Palliative Coping Styles Research Articles

Cognitive Behavioral Intervention Program Aimed at Patients Tributary for Cardiopulmonary Bypass Surgery

Objective: The present study proposes a psychological preparation program with a cognitive behavioral intervention to reduce levels of anxiety and depression in addition to modifying the coping style of patients with heart disease who will undergo a surgical intervention with cardiopulmonary bypass. Method: A quasi-experimental pre-test-posttest study was carried out with a control group. 91 patients were evaluated prior to undergoing cardiac cardiopulmonary bypass surgery, of which 16 were selected for this study, 8 participated in psychological treatment and 8 patients were selected for the control group. Instruments: Hospital Anxiety and Depression Scale and the Questionnaire for Coping with Injuries and Health Problems. Results: Differences were found in the anxiety and depression scores of the experimental group, although these results were not statistically significant. On the other hand, a significant difference was found as a treatment effect between the groups in favor of the experimental group in the greater use of the Palliative coping style (p = 0.05) and less predominance of the Emotional style (p = 0.05). Conclusion: It is essential that the psychologist specialized in behavioral cardiology develops and carries out interventions so that the patient develops cognitive, emotional and coping strategies for the management of anxiety and depression.

Prevalence and predictors of major depressive disorder in bereaved caregivers at 6 and 13 months.

Depressive symptoms are common in bereaved caregivers; however, there have been few prospective studies using a structured interview. This study investigated the prevalence and preloss predictors of major depressive disorder (MDD) in bereaved caregivers of patients in a palliative care unit. This prospective cohort study collected caregiver sociodemographic and psychological data before the death of a palliative care unit patient, including MDD, care-burden, coping style, and hopeful attitude. Postloss MDD was assessed 6 and 13 months after death, and a multivariate logistic regression analysis was conducted to identify its predictors.ResultOf 305 caregivers contacted, 92 participated in this study. The prevalence of preloss MDD was 21.8%; the prevalences of postloss MDD were 34.8% and 24.7% at 6 and 13 months, respectively. Preloss MDD predicted postloss MDD at 6 months (odds ratio [OR] = 5.38, 95% confidence interval [CI95%] = 1.29, 22.43); preloss nonhopeful attitude and unemployment status of caregivers predicted postloss MDD at 13 months (OR = 8.77, CI95% = 1.87, 41.13 and OR = 7.10, CI95% = 1.28, 39.36, respectively).Significance of resultsApproximately 35% of caregivers suffered from MDD at 6 months postloss, but the prevalence of MDD decreased to about 25% at 13 months. Preloss MDD significantly predicted postloss MDD at 6 months, whereas hopeful attitude and unemployment at baseline were significantly associated with postloss MDD at 13 months.

Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model.

To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI). A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI. Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles. The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.

The relationship of coping style with depression, burden, and life dissatisfaction in caregivers of patients with subarachnoid haemorrhage

To assess the relationship of coping style with depression, burden and life satisfaction in caregivers of patients with subarachnoid haemorrhage. Cross-sectional study. Forty-one primary caregivers of patients with subarachnoid haemorrhage. Caregivers completed several questionnaires within the first year after subarachnoid haemorrhage. Coping style was assessed using the Utrecht Coping List, depression with the Goldberg Depression Scale (GDS), burden with the Sense of Competence Questionnaire, and life satisfaction with the Life Satisfaction Questionnaire. Caregivers had a mean burden score of 37.8 (standard deviation (SD) = 7.4) and a life satisfaction score of 5.0 (SD = 0.6). Nine caregivers (23%) had depressive symptoms (GDS ≥ 2). A palliative coping style was positively associated with the presence of depressive symptoms (odds ratio (OR) = 1.45, p = 0.016). A passive coping style was positively related to burden (ß = 1.61, p = 0.024), adjusted for morbidity of the caregiver (ß = 11.90, p = 0.013), and inversely related to life satisfaction (ß = -0.10, p = 0.025). In caregivers of patients with subarachnoid haemorrhage palliative or passive coping styles are related to depressive symptoms, higher burden and life dissatisfaction. This implies that rehabilitation programmes for patients with subarachnoid haemorrhage should also include caregiver support programmes that focus on coping style.

