Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured

Abstract

BackgroundIndividuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.MethodOne hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.ResultsA four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.ConclusionsThis study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

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

“…We examined the literature for higher order factor structures for the purpose of identifying the best fitting model. Several principal models were identified (with defining subscales for higher order factors included in parentheses): (a, b) two-factor models by Tuncay, Musabak, Gok, and Kutlu (2008) and Moore, Biegel, and McMahon (2011) examined similar factors labeled as problem-focused or adaptive , respectively (acceptance, religion, planning, positive reframing, instrumental support, active coping, emotional support, humor) versus emotion-focused or maladaptive , respectively (self-distraction, venting, self-blame, behavioral disengagement, denial, substance use) coping strategies; (c) a four-factor model (Nahlen Bose, Bjorling, Elfstrom, Persson, & Saboonchi, 2015) examining problem-focused (active coping, planning), avoidant (behavioral disengagement, denial, substance use), socially supported (emotional support, instrumental support, venting), and emotion-focused (positive reframing, acceptance, humor, religion) coping strategies; (d) Carver’s (1997) original 14 subscales without higher order factors included; and (e) unnamed higher order factors identified by Carver (1997; Factor 1 : emotional support, instrumental support; Factor 2 : active coping, planning, positive reframing; Factor 3 : venting, self-distraction; Factor 4 : denial, self-blame) with remaining subscales included in the model as single observed variables (i.e., substance use, religion, humor, behavioral disengagement, acceptance).…”

“…It should be noted that the four-factor model (Nahlen Bose et al, 2015) is the only one that omits select subscales (i.e., Self-Blame and Self-Distraction), therefore containing less items. The four-factor model also possesses certain strengths relative to other models that provide initial rationale to expect it to generate best model fit.…”

Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study

“…Sense of coherence has been found to predict coping and QoL in patients with Parkinson’s disease [ 24 ]. More use of problem-focused coping was associated with better QoL in patients with chronic heart failure [ 1 , 11 ], Parkinson’s disease [ 25 ], and stroke [ 26 ], whereas more use of emotion-focused coping was associated with poorer QoL [ 11 , 12 , 25 , 27 ]. Positive correlations between coping and QoL have been found in patients with stroke [ 5 ], multiple sclerosis [ 13 ], and end-stage renal disease [ 7 , 28 ].…”

The influence of coping strategies on quality of life in a community facing environmental and economic threats

“…The brief COPE Inventory (Carver, ) originally investigated 14 coping strategies, including 28 items rated on a 5‐point Likert‐type scale ranging from 1 ( never ) to 5 ( very often ). Using the four‐factor structure (Nahlen Bose et al., ), we grouped the strategies to measure problem‐focused coping (active coping and planning; α = .73), avoidant coping (behavioral disengagement and denial; α = .73), socially supported coping (emotional support, instrumental support, and venting; α = .80), and emotion‐focused coping (positive reframing, acceptance, and humor; α = .78).…”

“…Researchers have attempted to incorporate these coping models into the development of various strategies that may lead to positive effects when individuals who are facing negative events use them. Carver () validated a scale measuring 14 coping strategies, grouped in the literature, in different numbers of second‐order factors (Nahlen Bose, Bjorling, Elfstrom, Persson, & Saboonchi, ).…”