Depressive Coping Style Research Articles

The effect of coping strategies on health–related quality of life in acromegaly patients

PurposePatients with acromegaly oftentimes exhibit a reduced physical and psychological health-related quality of life (HRQoL). Maladaptive coping styles are associated with poor HRQoL in a number of diseases and patients with pituitary adenomas in general exhibit less effective coping styles than healthy controls. This study aimed to assess coping strategies in acromegaly patients in order to explore leverage points for the improvement of HRQoL.MethodsIn this cross-sectional study, we administered self-report surveys for coping strategies and HRQoL (Short Form SF-36, Freiburg questionnaire on coping with illness, FKV-LIS) in patients with acromegaly. These were set into relation with a variety of health variables.ResultsAbout half of the 106 patients (44.3% female) with a mean age of 56.4 ± 1.3 years showed impaired physical and psychological HRQoL on average 11.2 years after the initial diagnosis. Body mass index, age at survey date and concomitant radiotherapy explained 27.8% of the variance of physical HRQoL, while depressive coping added an additional 9.2%. Depressive coping style and trivialization and wishful thinking were pivotal predictors of an impaired psychological HRQoL with a total explained variance of 51.6%, whereas patient health variables did not affect psychological HRQoL.ConclusionOur results show that maladaptive coping styles have a substantial negative impact on psychological HRQoL in patients with acromegaly, whereas physical HRQoL is influenced to a lesser extent. Specialized training programs aimed at improving coping strategies could reduce long-term disease burden and increase HRQoL in the affected patients.

Coping and Health-Related Quality of Life after Closed Head Injury

ObjectivesIn the present study the relationship between illness coping and health-related quality of life (HRQOL) in patients after closed head injury (CHI) was analyzed. Furthermore, the study was performed to assess the relative significance of clinical, neuroradiological, psychosocial variables and coping activities after CHI. We hypothesized that the effect of a depressive coping style is significantly stronger than that of all other variables considered. Patients and MethodsThis cross-sectional study took place at the outpatient clinic of the Department of Neurosurgery of the University of Technology (RWTH) Aachen, Germany. Of a total of 98 patients 1-2 years after CHI living in the catchment area of the university hospital fulfilling the inclusion criteria 63 individuals (mean age 40.6 years; 46 males) with a mean of 17.6 months after CHI took part in the study. HRQOL was assessed by means of the Aachen Life Quality Questionnaire (ALQI) and illness coping by the Freiburger Fragebogen zur Krankheitsverarbeitung (FKV). ResultsThe patients complained most frequently of impairments in their HRQOL in the areas of free-time activities and social contact. The most intensely used coping activities were distraction and self-management, active problem-oriented coping and religion and looking for sense. Regression analyses revealed exclusively the depressive coping style as the most important predictor of subjectively impaired HRQOL explaining up to 44% of the variance. There was only a modest relationship between patient age and active problem-oriented coping (r = .43; p < .01). The degree of education was negatively associated (r= -.35; p < .01) with depressive coping. A moderate severity of the injury led to significantly more intense activities in the area of minimizing and wishful thinking as compared to a mild CHI (p < .05). ConclusionsIn patients after CHI rehabilitation measures should focus to the HRQOL areas of free-time activities and social contact. Specific psychological interventions are called for in order to tackle the obviously dysfunctional depressive coping style.

Association between spiritual intelligence and stress, anxiety, and depression coping styles in patients with cancer receiving chemotherapy in university hospitals of Tehran University of medical science.

Holistic care addresses the physical, psychological, social, and spiritual dimensions of the patient in which spiritual dimension plays a pivotal role in patient care. The objective of this study is to investigate the association between spiritual intelligence with stress, anxiety, and depression coping styles in patients with cancer. This analytic descriptive study was carried out on 276 patients with cancer receiving chemotherapy in university hospitals of Tehran University of Medical Sciences during 2013-2014. The participants were selected using cluster sampling. Data collection tools included patients' medical history, demographic questionnaire developed by researcher, spiritual intelligence self-report inventory questionnaire, ways of coping questionnaire, and depression, anxiety, and stress scales-42. Pearson correlation and multiple regression analyses were conducted to analyze the data using SPSS 20. Differences were considered significant at the P < 0.05 level. There was inverse significant relationship between spiritual intelligence and stress (r = -0.268 and P < 0.001) and between spiritual intelligence and anxiety (r = -0.200 and P = 0.001) and between spiritual intelligence and depression (r = -0.317 and P = 0.000). There was a significant relationship between spiritual intelligence and coping styles (P < 0.01). The highest association was observed between spiritual intelligence and problem-focused strategy or positive reevaluation strategy (P = 0.000 and r = 0.668 and P = 0.000 and r = 0.667, respectively). Spirituality and religion are an important source of strength for adjusting of patients to cancer and help patients to achieve the sense of meaning and purpose in the course of disease. Establishment of settings in hospitals focusing on using spiritual intelligence to improve treatment outcomes in patients with cancer.

