged from 2 to 15, with dichotomous factors most frequently identified (25%; n = 21). A smaller number of factors may be able to represent the Brief COPE. Research is needed to test a condensed instrument.

Coping and Post-Traumatic Stress in Children and Adolescents after an Acute Onset Disaster: A Systematic Review

Acute onset disasters impact children’s and adolescents’ psychological well-being, often leading to mental health challenges. The way a young person copes with the event plays a significant role in development of post-disaster psychopathology. Coping has been widely studied after acute onset disasters, however, difficulties conducting research in post-disaster contexts and the individualized nature of coping make accurate assessment of coping a significant challenge. A systematic literature search of multiple databases and previous reviews was conducted, exploring scholarly documentation of coping measurement and the relationship between coping and post-traumatic stress (PTSS) symptoms after acute onset disasters. A total of 384 peer-reviewed manuscripts were identified, and 18 articles met the inclusion criteria and were included in the current review. The studies examined coping and post-traumatic stress in the wake of acute onset disasters such as terrorist events and natural disasters, such as hurricanes, earthquakes, and wildfires. Greater PTSS symptoms were related to internalizing, externalizing, rumination, and avoidant coping strategies. Coping measurement was constrained due to measurement variance, lack of developmentally and contextually vali-dated instruments, theoretical misalignment, and absence of comprehensive tools to assess coping. Robust and consistent measures of coping should be established to inform research and interventions to reduce the impact of disasters on children’s and adolescents’ well-being.

Empathy and Coping in Allied Health Sciences: Gender Patterns

This study aimed to examine the patterns of associations between empathy and coping among undergraduate men and women studying at Allied Health Sciences. This cross-sectional study is part of a larger longitudinal study conducted in an Allied Health Sciences School. Participants were 183 undergraduate students from 12 training programs (e.g., Physiotherapy, Occupational Therapy, Speech Therapy). Their mean age was 20.79 years (SD = 2.64), and they were in their first, third, and fourth years of school. The instruments were the Brief-COPE and the Interpersonal Reactivity Index (IRI). Empathy correlated with coping strategies in both genders, though showing different patterns of association. First, distinct coping strategies were associated with the same empathy dimension (perspective taking) among women (positive reframing and self-blame) and among men (active coping). Second, the same three coping strategies appeared in both genders (seeking emotional or instrumental support and resorting to religion) but associated with different empathy dimensions (cognitive empathy among women and mostly emotional empathy among men). Third, among women (but not among men), two coping strategies (positive reframing and behavioral disengagement) were each simultaneously correlated with cognitive and emotional empathy in opposite directions. Fourth, emotional empathy correlated, only among women, with several coping strategies considered to be maladaptive (behavioral disengagement, denial and substance use). Among men, only one significant coping strategy was considered to be maladaptive (behavioral disengagement) and it was negatively correlated with cognitive empathy (perspective taking). Unlike in women, relationships between the empathic dimension of fantasy and coping strategies were non-significant among men. These distinct patterns of associations emerged despite significant differences in empathy by gender (fantasy, personal distress and empathic concern) and in coping strategies (instrumental support, emotional support, religion and venting). These results support the idea that the display of empathy might be associated with gender differences in the underlying empathy dimensions and in the coping strategies used to deal with stress in the undergraduate programs of Allied Health Sciences.

Coping strategies, cyberbullying behaviors, and depression among Chinese netizens during the COVID-19 pandemic: a web-based nationwide survey

BACKGROUND

As a major life stressor now, the COVID-19 pandemic could substantially increase risks of cyberbullying and depression for global people, especially in the context of increased digital interconnectedness and strict social distancing. Though people are adopting different coping strategies, still little is known about their cyberbullying and depression and how the two associated with coping strategies.

METHODS

A web-based nationwide questionnaire survey was conducted among 5,608 netizens during the peak time of COVID-19 in China. The study collected cross-sectional data on participants' coping strategies, general cyberbullying behaviors, cyberbullying behaviors specifically to residents of Hubei Province where first COVID-19 case was reported, and depression.

