STAI, BDI, IPQ, COPE,
552 33 I focus on this problem and if necessary let
other things slide a little
.737 Suppression of Competing 55 1 put aside other activities in order to
concentrate on this
.735 Activities 56 I think hard about what steps to take .612 Planning 39 I think hard about how I might best
handle the problem
.599
25 I take additional action to get around the problem .575 Active Coping 58 I do what has to be done, one step at a time .517
59 I leam something from the experience Factor 3 Eigen value: 5.03: % var. 8.4
.528 Positive Reinterp. & Growth
35 I drink alcohol in order to think about it less .948 Alcohol 26 I try to lose myself for a while by drinking alcohol .929
53 I use alcohol to help get me through .925 12 I use alcohol to make myself feel better
Factor 4 Eigen value: 3.48: % var. 5.8
.894
50 I make fun of the situation .873 Humour
20 I make jokes about it .865
36 I kid around about it .829
8 I laugh about the situation
Factor 5 Eigen value: 2.98: % var. 5.0
.717
18 I seek God's help .892 Religion
7 I put my trust in God .889
48 I try to find comfort in my religion .862 60 I pray more than usual
Factor 6 Eigen value: 2.43: % var. 4.0
.839
38 1 look for something good in what is happening .694 Positive 29 1 try to see it in a different light to make it seem more
positive
.634 Reinterp. & Growth 5 I concentrate my efforts on doing something about it .544 Active Coping 47 I take direct action to get around the problem .528
Table 4.16 contd: Principle Components Factor Analysis of the COPE scale using the adolescent control group (n=173)
COPE Factor COPE dimension
Ques .no Loading (from oiig. ques.)
Factor 7 Eigen value: 1.92: % var. 3.2
40 I pretend it hasn’t really happened .803 Denial
27 I refuse to believe that it has happened .790 6 I say to myself "this isn't real" .736 57 1 act as though it hasn't even happened
Factor 8 Eigen value: 1.8: % var. 3.0
.544
54 I leam to live with it .731 Acceptance
44 I accept the reality of the fact that it happened .634 21 I accept that this has happened and it can't be changed .602 13 I get used to the idea that it happened
Factor 9 Eigen value: 1.59: % var. 2.7
.599
37 I give up the attempt to get what I want .692 Behavioural 24 I just give up trying to reach my goal .688 Disengagement
9 I admit to myself that I can't deal with it and quit trying
Factor 10 Eigen value: 1.42: % var. 2.4
.534
15 I keep myself from getting distracted by other thoughts or activities
.712 Suppression of Compet. Activities 2 I turn to work or other substitute activities to take my .523 Mental Disengage.
mind off things
19 I make a plan of action .509 Planning
32 I try to come up with a strategy about what to do Factor 11 Eigen value: 1.3: % var. 2.2
.507
22 I hold off doing anything until the situation permits .700 Restraint Coping 10 I restrain myself from doing anything too quickly .676
49 I force myself to wait for the right time to do something
Factor 12 Eigen value: 1.25: % var. 2.1
.532
41 I make sure not to make matters worse by acting too soon
.692 Restraint Coping 42 I try hard to prevent other things from interfering
widi my efforts at dealing with this Factor 13 Eigen value: 1.16: % var. 1.9
.596 Suppression Compet. Activities 43 I go to the movies or watch TV to think about it less
Factor 14 Eigen value: 1.12: % var. 1.9
.826 Mental Disengage. 31 I sleep more than usual
Factor 15 Eigen value: 1.04: % var. 1.7
.632 Mental Disengage. 1 I try to grow as a person as a result of the experience .518 Positive
Reinterp. & Growth Q uestions with a factor loading of less than .5
51 1 reduce the amount of effort I'm putting into solving the problem
.484 Behav. Disengage. 16 1 daydream about things other than this .366 Mental Disengage.