Coping with oral cancer: the impact of health and disease-related personality traits.

Oral tumours lead to critical reductions in quality of life and well being. Coping with illness is a multidimensional construct that is affected by various factors, including social structure, social support, locus of control and religious considerations. However, the effect of personality on coping with illness has hardly been studied. In this context, just one personality model has been developed, but this defines personality in very wide dimensions. Therefore, this study considered the personality factors related to health and disease and aimed to identify potential clinical applications in patients with oral cancer. We enrolled 104 patients suffering from oral cancer. Participants were asked about their personality and illness coping styles using the Freiburg Personality Inventory and the Freiburg Questionnaire of Coping with Illness, respectively. Regression analyses revealed that specific personality structures of the patients determine their way of coping. Patients primarily used active and problem-oriented coping styles; spirituality, depressive coping and minimization were used less frequently. The results demonstrate that personality affects coping behaviour. When treating patients, both situational factors and personality traits affect how patients cope with their disease. We note that it is important to give particular attention to patients who use depressive coping styles, as these patients are often incapable of coping with their diseases without external support.

The psychological assessment of candidates for reconstructive hand transplantation

Standardized psychological assessment of candidates for reconstructive hand transplantation (RHT) is a new approach in transplantation medicine. Currently, international guidelines and standardized criteria for the evaluation are not established. Patients suffering from the loss of a hand or an upper extremity have to cope with multiple challenges. For a selected group of patients, RHT represents an option for restoring natural function and for regaining daily living independence. The identification of at-risk patients and those requiring ongoing counseling due to poor coping or limited psychological resources are the primary focus of the psychological assessment. We have developed the 'Innsbruck Psychological Screening Program for Reconstructive Transplantation (iRT-PSP)' which utilizes a semi-structured interview and standardized psychological screening procedures and continuous follow-up ratings. Between January 2011 and October 2011, four candidates were evaluated using the iRT-PSP. Psychological impairments including social withdrawal, embarrassment, reduced self-esteem, and a depressive coping style were identified and poor quality of life was reported. The motivation for transplantation was diverse, depending on many factors such as bi- or unilateral impairment, native or accidental loss of hand, and social integration.

Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies

The purpose of the present study was to identify preoccupation with death in relation to levels of psychological distress in patients with haematologic malignancies. One hundred and two inpatients with haematologic malignancies, treated with curative intent, and thirty-three control inpatients with benign dysfunction participated in the present study. Psychological distress was measured with the Hospital Anxiety and Depression Scale and the Freiburg Questionnaire of Coping with Illness. Preoccupation with death was assessed with the Subjective Estimation of Sickness and Death Scale. Patients with haematologic malignancies had significantly more preoccupation with death than the control group. In patients with haematologic malignancies preoccupation with death was related to depressive coping style as well as symptoms of depression and anxiety; regression analyses reveal that the diagnosis of haematologic malignancy leads to stronger subjective feelings of being close to death, which in turn leads to more psychological distress. To the best of our knowledge this is the first study that quantitatively shows the existence of preoccupation with death in patients with haematologic malignancies and its association with psychological distress. Our findings indicate that patients who are treated with a curative regime need psychological intervention focusing on death-related fear in order to prevent severe emotional distress.

Social Anxiety in Patients With Parkinson's Disease

Social Anxiety in Patients With Parkinson's Disease

Fear of cancer progression and cancer‐related intrusive cognitions in breast cancer survivors

To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer-related intrusive cognitions in breast cancer survivors. A sample of 1083 patients was recruited in this cross-sectional study through a population-based Cancer Registry an average of 47 month following diagnosis (66% response rate). Participants completed self-report measures assessing fear of cancer progression (FoP-Q-SF), posttraumatic stress-disorder symptoms (PCL-C), coping strategies (DWI) and quality of life (QoL) (SF-8). In total, 23.6% of women were classified as having moderate to high FoP. Being nervous prior to doctors' appointments or examinations and being afraid of relying on strangers for activities of daily living were the most frequent fears. FoP was significantly associated with younger age, having children, disease progress, chemotherapy, perceived amount of impairments, physical and mental QoL, but not with time since initial diagnosis. Intrusive cognitions were screened in 37% of the sample. We found significant correlations between FoP and intrusive thoughts (r=0.63), avoidance (r=0.57), hyperarousal (r=0.54) and posttraumatic stress disorder diagnosis (r=0.42). Factors significantly associated with moderate and high FoP included a depressive coping style as well as an active problem-oriented coping style, intrusion, avoidance and hyperarousal symptoms (Nagelkerke's R(2)=0.44). Findings of this study give information regarding the frequency and the character of anxiety in breast cancer survivors and underline the relation of FoP to the reality of living with breast cancer. Results suggest that intrusive cognitions as well as avoidance and hyperarousal symptoms seem to be closely related to future-oriented fears of cancer recurrence.