RESULTS

A two-factor structure applied to participants' coping strategies, namely problem-focused coping and emotion-focused coping, and the former was more adopted. There existed gender, age, education, and income differences in the coping strategies. Problem-focused coping was associated with less cyberbullying behaviors while had no correlation with depression; emotion-focused coping was found positively correlated with cyberbullying and depression. The association between emotion-focused coping and depression was mediated by cyberbullying.

LIMITATIONS

The study used cross-sectional design, and its findings should be cautioned to be generalized to other countries, due to the differences in culture, stage of crisis, and government policies on COVID-19.

CONCLUSIONS

Problem-focused coping was associated with less cyberbullying, and emotion-focused coping predicted cyberbullying and depression. Cyberbullying mediated the correlation between emotion-focused coping and depression. These findings provide new perspectives for interventions on people's coping strategies towards COVID-19 pandemic.

Psychometric qualities of the English Coping Scales of the Stress and Coping Inventory in a representative UK sample

Background

The Coping Scales of the Stress and Coping Inventory (SCI; Satow in Stress- und Coping-Inventar (SCI): Test- und Skalendokumentation. Stress and coping inventory. http://www.drsatow.de, 2012) are well-established German self-report scales measuring five coping styles: Positive Thinking, Active Coping, Social Support, Support in Faith, and Alcohol and Cigarette Consumption. The purpose of this study was to translate the scales into English and to psychometrically evaluate this English version of the SCI coping scales with a representative sample of the UK population.

Methods

The coping scales of the SCI were forward–backward translated into English and administered to a representative sample according to age, gender, education, and region for the UK (N = 1006). Internal consistencies, factorial validity, and construct validity were assessed for both the original factor structure of the SCI, as well as a newly identified factor structure.

Results

The results for the original factor structure indicated good internal consistency and construct validity. The adaptive coping styles of this version were positively correlated with resilience and negatively with perceived stress. The maladaptive coping strategy, alcohol and cigarette consumption, showed the opposite correlations. The exploratory factor analysis (EFA) of the English version resulted in a five-factor structure, but some items loaded on different factors than in the German version. These new factors were Religious Coping, Social Support, Various Coping, Alcohol and Cigarette Consumption, and Reflective Coping. The novel factors showed similar correlations to resilience and perceived stress as the original factor structure. Only religious coping did not significantly correlate to perceived stress. Confirmatory factor analysis with the original factor structure of the German SCI coping scales revealed poor model fit for the English SCI coping scales.

Conclusion

The English SCI coping scales consistently and accurately measure five different coping styles. Nevertheless, the original factor structure of the SCI coping scales, when applied to an English-speaking sample, did not fit the data well. The new factor structure established by EFA is only preliminary and needs further validation in future large samples using the English version of the SCI coping scales.

An Intervention to Change Illness Representations and Self-Care of Individuals With Type 2 Diabetes: A Randomized Controlled Trial

OBJECTIVE

Suboptimal self-care by individuals with diabetes mellitus (DM) is a significant public health concern. The common-sense model (CSM) proposes that illness representations are associated with coping and health outcomes across various conditions. The present study examined the efficacy of a CSM-based intervention in improving illness representations, self-care, self-care self-efficacy, use of adaptive coping strategies, and glycated hemoglobin among individuals with type 2 DM (T2DM).

METHODS

A two-arm randomized controlled trial was used. A total of 455 T2DM patients were recruited from an outpatient DM clinic and randomized to an intervention group that consisted of five weekly group-based education sessions or a control group that received five weekly educational booklets. Evaluation was conducted at baseline and at 1- and 6-month follow-up.

RESULTS

The 2 × 3 linear mixed-model analysis using a modified intention to treat revealed a significant time by condition interaction effect on level of self-care (F(2,840) = 7.78, p < .001), self-care self-efficacy (F(1.89,794.57) = 14.40, p < .001), and use of adaptive coping strategies (F(1.94,812.93) = 4.75, p = .010) in which participants in the intervention group reported greater improvement in such aspects compared with those in the control group. A significant time effect was observed in some dimensions of illness representations. No significant effect was found in glycated hemoglobin. Participants reported positive feedback to the intervention and perceived improvement in various domains.

