Journal of Personality and Social Psychology 1991, Vol. 61, No. 5,801-810
Copyright 1991 by the American Psychological Association Inc. 0022-3514/9I/J3.00
Coping Success and Its Relationship to Psychological Distress for Older Adults Alex J. Zautra and Amy B. Wrabetz
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Arizona State University
The role of coping success on psychosocial distress was investigated in 147 older adults who experienced a major health problem and 82 older adults who reported a major loss in the past 6 months. Home interviews provided data on satisfaction with coping efforts and negative changes associated with events. Significant predictors of coping success were identified and controlled for in subsequent analyses predicting mental health. Efficacy in coping with loss was associated with less psychological distress. Coping efficacy interacted with coping efforts in predicting distress for those with health downturns; efficacy in coping was associated with less distress only for those who were actively engaged in coping. Analyses of longitudinal data replicated the cross-sectional findings for coping with loss.
A number of investigators have suggested that an individual's coping response plays a critical role in shaping the meaning and impact of stressful life events. Lazarus (1966) was among the first to recognize the importance of studying responses to stress and to develop a transactional framework to study the person's role in appraisal of and active defense against threats or harm associated with stressors. This pioneering work has been followed by several studies that have further elucidated and clarified the underlying processes (e.g., Folkman & Lazarus, 1980; Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). Within this framework, coping is seen as a dynamic process of purposeful efforts focused on the resolution of difficulties that place demands on the organism for adjustment. To examine coping processes fully, Elliott and Eisdorfer (1982) proposed that life stress transactions may be usefully partitioned into three interrelated yet distinct components: the stressor itself, the person's response or efforts to cope, and the outcome of that sequence of stress occurrence and response. The first two of these components continue to be studied in some detail; only a few studies thus far have addressed the importance of the person's evaluation of his or her efforts to cope with specific events (Aldwin & Revenson, 1987; Lennon, Dohrenwend, Zautra, & Marbach, 1990). There is good reason, however, to suspect that research on coping would benefit from more attention to the role of perceptions of coping success in the maintenance of psychological
that cannot be explained by individual differences in global personality traits, such as neuroticism. Folkman, Lazarus, Gruen, and DeLongis (1986), for example, found that appraisals of the changeability of a specific stressful situation were only weakly associated with a general sense of mastery. Second, a transactional approach posits that the person's interpretations of events play a unique role in adaptation to life stressors. Therefore, perceptions of one's own coping success should contribute to the prediction of overall distress beyond other indicators of individual differences in coping ability and outcome. In the present study, we examine evidence that measures of coping success with specific events add to our understanding of the processes of adaptation to stress. Two questions are addressed: (a) What characteristics of the person, situation, or both predict coping success? and (b) Does greater success in coping with specific stressors add uniquely to the prediction of mental health? Recent empirical studies indicate two fruitful ways of measuring successful outcomes: (a) self-evaluations of coping efficacy and (b) the absence of lasting negative life changes reported after the occurrence of a major stressor. Coping efficacy refers to subjective assessments of the outcome of the coping process. In their investigations of phobic reactions, Bandura and Adams (1977) showed that self-efficacy expectations predicted approaches to the feared object beyond the person's level of anxiety, suggesting that subjective estimates of efficacy in coping play an important role in the regulation of future behavior beyond objective evidence of a successful coping outcome. Coping efficacy has been assessed somewhat differently than self-efficacy. In two recent studies (Aldwin & Revenson, 1987; Zautra et al, 1989) coping efficacy was operationally defined as ratings made by respondents of their success in coping with specific life stressors. These assessments did not include efficacy assessments for each specific behavior thought to encompass the person's coping efforts, as in Bandura and Adams's (1977) work. Nevertheless, the studies share an interest in examining the utility of self-evaluations of past efforts and future expectations of successfully coping with a potentially distressing situation.