Long‐term psychological distress in women at risk for hereditary breast cancer adhering to regular surveillance: a risk profile

Some women at risk for hereditary breast cancer are at increased risk of psychological distress. In order to tailor support for individual women, the availability of a tool enabling the identification of psychologically vulnerable women at an early stage is warranted. The objectives of this study were (1) to explore long-term psychological distress in women at risk for hereditary breast cancer adhering to regular surveillance, and (2) to identify women being vulnerable for long-term psychological distress, defined in terms of a multifactorial risk profile. General distress and cancer-related distress were assessed at baseline (T0) and after 5-8 years (T1) in 197 high-risk women adhering to breast cancer surveillance. Coping styles, occurrence of breast cancer in the family of origin, breast cancer risk perception, and frequency of breast self-examination, as assessed at T0, were examined as predictor variables for long-term distress (T1). Across time, women reported a significant reduction in intrusion and avoidance. Intrusion levels were increased among women who had lost a first-degree relative to breast cancer. Predictors of increased long-term distress were passive and palliative coping styles, excessive breast self-examination, and overestimation of breast cancer risk. On the other hand, coping through fostering reassuring thoughts was predictive for decreased long-term distress. On the basis of the identified risk profile, it is possible to identify vulnerable women at an early stage, who then may be offered additional and individually tailored support.

Symptoms of Acute Posttraumatic Stress Disorder in Patients With Acute Hand Injuries

Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of acute PTSD in hand-injured patients. Sixty-seven employed patients with hand injuries completed a number of questionnaires. The following factors were investigated: sociodemographic characteristics, injury severity, accident location, pain, satisfaction with hand functioning, aesthetics of the hand, social support, and coping styles. The primary outcome measure was the number of symptoms of PTSD. We analyzed factors that were univariately significantly associated with symptoms of PTSD using linear regression analysis, and explored interaction effects. One patient met the criteria for PTSD; 44 patients experienced symptoms but did not meet the criteria (median, 1; interquartile range (IQR), 0-2); 22 patients experienced no symptoms of PTSD. Patients had a median pain score of 30 (IQR, 10-45), median satisfaction score of 60 (IQR, 45-70), median aesthetics score of 66.7 (IQR, 45.8-79.2), median palliative coping style score of 16 (IQR, 14.8-17.3), and median avoidance coping style of 15 (IQR, 13-16). Symptoms of PTSD were associated with pain (r, .530; p < .001), satisfaction with hand function (r, -.451; p < .001), aesthetics (r, -.320; p = .009), palliative coping style (r, .281; p = .022) and avoidance coping style (r, .283; p = .022). Pain and aesthetics remained significant after regression analysis. No interaction effects were significant. Pain and aesthetics statistically predict symptoms of acute PTSD in patients with acute hand injuries. Patients with disproportionate pain or dissatisfaction with aesthetics should be evaluated for PTSD. Prognostic IV.

Substance abuse, coping strategies, adaptive skills and behavioral and emotional problems in clients with mild to borderline intellectual disability admitted to a treatment facility: A pilot study

Many clients with mild to borderline intellectual disability (ID) who are admitted to a treatment facility show serious problems in alcohol and/or drugs use. In the present case file study, we explored differences in coping strategies, adaptive skills and emotional and behavioral problems between clients who showed substance abuse and clients who did not. There were no differences in adaptive skills between groups. However, compared to clients without substance abuse, those who abused substances showed a more palliative coping style, and had more severe emotional and behavior problems such as anxiety/depression and intrusive thoughts and aggressive and antisocial behaviors. Implications for treatment are discussed.

In an exploratory prospective study on multimorbidity general and disease-related susceptibility could be distinguished

Objectives To further disentangle multimorbidity and its relation with psychosocial characteristics, by categorizing combinations of diseases within a patient as general or disease-related susceptibility, based on the presence or absence of a pathophysiological communality of diseases. Study Design and Setting A cohort of 3,460 patients that previously took part in a study on multimorbidity was followed up for a period of 2 years. Context: the Registration Network Family Practices, which is a continuous and computerized database in Dutch general practice that covered over 60,000 patients at the time of the study. Results During 2-year follow-up 91.6% did not show susceptibility, 4.2% showed general susceptibility, 1.4% disease-related susceptibility, 0.8% both general and disease-related susceptibility, and 1.9% patients could not be classified. None of the studied characteristics was significantly related to the occurrence of disease-related susceptibility. A decreased risk for general disease susceptibility related to an internal health locus of control, an active and palliative coping style, and the occurrence of positive life events. Conclusion The distinction between general susceptibility and disease-related susceptibility is feasible and seems useful. Further development of this methodology is needed, as is confirmation of these results in a larger study population.