CONCLUSIONS

The CSM-based intervention was effective in improving self-care and coping among DM patients. The intervention also demonstrated high feasibility and acceptability. Findings provided important insights in improving health-related outcomes for patients with T2DM using the CSM framework.

The Brief COPE: Factor Structure and Associations With Self- and Other-Directed Aggression Among Emerging Adults

The Brief COPE has seen frequent use across populations despite lack of confirmatory factor-analytic examination. We further examine Brief COPE validity with respect to self- and other-directed aggression because emerging adulthood represents a distinct developmental time period in which stress, poor coping, and aggression intersect. Drawing on archival data (n = 576) from a larger investigation of college student health, this cross-sectional survey study tested (1) four competing Brief COPE factor structures, (2) Brief COPE factor associations with aggression, and (3) stress by coping interactions predicting aggression outcomes. Prominent findings included (1) poor-to-marginal confirmatory factor-analytic support for a four-factor structure; (2) positive bivariate associations of avoidant coping with elevated stress, depression, suicide, self-injury, and aggression; (3) positive bivariate associations between adaptive coping strategies with stress and aggression; and (4) an interaction where avoidant coping has a stronger association with other-directed aggression for those low in stress. The interaction findings were significant for males only and applied specifically to hostility. Findings are contextualized within future Brief COPE research as well as emerging adulthood theory.

Coping Strategies Used by Breast, Prostate, and Colorectal Cancer Survivors: A Literature Review

BACKGROUND

Individual coping strategies are a fundamental element underpinning psychosocial distress.

OBJECTIVE

The aim of this study was to describe coping strategies and their measurement used by survivors of breast, prostate, and/or colorectal cancer after treatment.

METHODS

A search of electronic databases (PubMed, CINAHL, and PsycINFO) was conducted from January 1980 to March 2015. Data were extracted using standardized forms and included studies that explored the coping mechanisms of survivorship of breast, prostate, or colorectal cancer.

RESULTS

Two thousand one hundred forty-seven studies were retrieved for potential inclusion; 19 publications met the inclusion criteria and were included in the review.

CONCLUSIONS

Breast, prostate, and colorectal cancer survivors seem to use different coping strategies that varied throughout the survivorship trajectory. Breast cancer survivors highlighted the importance of accepting their diagnosis and engaging in physical activities that provided social and emotional support. Personality seemed to have a significant effect on coping for prostate cancer survivors. Colorectal cancer survivors emphasized the importance of seeking information to master self-management and return to social activities.

IMPLICATIONS FOR PRACTICE

Understanding coping strategies, during the survivorship trajectories, is essential to planning contemporary care after cancer treatment. Nurses and other healthcare professionals may use this knowledge to improve quality of life and decrease distress after diagnosis.

Caring helps: Trait empathy is related to better coping strategies and differs in the poor versus the rich

Coping has been extensively studied in health psychology; however, factors influencing the usage of different coping strategies have received limited attention. In five studies (N = 3702), we explored the relationship between trait empathy and coping strategies, and how subjective socioeconomic status (SES) moderates this relationship. In Studies 1-4, we found that people with higher level of empathic concern use more adaptive coping strategies, seek more social support, and use fewer maladaptive coping strategies. Moreover, higher trait empathy related to more adaptive coping strategies among the poor, and fewer maladaptive coping strategies among the rich. In Study 5, we tested the potential biological basis of the relationship between trait empathy and coping by examining the effect of the oxytocin receptor gene (OXTR) rs53576 polymorphism on coping. We found that individuals with the GG phenotype-who in previous research have been found to be more empathic-were more likely to seek social support than AG or AA individuals. Furthermore, in line with findings in Studies 1-4, amongst people with low SES, individuals with GG genotype used more adaptive coping strategies than AG or AA individuals. Our results highlight the selective role trait empathy plays in influencing coping strategy deployment, depending on the SES of individuals.