How often do patients with IBD have symptom recurrence?

The issues that some patients with inflammatory bowel disease (IBD) must face are numerous. The greatest concerns are the uncertain nature of IBD and the unpredictability of the illness. For symptom recurrence it is important to differentiate between inflammatory relapse versus symptoms occurring during IBD remission that suggest functional disorders. For inflammatory recurrence of ulcerative colitis (UC), Langholz et al1 have shown that after years from the first diagnosis about 40%–50% of patients were in clinical remission in any 1 year. In years 3–7 after diagnosis of UC, 25% of patients were in remission, 18% had activity every year, and 57% had intermittent relapses. More and earlier relapses predicted even more relapses later in the disease. The initial extent of UC did not affect the subsequent clinical course, apart from those with more extensive disease being more likely to undergo colectomy within the first few years. For Crohn’s disease (CD) Munkholm et al2 have shown that each year 30% of patients had very active disease, 15% less active disease, and 55% were in remission. Approximately half of patients with CD have a further relapse in the year following a flare.3 The relapse rates among patients with CD receiving placebo range from 30%–60% at 1 year, and from 40%–70% at 2 years. The probability of relapse during the first 3 years correlates well with that during the following years. Therefore, the global course of CD can be estimated after 3 years of follow-up. Patients in remission for at least 1 year have a risk of relapse lower than those with a flare during the previous year. Four predictive factors of relapse within the 6 months following a flare are: age younger than 25 years, interval shorter than 6 months since the previous flare, more than 5 years since the first symptoms of the disease, and colonic involvement.4 In retrospective studies smoking has been associated with relapse, especially in young women.5 Psychological distress like anxiety and depressive coping style may influence the further course of IBD. Prospective studies have shown that patients with psychological distress, depressive mood, and anxiety developed more and earlier relapses during long-term follow-up.6,7 For UC, stressful events are associated with earlier time to relapse.8 In 1 study, high long-term stress tripled the risk of exacerbation during the next 8 months.9 It has to be considered that the prevalence of irritable bowel syndrome (IBS)-like symptoms in IBD patients in long-standing remission is 2–3 times higher than that in the normal population. Simren et al10 found that 32% of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety, depression, and more reduced well-being than those without IBS-like symptoms. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients. Therefore, psychological factors seem to be of importance for IBS-like symptoms, as well as for symptom recurrence due to inflammatory relapses in IBD patients.

P.2.b.012 Depressive coping style predicts the relationship between cortisol responses and stress experience

P.2.b.012 Depressive coping style predicts the relationship between cortisol responses and stress experience

For Depressed Lung Cancer Patients, Life May Be Shorter

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessFor Depressed Lung Cancer Patients, Life May Be ShorterJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Jan 2003https://doi.org/10.1176/pn.38.1.0024aCan a positive outlook or fighting spirit extend the survival of cancer patients? Most studies exploring the question have, unfortunately, produced a negative answer. A few, however, have yielded a positive one.And now comes still another study that suggests that a positive outlook—or at least absence of a depressive outlook—may be able to extend survival from cancer, and in one of the most intractable of malignancies, lung cancer.The investigation was conducted by Hermann Faller, M.D., Ph.D., and Henrich Bülzebruck, Ph.D., of the Institute of Psychotherapy and Medical Psychology at the University of Würzburg in Wurzburg, Germany. The results were published in the December American Journal of Psychiatry.Faller and Bülzebruck launched their study in 1989 to see whether a depressive coping style could influence survival in patients with lung cancer. Between 1989 and 1991, they recruited 103 patients newly diagnosed with lung cancer for the study. They made a point of selecting patients with different kinds of lung cancer so that they could take lung cancer type into consideration when analyzing their results.Subjects were given a Freiburg Questionnaire on Coping With Illness. It included short statements designed to reveal whether the person filling it out engaged in a depressive manner of coping with illness or not—say, brooding, arguing with fate, pitying oneself, acting impatiently and taking it out on others, or withdrawing from other people. Subjects were asked to indicate, on a five-point scale, whether they agreed or disagreed with each statement and to what degree. A rating of 1 meant “not at all,” and a rating of 5 meant “very much.”Faller and Bülzebruck then followed the outcomes of the 103 subjects until 2001. By this time, 95 of the 103 subjects had died. The researchers then attempted to see whether there was any link between subjects’ manner of illness coping a decade earlier and their length of survival.Even when types of lung cancer, stage of lung cancer, and amount of chemotherapy were taken into consideration, subjects who had scored high on statements reflecting a depressive coping style lived, on average, only nine months, whereas those who had scored low on these statements lived, on average, 14 months.“These results,” Faller and Bülzebruck concluded in their study report, “support the hypothesis that style of coping predicts survival in lung cancer.”If there is indeed a link between a depressive coping style and lung cancer survival, however, the researchers admit that they can only speculate at this point how it might work—say, via neuroendocrine and immune pathways. In contrast, depression appears capable of shortening heart attack survival via cardiac autonomic nervous system activity (Psychiatric News, November 16, 2001).The study was supported in part by a research grant from the German Ministry of Research and Technology.The study, “Coping and Survival in Lung Cancer: A 10-Year Follow-up,” is posted on the Web at http://ajp.psychiatryonline.org/cgi/content/full/159/12/2105?. ▪ Am J Psychiatry 2002 159 2105 ISSUES NewArchived