well-being. Indeed, two premises of a transactional approach are tested when research focuses on subjective appraisals of coping success. First, responses to specific events are expected to provide evidence of the quality of the person's transactions
Portions of this research were presented at the 96th Annual Convention of the American Psychological Association, Atlanta, Georgia, August 1988, and at the Second Biennial Conference on Community Research and Action, East Lansing, Michigan, June 1989. Correspondence concerning this article should be addressed to Alex J. Zautra, Department of Psychology, Arizona State University, Tempe, Arizona 85287-1104. 801
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ALEX J. ZAUTRA AND AMY B. WRABETZ
There is some evidence that the value of self-efficacy judgments in coping with life stress may depend on how much effort the person expended in attempting to cope. Aldwin and Revenson (1987) found that coping efforts interacted with efficacy to predict mental health; certain types of active coping were positively associated with adjustment only when the person rated his or her own efficacy as high. Thus, knowledge of how a person copes with a stressor may be important when evaluating the contribution of self-evaluations of those coping efforts. A second way of assessing coping success is to identify how widespread the negative effects of the event have become. From that assessment, we may infer how successful the person was in adapting to the event. Lennon et al. (1990) used this method to assess coping successes of myofascial pain patients. They asked each person to identify negative changes in major areas of life (social, family, economic, etc.) lasting a week or more that resulted from the stressful life experience. They found that negative changes were reported more frequently as consequences of major stressors by chronic pain patients than by controls and that those changes were associated with reports of greater psychological distress. An awareness of negative consequences may lead respondents to lower their ratings of coping efficacy, so it would be of value to know whether coping efficacy was associated with psychological well-being independent of negative change. This method of analysis would be analogous to Bandura and Adams's (1977) studies in which efficacy judgments were tested to see whether they predicted future success beyond the contribution of other, more objective estimates of coping success. Predictors of Coping Success The relationship between the two measures of coping success and other, more stable individual differences in personality and social situation deserves attention for two reasons. First, it may be valuable to identify those individual attributes associated with coping success. Individual differences in coping success may arise from a number of sources, including background differences in education, age, and the tendency to give socially desirable responses, as well as more central personality variables, such as neuroticism and internal locus of control. The presence of supportive social ties and the relative absence of negative social ties may also affect coping success (Manne & Zautra, 1989); other stressful events may diminish resources, whereas the occurrence of desirable events may enhance efficacy-related efforts. However, if perceptions of coping success are to contribute uniquely to an understanding of a person's coping and adaptation to stress, they should not be fully accounted for by other individual differences in background, personality, or social situation. Thus, we would expect only modest relationships between coping success and this set of explanatory variables. A second reason to identify those variables associated with coping success is to control for their effects on mental health when analyzing the contribution of coping success. This reduces the likelihood of spurious associations between measures of coping success and mental health outcomes. The issue is essentially one of incremental validity; There is some evidence from McCrae and Costa (1988) to suggest that measures of
coping efficacy would not add to the prediction of psychological distress beyond dispositional measures. Coping Success With Different Stressors The coping process may also depend greatly on the nature of the threat posed by the stressor. Life events are heterogeneous in both magnitude and content. The level and nature of the stressful experience are likely to be especially important in the study of coping. Chronic life stressors, such as a disabling illness, impose repeated demands for coping with the everyday life consequences of these conditions. Ratings of coping success for these stressors may be influenced by the need of participants to defend their self-esteem in the face of repeated occurrence of stress. Acute stressors, such as a loss of a spouse, on the other hand, may place demands on coping that are exacting but of a very different sort. Daily life may not be disturbed, but the person's image of his or her life course may be profoundly altered. Finally, some stressors are recurrent everyday events, and a person may cope well with major crises but be hopelessly entangled in mundane events. To examine the role of coping success across different life stress contexts, separate coping scores must be obtained for each type of life stress event. In the present investigation, coping with three types of events was examined: major health downturns, major social losses, and small events. Study Overview We investigated coping success through a study of older adults between the ages of 60 and 80 years. Our selection procedures assured that an adequate number of participants would have experienced either a significant social loss or a major health downturn from a chronic illness. Half of the sample was selected because of recent stressful events of two kinds: a conjugal bereavement or a worsening of a disabling illness or injury. The other half of the sample consisted of participants who were neither disabled nor recently conjugally bereaved. The participants were interviewed monthly for 10 months concerning the nature of events that had occurred, how they coped with those events, and their level of psychological distress. We formulated two general hypotheses prior to analysis of these data. First, we expected coping success, as evidenced by efficacy judgments and reports of negative change, to be predicted only in part by individual differences in personal disposition and social situation. Specific predictions were not made, with the exception of our expectation that those participants who had suffered the loss of a spouse and those participants who were disabled by health problems would report more negative changes associated with stressful events than participants who were without those difficulties. Second, we expected that coping success with life events would be associated with less psychological distress even when controlling for all its predictors. In this second set of analyses, we reasoned that the effects of coping efficacy and negative changes might depend on the type of stress encountered. We were also interested in examining whether the effects of coping efficacy on distress depended on the extent of coping efforts, as found by Aldwin and Revenson(1987).