Predictors of health status in women with fibromyalgia: A prospective study

Although cross-sectional studies have identified correlates of dysfunction in fibromyalgia (FM) patients (e.g., psychological distress and pain), predictors of health status have not been previously investigated using a longitudinal research design. We gathered data from 156 women who met American College of Rheumatology criteria for primary FM recruited from both tertiary care and community settings. Stepwise multiple linear regression analysis indicated that poorer health status (p < .0001) and more comorbidity (p = .0089) at baseline were predictors of poorer health status 6 months later. After controlling for these covariates, psychological distress contributed significantly to the model (p = .01). There was a trend indicating that palliative coping styles (i.e., self-care, energy conservation) altered the impact of pain on 6-month health status (p = .06). These findings highlight the need for multidisciplinary interventions that target psychological distress, coping, and comorbidity in patients with FM.

Do social comparison and coping styles play a role in the development of burnout? Cross‐sectional and longitudinal findings

The present longitudinal research among 558 teachers focused on the role of upward comparisons (with others performing better), downward comparisons (with others performing worse), and coping styles in relation to burnout. Assessed were identification (recognizing oneself in the other) and contrast (seeing the other as a competitor) in upward and downward comparison. Cross‐sectionally, downward identification and upward contrast were positively related to burnout and negatively related to a direct coping style, whereas upward identification was negatively related to burnout and positively related to a direct coping style. Downward identification was positively related to a palliative coping style. Direct and palliative coping styles were independent predictors of burnout: those who reported using a direct coping style had lower levels of burnout and those who reported using a palliative coping style had higher levels of burnout. Longitudinally, the use of a direct coping style was associated with a decrease and downward identification with an increase of burnout over time.

Tobacco usage interacts with postdisaster psychopathology on circadian salivary cortisol

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) have been associated with increased rates of tobacco usage as well as with dysregulations of the hypothalamus–pituitary–adrenal (HPA) axis. At the same time tobacco also affects the HPA axis. This paper examines the relationships between PTSD, posttraumatic MDD, smoking and levels of circadian cortisol 2–3 years postdisaster. Subjects were survivors of the Enschede fireworks disaster. The sample consisted of 38 healthy survivors, 40 subjects with PTSD, and 17 subjects with posttraumatic MDD. The Composite International Diagnostic Interview was used to determine mental disorders in accordance with DSM-IV criteria. Salivary cortisol samples were collected at home immediately upon awakening, 30 min after awakening, at noon, and at 10 p.m. Quantity of smoking was measured through self-report. The results of the study show that salivary cortisol concentrations were higher in smoking subjects. Survivors with MDD following the disaster had a flatter diurnal cortisol curve than subjects with PTSD or healthy survivors. In survivors with PTSD and healthy individuals the usual dynamic pattern of increase in cortisol past awakening was present, while we did not observe this in posttraumatic MDD. These survivors with MDD tended to use more tobacco per day, and the cortisol group differences could only be revealed when we adjusted for quantity of smoking. Smoking, which may be an important palliative coping style in dealing with posttraumatic arousal symptoms, seems to mediate the relationship between traumatic stress and the HPA-axis.

Coping strategies among patients receiving continuous ambulatory peritoneal dialysis

Objective The aim of this study was to explore coping strategies of patients undergoing continuous ambulatory peritoneal dialysis. Methods A descriptive design was used to conduct this study. The purposive sampling method was used to select study samples. A total of 41 patients on continuous ambulatory peritoneal dialysis were included in the study. The coping was measured on the Jalowiec Coping Scale. Results The optimal coping style was the most used by participants in the study, followed by fatalistic, confrontive, self-reliant, emotion, supportant, evasive, and palliative coping styles. The optimal coping method was effected by age and complication (p<0.01). Age was the influencing factor for the evasive coping method (p<0.05). Participants more than 60 years of age were less likely to use this method than middle-aged and young patients (p<0.005). The self-reliant coping method was effected by the severity of disease and the educational level of the participants (p<0. 05). Participants using the supportant coping method were influenced by their occupation (p<0.05). The severity of disease and hospital fee payment influenced patients using the palliative coping method (p<0.05). The fatalistic coping method was the second most commonly used by women in this study. Conclusion The results showed that patients used various types of coping strategies. Age, sex, educational level, occupation, severity of health condition, and manner of hospital payment had significant influence on the coping style. To probe the coping style of continuous ambulatory peritoneal dialysis patients, nurses have the responsibility of helping patients to use positive coping methods to deal with this stressor. Nurses also need to give attention to assessing the coping style of women receiving continuous ambulatory peritoneal dialysis to assist them in using a positive coping method.