Table 4.17: Alpha coefficient scores for the COPE sub-scales in adolescent patients, controls and parents
COPE Dimensions A dolescent Cancer a (n= 50) A dolescent
CogtrS#
a(n=168) Parents' a (n=68)Positive re-interpretation and grow th .75 .70 .75
Active coping .72 .72 .70
Planning .77 .79 .84
I Seeking em otional social support .83 .90 .90 Seeking instrum ental social support .76 .85 .79 Suppression of com peting activities .73 .68
Religion .96 .91 .95
Acceptance .75 .70 .69
Mental disengagem ent .44 .38 -.42
Venting emotions .84
Behavioural disengagem ent .67
.85 .66 .85 .47 Denial .57 .76 .65 Restraint coping .66 .55 .68 :87 :87 Alcohol use 1.0 H um our .95 .96 .87
A d d itio n al dim ensions w ith p oor internal reliability w ere denial for the adolescent patients and behavioural disengagement for the parents. Denial may have been seen by the adolescents as p articularly in ap p ro p riate, or even incom prehensible, in the context of a recent cancer diagnosis. Q uestions on the denial sub-scale were; 'I pretend it h asn 't really h ap p en ed ' (1;42, 2;6, 3;2, 4;1), 'I refuse to believe that it has h ap p en ed ' (1;43, 2;6, 3;2), 'I say to myself "this isn 't re a l'" (1;34, 2;12, 3;3, 4;2) and 'I act as th o u g h it h a s n 't even hap p en ed ' (1;36, 2;8, 3;4, 4;3). The num bers in brackets are the frequencies of scores p er qu estio n , so for exam ple, for the first q u estio n , 42 of the adolescents answ ered '1' w hich corresponds w ith 'I usually d o n 't do this at all' and 1 adolescents answ ered '4' which corresponds w ith 'I usually do this a lot'.
The behavioural disengagement sub-scale h ad a low alpha coefficient in the p aren tal group. This dim ension com prised the follow ing statem ents; 'I reduce the am ount of effort I'm p u ttin g into solving the problem ' (1;48, 2;15, 3;5, 4;1), 'I adm it to m yself that I can't deal w ith it and stop trying' (1;58, 2;7, 3;4), 'I just give up trying to reach my goal' (1;44, 2;13, 3;9, 4;3) and 'I give up the attem pt to get w hat I w ant' (1;44, 2;17, 3;5, 4;3). As above, the num bers in
brackets are the frequencies of p aren tal responses in the range 1 to 4. As w ith denial, these four questions seem ed in ap p ro p riate to the cancer diagnosis the parents w ere facing w h en 'g iv in g u p ' is n o t feasible.
Ad o l e s c e n t p a t ie n t s
Tables 4.18 show s th e m ean scores, sta n d a rd d ev iatio n s a n d ran g es for the COPE dim ensions as an sw ered by the adolescent p atien ts a t th e tim e of their cancer diagnosis.
Hypothesis: That acceptance would be frequently used as a coping strategy in all family members.
Hypothesis: That adolescent girls will use the social support coping strategies of seeking em otional and instrum ental support more frequently than adolescent boys. Hypothesis: That adolescent boys will use the coping strategy of d en ia l more than girls.
Hypothesis: That boys will use more hum our than girls.
The m ost com m on strategy a d o p te d by the adolescent p atien ts w as acceptance
follow ed b y positive re-interpretation and grow th (highest m ean scores). Alcohol use w as the least ad o p ted coping strategy. A t the tim e of diagnosis, girls w ere significantly m o re likely to u se the co p in g strateg ies of th e seeking o f social support fo r em otional reasons (t=-.40, d f 49, p<.001) an d the v e n tin g o f em otions
(t=-4.56, d f 49, p<.001) th an boys. It h ad b een p ro p o se d th a t girls w o u ld use m ore seeking o f social support fo r in stru m en ta l reasons (t=-2.41, p=.02) an d th at boys w o u ld use m ore denial (t=.79, p=.43) an d h u m o u r (t=.69, p=.49), how ever these hypotheses w ere n o t up h eld .
Hypothesis: That there would be negatiye correlations between the use of seeking
em otional and instrum ental social support as coping strategies and anxiety and depression in the adolescent patients.
Hypothesis: That the use of positive re-interpretation and grow th, active coping, and
planning would be negatiyely correlations with anxiety and depression.
Hypothesis: That the coping strategies of behavioural and m e n ta l d isen g a g em en t
Table 4.18: Mean scores, standard deviations and ranges for the COPE sub-scales in adolescent patients and controls
Mean SD Min. Max. Mean SD Min. Max. Positive re-interpretation & grow th 2.63 .71 1.0 4.0 233 .63 1.0 4.0 Active coping 237 .68 1.25 3.75 2.43 .61 1.0 4.0
Planning 1.94 .70 1.0 4.0 2.25 .55 1.0 3.5
Seeking em otional social support 2.57 .86 1.0 4.0 2.15 .87 1.0 4.0 Seeking instrum ental social support 233 .77 1.0 4.0 2.27 .81 1.0 4.0 Suppression of com peting activities 1.84 .63 1.0 375 2.14 .55 1.0 3.75
Religion 1.77 .99 1.0 4.0 133 .87 1.0 4.0
Acceptance 3.43 .59 2.0 4.0 230 .66 1.0 4.0 Mental disengagem ent 2.40 .65 1.5 3.75 2.17 .58 1.25 3.75 Venting em otions 2.04 .74 1.0 3.5 238 .82 1.0 4.0 Behavioural disengagem ent 133 .47 1.0 2.75 1.65 .53 1.0 4.0 Denial 1.35 1 .47 1.0 2.75 1.53 .60 1.0 3.5 Restraint coping 138 .60 1.0 3.25 2.14 .54 1.0 3.75 Alcohol use 1.08 .44 1.0 4.0 1.61 i .84 1.0 4.0
H um our 233 1.01 1.0 4.0 237 .82 1.0 4.0
Hypothesis: That anger and the coping strategy of religion would be negatively correlated.