Coping and survival in lung cancer: a 10-year follow-up.

Little evidence is available to clarify the influence of psychological variables on the outcome of cancer. The authors studied whether style of coping was predictive of survival in lung cancer. A cohort of 103 patients newly diagnosed with cancer was followed for 10 years. Coping was assessed before treatment by using both self-reports and interviewer ratings. In a survival analysis with adjustment for known biomedical prognostic factors such as tumor stage, histological classification, and Karnofsky performance status, a depressive coping style, assessed by patients' self-reports, was linked with shorter survival (relative risk=1.91), and an active coping style, as assessed by interviewers' ratings, was linked with longer survival (relative risk=0.72). These results support the hypothesis that style of coping predicts survival in lung cancer. The observational design of the study, however, precludes any causal interpretation.

Use of alternative/complementary therapy in breast cancer patients--a psychological perspective.

The objectives of this study were to assess the additional use of alternative (complementary) therapies in patients with breast cancer who were receiving conventional treatment and to compare patients using alternative therapies with patients receiving only conventional treatment with special reference to psychological adaptation, causal attribution and quality of life. A sample of 117 female out-patients with a diagnosis of breast cancer filled in the following assessment instruments: FQCI (Freiburg Questionnaire for Coping with Illness), PUK (Causal Attribution Questionnaire), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), POMS (Profile of Mood States), and a self-developed questionnaire on alternative therapies. Nearly half the patients (47%, n = 55) reported that they had used alternative therapies in addition to conventional treatment. The methods applied most frequently were nutrition-related measures (special drinks, vitamin preparations and whole-foods - each applied by about 50% of users), mistletoe preparations (49%), trace elements (47%), and homeopathy (31%). Compared with patients receiving only conventional treatment, the users of alternative therapy were younger and better educated. Users developed a more active style of illness coping than nonusers and showed more religious involvement. Patients using a large number of alternative therapies (>3) tended to adopt a more depressive coping style than those using only a small number (< or =3). For a substantial proportion of cancer patients alternative therapies apparently fulfil an important psychological need. However, a subgroup of patients using many alternative therapies seem to have considerable adjustment problems. In dealing with cancer patients the treatment team should be aware of both these groups.

Need for Supportive Counselling – the Professionals’ versus the Patients’ Perspective

Background: The aim of the study was to identify melanoma patients who suffered significant distress and were judged to be in need of supportive counselling, on the one hand, and, on the other, to investigate patient interest in such support. Methods: Out of 236 melanoma patients, who constitute a representative sample of melanoma patients in Western Austria, 215 patients participated in the study and were assessed with regard to psychosocial distress, coping strategies, social networks and interest in receiving psychosocial support. Multiple logistic regression analyses were performed with regard to patient interest in receiving psychosocial support either from the attending oncologist or from a mental health professional. Results: 65 patients (30.2%) experienced moderate and 30 patients (14.0%) severe distress, which was predominantly caused by tumour-related fears, tension and disturbance of emotional well-being. 83% of the severely distressed patients wanted psychosocial support from their oncologists, whereas only half of them were interested in additional support from a psychotherapist. In particular, patients who showed fear of tumour progression and felt that they were insufficiently informed about their disease preferred to consult their dermatologist for psychosocial support. On the other hand, patients with poor prognosis, receiving only low levels of support from their social network, and exhibiting a depressive coping style, showed interest in getting supplementary support from a psychotherapist. Conclusions: These findings underline the importance of educating oncologists with a view both to improve their communication skills and to help them identify patients making poor adjustment to illness in order to offer them appropriate emotional support.