The Effectiveness of Self-Management Training for Individuals With HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned to the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

The Effectiveness of Self-Management Training for Individuals With HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Coping and psychosocial adjustment of women with diabetes.

The purpose of this study was to investigate relationships between coping styles and psychosocial adjustment for women with diabetes. The sample consisted of 115 community-residing women with diabetes. Coping was measured by the Revised Jalowiec Coping Scale and psychosocial adjustment by the Psychosocial Adjustment to Illness Scale. Pearson's product moment correlation was used to assess relationships between coping and adjustment. The most frequently and effectively used coping styles were optimistic, confrontive, self-reliant, and supportant. The psychological, social, and health care domains showed the most problems; the fewest were in the extended family, sexual, and vocational domains. Relationships were found between women's coping styles and psychosocial adjustment, with better adjustment associated with effective use of confrontive, supportant, optimistic, self-reliant, and palliative coping styles. Important relationships exist between the ways women cope with diabetes and their level of psychosocial adjustment to the illness. Knowledge of these relationships can help diabetes educators assist clients in making lifestyle changes.

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15–74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.

Potential Mediators of Post-Traumatic Stress Disorder in Child Witnesses to Domestic Violence

Objective: The aim was to examine variables that might mediate the incidence of Post-Traumatic Stress Disorder (PTSD) in child witnesses to domestic violence. These variables included age, gender, locus of control, self-blame, perception of threat, active versus palliative coping style, maternal emotional health plus aspects of the violence witnessed (intensity, frequency, age of child when first witnessing violence, and time since the last violent episode). Method: Following screening for other PTSD inducing experiences, a sample of 20 child witnesses to domestic violence, 15 matched control children, and their mothers were assessed using the following tools: The Straus Conflict Tactics Scale; the Child Post-Traumatic Stress Reaction Index; the Nowicki-Strickland Locus of Control Scale; the General Health Questionnaire, and a Screening Questionnaire designed to elicit qualitative information from both children and mothers including data about any other potential PTSD inducing stressor the subject child may have been exposed to. Results: None of the factors under examination were found to contribute significantly to the severity levels of Post-Traumatic Stress Disorder in relation to witness status. Conclusion: The small sample size of the study necessitates that the results be interpreted with caution. Nevertheless the findings indicate that the impact of witnessing domestic violence, in terms of PTSD, is not mediated by factors such as maternal emotional well-being, age and gender of the child, or the child’s style of coping with parental conflict. Evidence that variables specifically related to the violence witnessed did not mediate the impact suggests that all domestic violence may have severe and long-term impact on child witnesses.

Patients with chronic renal failure and their ability to cope.

The subject studied in this paper, describing uremic patients' use of coping strategies and their sense of coherence, was 48 consecutively selected patients with chronic renal failure at a Swedish hospital. The questionnaires used were the Jalowiec Coping Scale (JCS-40) and the Sense of Coherence Scale (SOC). The results showed that the patients used a variety of coping strategies, such as maintaining control, finding out more about the situation and hoping. In the use of coping styles, the confrontational style was the most favoured one, compared with the palliative and the emotive styles. There was a significant distinction between the predialysis patients and those on dialysis treatment concerning the use of strategies and coping styles. Patients on dialysis treatment showed significantly higher scores in overall strategies and in confrontational and palliative coping styles. The results revealed significant correlations between the JCS and the SOC scores, age and duration of kidney disease. Knowledge of the patients' commonly used coping strategies and sense of coherence is important when nursing care is being planned for the patient.

Leisure lifestyle education for people with disabilities: The leisure supermarket

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15–74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.