Hypothesis: That optimism would be positively correlated with acceptance, planning and humour as coping strategies.
Hypothesis: That optimism would be negatively correlated with the coping strategies of avoidance and behavioural disengagement.
There w ere no significant neg ativ e relatio n sh ip s b e tw e en th e co p in g strategies o i positive re-interpretation and grow th, seeking social su pport fo r em o tio n a l/in stru m en ta l reasons, active coping a n d p la n n in g , a n d sta te anxiety or depression. Sim ilarly th ere w ere no po sitiv e relatio n sh ip s b e tw e e n m o o d an d th e co p in g strateg ies of m en ta l a n d b e h a v io u ra l disengagem ent. There w as no significant correlation betw een the coping strategy of religion an d state anger. There w ere no significant positive o r n e g a tiv e c o rre la tio n s b e tw e e n d is p o s itio n a l o p tim is m a n d a c c e p ta n c e , p la n n in g , h u m o u r , a v o id a n c e a n d b e h a v io u r a l disengagem ent as coping strategies.
Ad o l e s c e n tc o n t r o l s
Table 4.18 show s the m ean scores, sta n d a rd deviations a n d ran g es for the COPE d im en sio n s as an sw ered b y the ado lescen t controls. The m ost com m on strategy ad o p ted by the boys w as acceptance follow ed by
positive re-interpretation and g ro w th (h ig h est m ean scores). The girls h ig h e st m e a n scores w e re for th e tw o seek in g of social s u p p o rt d im e n sio n s a n d th e v e n tin g o f em otions. D e n ia l w as th e le a st u se d coping strateg y b y th e control boys w h ereas alcohol use w as th e least ad o p ted coping strategy in the girls.
Girls w ere significantly m ore likely to use the seeking o f social support fo r em otional reasons (t=-6.80, d f 168, p<.001), th e seeking o f su p p o rt fo r in stru m en ta l reasons (t=-.4.39, df 168, p<.001) an d the v e n tin g o f em otions
(t=-6.86, d f 167, p<.001) th a n the control boys, th e sam e p a tte rn as in the adolescent p atien t group.
Figure 4.5: M ean coping scores by sex for ad o lescen t p a tie n ts an d controls
Positiv. re-interp. g ro w th Active coping P lanning Seeking em otional soc. sup. Seeking instrum ental soc. sup. Suppression com peting activ.
R eligion A cceptance M ental disengagem ent Venting em otions B ehavioural disen g ag em en t D e n ia l
Boys R estraint coping Alcohol use
Humour Positiv. re-interp. gro w th G i r l s Active coping P lanning Seeking em otional soc. sup. Seeking instrum ental soc. sup. Suppression com peting activ.
R eligion Acceptance M ental disengagem ent Venting em otions B ehavioural disen g ag em en t D e n ia l R estraint coping Alcohol use Humour Q P a t i e n t s r ~ | C o n t r o l s 1 2 3
Ad o l e s c e n tp a t ie n t sa n d c o n t r o l s
There w ere significant differences in the coping strategies a d o p te d by the stu d y a n d co n tro l groups. A dolescents w ith cancer u se d m ore;
seekin g o f em otional su p p o rt (t=3.05, d f 219, p=.003) a n d a cce p ta n ce
(t=8.05, d f 218, p<.001) th a n th e co n tro l ad o lescen ts. The c o n tro l adolescents rep o rted they used m ore; p la n n in g (t=-2.91, d f 219, p=.005, se p arate variance), suppression o f com peting activities (t=-3.24, d f 218, p=.001), behavioural disen gagem ent (t=-3.87, d f 218, p<.001), r e s tr a in t c o p in g (t=-2.93, d f 218, p=.004) a n d alcohol (t=-6.01, d f 219, p<.001, separate variance) to deal w ith stressful situations.