The meaning of coping for kidney transplant recipients: a phenomenological study

Background

The meaning of coping, which can be affected by the nature and type of stress and by individuals' background and culture, has not been studied in the context of specific stress conditions, such as kidney transplant.

Aims

The present study aims to explore the meaning of coping for kidney transplant recipients.

Methods

Purposeful sampling was employed for this hermeneutic phenomenological study. Participants were nine kidney transplant recipients who had received treatment at specialised hospital centres in Mashhad and Ahwaz, Iran, in 2013. Data were collected from unstructured interviews and analysed using Van Manen's approach.

Results

From 10 sub-themes emerged 4 major themes characterising the meaning of coping with renal transplantation: intelligent acceptance of changes, understanding the necessity of self-care, enduring, and understanding supportive encouragement.

Conclusions

The meaning of coping for kidney transplant recipients in Iran encompasses a wide range of cognitive, behavioural, psychological, spiritual and social dimensions. Relying on God's eternal power and on imams emerged as major dimensions of the meaning of coping.

Does the Factor Structure of the Brief COPE Fit Different Types of Traumatic Events?

Abstract. The current study aims to explore the likelihood of there being a higher-order factorial model of the Brief COPE ( Carver, 1997 ) that is equally appropriate and valid for different traumatic groups (i.e., breast cancer patients and female flood survivors) at 3–4 months after the traumatic event. Both groups of participants include 180 survivors. Five factorial models for the Brief COPE were identified when reviewing the literature, and model comparisons were made by conducting confirmatory factor analyses (CFAs). The three dimensions of the Brief COPE posited by Litman (2006) and Gutiérrez, Peri, Torres, Caseras, and Valdés (2007) , namely self-sufficient coping, socially-supported coping, and avoidant coping, were supported in both traumatic populations. Tests of measurement invariance generally supported invariance (factor form, factor loadings, item intercepts, error variances, factor variances, and covariances) across groups, implying that groups perceive the latent factors in the same way and the higher-order coping across different traumatic groups is meaningful. Moreover, the relationship between the three higher-order coping factors and variables of psychological adjustment was examined. Generally, different relationships between the subtypes of coping and the outcomes of adaptation existed between female flood survivors and breast cancer patients. Further theoretical and practical implications for these relationships are discussed.

Determinants of illness-specific social support and its relation to distress in long-term melanoma survivors

Background

Social support is considered to be one of the most important resources for coping with cancer. However, social interactions may also be detrimental, e. g. disappointing or discouraging. The present study explored: 1. the extent of illness-specific positive aspects of social support and detrimental interactions in melanoma survivors, 2. their relationships to mental health characteristics (e. g. distress, quality of life, fatigue, coping processes, and dispositional optimism) and 3. Combinations of positive social support and detrimental interactions in relation to depression and anxiety.

Methods

Based on the cancer registry of Rhineland-Palatinate, Germany, melanoma patients diagnosed at least 5 years before the survey were contacted by their physicians. N = 689 melanoma patients filled out the Illness-specific Social Support Scale ISSS (German version) and standardised instruments measuring potential psychosocial determinants of social support.

Results

Using principal component analysis, the two factor structure of the ISSS could be reproduced with acceptable reliability; subscales were “Positive Support” (PS) and “Detrimental Interactions” (DI); Cronbach’s α = .95/.72. PS was rated higher than DI. Multivariable linear regressions identified different associations with psychosocial determinants. Survivors living in a partnership and those actively seeking out support had a higher probability of receiving PS, but not DI. PS and DI interacted regarding their association with distress: Survivors reporting high DI but low PS were the most depressed and anxious. High DI was partly buffered by PS. When DI was low, high or low PS made no difference regarding distress.

Conclusion

Psycho-oncologic interventions should take into account both positive and negative aspects of support in order to promote coping with the disease.

Coping strategies of women with postpartum depression symptoms in rural Ethiopia: a cross-sectional community study

BACKGROUND

Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions.

METHODS

A population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum (n = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, 'high PPD symptoms', (n = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis.