A dolescent sex ex plained som e of th e differences in th e a d o p tio n of co p in g strateg ies. D ifferences b y sex w ere fo u n d fo r seeking social su p p o rt fo r em otional reasons (F=61.6 6(2^219)/ P< 01), seeking in s tr u m e n ta l social su p p o rt (F=24.61(2,2i9), p< 0 1) a n d v e n tin g em o tio n s (F=6 6.2 6(2,2i9), p< .0 1) w ith girls hav in g higher scores th an boys.
For one coping strategy, stu d y g ro u p an d sex h a d m ain effects on the score; p la n n in g (gro u p ; F=14.09(22i9), p< 01; sex; F=7.9^2,2i9), P= 005). U sing p la n n in g as a coping strategy w as rep o rted m ore b y the control g ro u p an d b y girls. There w ere no significant tw o -w ay in teractio n s b etw een stu d y group an d sex.
Pa r e n t s
The m ean s scores a n d sta n d a rd d ev iatio n s p e r COPE d im en sio n are sh o w n in Table 4.19 for m others an d fathers.
Hypothesis: That acceptance would be frequently used as a coping strategy in all family members.
Hypothesis: That the coping strategy of behavioural disengagem ent would not generally be used.
Hypothesis: That mothers and adolescent girls will use the social support coping strategies of seeking em otional and in s tr u m e n ta l support more frequently than fathers and adolescent boys.
Table 4.19: Mean scores, standard deviation and ranges for the COPE sub-scales in mothers and fathers
PE dimension 'M others (n=41) Fathers ,( n = ^
» 4P-
Mean SD Min. Max. Mean SD Min. Max. Positive re-interpretation & grow th 3.18 .68 1.25 4.0 2.88 .63 1.0 4.0 Active coping 3.12 .60 1.25 4.0 2.67 .70 1.25 4.0
Planning 2.74 .50 1.5 3.5 2.40 .59 1.0 3.5
Seeking em otional social support 2.96 .93 1.0 1 4.0 1 2.17 .78 1.0 3.5 Seeking instrum ental social support 3.04 .66 1.0 1 4.0 2.44 .75 1.0 3.75 Suppression of com peting activities 2.73 .71 1.25 4.0 2.33 .69 1.0 3.75 Religion 2.34 1.15 1.0 ; 4.0 2.01 1.11 1.0 4.0
Acceptance 3.10 1
1 .64 1.0 : 4.0 3.04 .69 1.5 4.0 M ental disengagem ent 1.82 .32 1.0 2.5 1.62 .39 1.0 2.5 Venting em otions 2.63 .78 1.0 4.0 1.96 .80 1.0 4.0 Behavioural disengagem ent 1.40 1 .40 1.0 2.25 1.48 .54 1.0 3.0 Denial 1.38 1 .46 1.0 i 3.0 1.49 .62 1.0 3.0 Restraint coping 2.52 .73 1.0 3.75 2.14 .52 1.0 3.0 Alcohol use 1.23 .42 1.0 1 2.5 1.27 .62 1.0 4.0 H um our 1.80 .78 1.0 4.0 1.53 .64 1.0 3.5 ; / 1 " 179
Hypothesis: That fathers will endorse the active coping strategies of p la n n in g , suppression o f com peting activities and restraint coping more than mothers.
Hypothesis: That mothers will use religion more then fathers in attempting to cope with their child's cancer.
As w ith th e ad o lescent p atien ts, acceptance h a d the h ig h est m ean s score for bo th m others an d fathers an d alcohol use the low est score. M others u sed four co p in g strate g ie s sig n ifican tly m o re th a n fath ers; seeking em otional social su p p o rt (t=3.70, d f 67, p<.001), seeking in stru m en ta l social suppo rt (t=3.53, d f 67, p=.001) an d th e v e n tin g o f em otions (t=3.50, d f 67, p=.001). A d d itio n a lly m o th ers u sed m ore active coping (t=2.87, d f 67, p=.006) th a n fathers alth o u g h the sta rtin g h y p o th ese s h a d b een th a t fath ers w o u ld u se m o re active coping
stra te g ie s, in c lu d in g p la n n in g , the su p p ressio n o f c o m p e tin g a c tiv itie s an d
restra in t coping. T hese h y p o th e se s w e re n o t u p h e ld , n e ith e r w a s th e h y p o th esis th a t m others w o u ld use the coping strateg y of religion m ore th an fathers.
Hypothesis: That there would be negatiye correlations between the use of seeking
em otional and in s tr u m e n ta l social support as coping strategies and anxiety and depression in parents.
Hypothesis: That the use of positive re-interpretation and grow th, active coping, and
planning would be negatiyely correlations with anxiety and depression.
Hypothesis: That the coping strategies of b e h a v io u ra l and m e n ta l disengagem ent