RESULTS

Confirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands.

CONCLUSIONS

As in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development.

Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study

BACKGROUND

Hemodialysis patients are exposed to disease- and treatment-related stresses, and use various coping strategies to deal with these stresses. Although some studies have reported the association of coping strategies with mortality or health-related quality of life (QOL) in some populations, the effect of coping strategies on clinical outcomes in hemodialysis patients remains unclear. We investigated the association in a longitudinal design among Japanese hemodialysis patients.

METHODS

We examined Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) IV, which was conducted between 2009 and 2012. The exposure variable was stress coping strategy, as assessed using subscales in Coping Strategies Inventory Short Form: problem-focused engagement, problem-focused disengagement, emotion-focused engagement, and emotion-focused disengagement. Hazard ratios were estimated using Cox proportional hazard model for all-cause mortality and mean differences for change in health-related QOL in 1 year were estimated using a regression model.

RESULTS

Among 1,354 patients, only problem-focused engagement was significantly associated with longer survival; other subscales were not associated with all-cause mortality after adjustment for potential confounding factors. In terms of health-related QOL, the subscale of problem-focused engagement was also associated with improvement in physical functioning and mental health among 1,045 patients. Emotion-focused disengagement was associated with deterioration in mental health, but not with change in physical functioning. The other subscales were not associated with change in physical functioning or mental health.

CONCLUSIONS

Among hemodialysis patients, "problem-focused engagement" coping strategies were associated with longer survival and also with improvement in physical functioning and mental health. To achieve greater longevity and improve QOL in hemodialysis patients under ongoing stresses, problem-focused engagement should be encouraged.

Measuring Coping Behavior in Liver Transplant Candidates: A Psychometric Analysis of the Brief COPE

Liver transplant candidates must cope with significant physiological and psychological challenges. The Brief COPE is a frequently used measure of coping behavior; however, knowledge of the scale's factor structure and construct validity is limited with regard to liver transplant candidates. This study assessed the validity of the Brief COPE in 120 liver transplant candidates using exploratory factor analysis. Results revealed a 6-factor solution, only 2 of which were consistent with the original scale assignments. Construct validity of the 6 Brief COPE scales yielded in this study was demonstrated. The results indicate that the Brief COPE is valid, reliable, and can be meaningfully interpreted in liver transplant patients. Future research should confirm this factor structure and examine its predictive validity prior to widespread use among liver transplant patients. Suggestions are presented for enhancing the care of transplant candidates by promoting the use of adaptive coping mechanisms to manage distress.

Controversies Regarding the Psychometric Properties of the Brief COPE: The Case of the Brazilian-Portuguese Version "COPE Breve"

The Brief Coping Orientation to Problems Experienced (COPE) inventory investigates the different ways in which people respond to stressful situations. Knowledge is lacking regarding the coping strategies and styles of people in developing countries, including Brazil. This study aimed to adapt and validate the Brief COPE to Brazilian Portuguese (named COPE Breve) by focusing on dispositional coping. For the cross-cultural adaptation, the original Brief COPE in English (28 items grouped into 14 subscales) was adapted according to a universalistic approach, following these steps: translation, synthesis, back-translation, analysis by an expert panel, and pretest with 30 participants. Then, 237 adults from the community health service responded to the COPE Breve. Psychometric analyses included reliability and exploratory factor analysis. Most of the 14 subscales from the original Brief COPE exhibited problems related to internal consistency. A Velicer's minimum average partial test (MAP) was performed and pointed out 3 factors. Exploratory factor analysis produced a revised 20-item version with a 3-factor solution: religion and positive reframing, distraction and external support. The psychometric properties of the COPE Breve with three factors were appropriate. Limitations of this study as well as suggestions for future studies are presented. The COPE Breve should be used in Brazilian clinics and investigations, but divergences in its psychometrics should be further explored in other contexts.

Stigma by association and family burden among family members of people with mental illness: the mediating role of coping

PURPOSE

When someone has a mental illness, family members may share the experience of stigma. Past research has established that family members' experiences of stigma by association predict psychological distress and lower quality-of-life.

METHODS

The present study, conducted with 503 family members of people with mental illness examined the prevalence of 14 different coping strategies. Of greater importance, we examined the role of these coping strategies as mediators of the relationships between stigma by association and family burden, on the one hand, and outcomes, such as psychological distress and quality-of-life, on the other.

RESULTS

The results showed that both perceived stigma by association and family burden are associated with greater psychological distress and lower quality-of-life, and that most coping strategies mediate these relationships.

CONCLUSIONS

Adaptive coping strategies were related to reduced negative outcomes, while most maladaptive coping strategies were related to enhanced negative outcomes. Implications for intervention development are discussed.

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.

Coping Styles Among Individuals with Severe Mental Illness and Comorbid PTSD

There is little known about coping styles used by individuals with severe mental illness (SMI) and even less known about the influence of a comorbid posttraumatic stress disorder (SMI-PTSD) diagnosis on coping. The current study examines differences in utilization of coping strategies, overall psychological distress, and exposure to traumatic events between SMI only and SMI-PTSD individuals seeking community mental health clinic services (N = 90). Results demonstrate that overall psychological distress and use of avoidance coping were significantly higher among the SMI-PTSD sample. Avoidance coping partially mediated the relationship between PTSD symptom severity and psychological distress. Findings suggest that the experience of PTSD for those with SMI is associated with increases in avoidance coping, a coping style that significantly contributes to psychological distress. Implications for further study and treatment within community mental health clinics are considered.

Spiritual quality of life and spiritual coping: evidence for a two-factor structure of the WHOQOL spirituality, religiousness, and personal beliefs module

Background

The WHOQOL-SRPB has been a useful module to measure aspects of QOL related to spirituality, religiousness, and personal beliefs, but recent research has pointed to potential problems with its proposed factor structure. Three of the eight facets of the WHOQOL-SRPB have been identified as potentially different from the others, and to date only a limited number of factor analyses of the instrument have been published.

Methods

Analyses were conducted using data from a sample of 679 university students who had completed the WHOQOL-BREF quality of life questionnaire, the WHOQOL-SRPB module, the Perceived Stress scale, and the Brief COPE coping strategies questionnaire. Informed by these analyses, confirmatory factor analyses suitable for ordinal-level data explored the potential for a two-factor solution as opposed to the originally proposed one-factor solution.

Results

The facets WHOQOL-SRPB facets connected, strength, and faith were highly correlated with each other as well as with the religious coping sub-scale of the Brief COPE. Combining these three facets to one factor in a two-factor solution for the WHOQOL-SRPB yielded superior goodness-of-fit indices compared to the original one-factor solution.

Conclusions

A two-factor solution for the WHOQOL-SRPB is more tenable, in which three of the eight WHOQOL-SRPB facets group together as a spiritual coping factor and the remaining facets form a factor of spiritual quality of life. While discarding the facets connectedness, strength, and faith without additional research would be premature, users of the scale need to be aware of this alternative two-factor structure, and may wish to analyze scores using this structure.

The relationship between quality of life and spirituality, religiousness, and personal beliefs of medical students

OBJECTIVE

This study investigated the effects of spirituality, religiousness, and personal beliefs on the quality of life (QOL) of medical students affiliated with a religious faith and those without affiliation.

METHODS

Using a cross-sectional design, 275 medical students (78 % response rate) in their fourth and fifth year of study completed the WHOQOL-BREF quality of life instrument and the WHOQOL-SRPB module for spirituality, religiousness, and personal beliefs.

RESULTS

For religious students, a larger range of characteristics of existential beliefs were positively related to quality of life. For all students, hope and optimism and meaning of life predicted higher scores on psychological.

CONCLUSIONS

For religious and nonreligious medical students, reduced meaning in life and hope were the strongest indicators of psychological distress. Interventions to improve the mental well-being of medical students may be more effective if aimed at teaching students how to find meaning and purpose in their lives and how to foster an enduring sense of hope and optimism.