COPING SUCCESS Last, we related subsequent reports of coping success to changes in psychological distress from the 1st to the 1 Oth month of the study. This analysis was a prospective one. The tests provided a means of probing the replicability of findings obtained from analyses of the first wave of data. They further evaluated the plausibility of causal relations between perceptions of coping success and psychological status. It was conceivable that perceptions of coping success, particularly efficacy judgments,
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were actually the result of psychological functioning rather than the cause. By controlling for initial psychological distress among participants and by testing to see whether coping with subsequent events would predict changes in distress, the study could probe the presumed temporal order of relations between successful adaptation to specific stressors and overall mental health.
Method Subjects Respondents were 246 noninstitutionalized adults between the ages of 60 and 80 years who reported coping with one or more stressful events. Participants were prescreened to fall into one of three groups: (a) participants who were conjugally bereaved within 4 to 6 months of the initial screening and who were not disabled (« = 62); (b) participants who were functionally disabled, who suifered from an illness or injury or the worsening of an existing physical condition within 3 months of initial screening, and who were not recently bereaved (n = 63); and (c) participants who were not bereaved within 2 years of initial screening, who were not functionally disabled, and who had not been disabled for the year prior to initial screening (n = 121). The choice of a 4- to 6-month window for interviews with the conjugally bereaved was established to reduce the intrusiveness of the interviewers in the lives of these older adults at a time of intense grief. Functional disability was assessed with self-reported activity limitation using the Instrumental Activities of Daily Living (IADL) Scale (Teresi, Golden, Gurland, Wilder, & Bennett, 1983). To be classified as disabled, a person had to report 7 or more limitations in daily activity from a scale of 22 possible limitations. According to the scale developers, such a score signifies moderate or high levels of impaired functioning. Also, respondents who evidenced signs of dementia during screening and the initial interviews by not being able to state their address were excluded from the study.
Sampling Procedure To recruit participants, a broad range of contacts was established throughout communities adjacent to the university. Initially, we focused on institutions where independently living bereaved and disabled older adults might be found, such as senior citizen centers, retirement villages, home health care organizations, and hospices. Of these, 13 organizations were enlisted. We also obtained clearance to identify prospective bereaved participants from vital statistics records, and we contacted these residents directly. Of 62 bereaved participants, 43 were selected from those records. Control participants were obtained through agency-assisted recruitment, participant and interviewer referrals, and neighborhood canvassing. In the canvassing efforts, neighborhoods where either bereaved or disabled participants had been identified were chosen (including approximately 20 mobile home parks). After the initial contact, we conducted a formal screening interview to assess whether each person fit into one of the four designated groups. Of the 710 residents who were contacted, 160 (23%) refused to
803
participate, and 281 agreed to participate but did not meet screening criteria, resulting in a final sample of 269 older adults. Twenty-three participants who were enrolled in the study (1 disabled participant and 22 controls) were eventually excluded from the study because they did not report a major loss or a significant health downturn at the time of the initial interview. After they were accepted into the study, participants were assigned to a trained female older adult interviewer, who interviewed them once a month for 10 months. Participants were paid $30 over the course of the 10 interviews. The initial and 10th interviews were in person, generally in the participant's home, and lasted approximately 2'h hours. The 2nd through 9th interviews were conducted by telephone and lasted approximately l/i hour. The interviewers obtained information regarding demographics (1st interview only), social network, life events, coping efforts, coping efficacy, and negative changes. Subsequent to each interview, participants completed and mailed in take-home packets, which contained the personality (1st interview only) and mental health measures. The results reported here pertain to data collected in the 1st interview on demographic, personality, and social characteristics, and stressful life events; data collected in the first 9 interviews on coping efforts, coping efficacy, and negative changes; and data collected in the 1st and 10th interviews on psychological distress.
Measures Demographic variables. Extensive background data were collected on each participant, including age, sex, income, education, and marital status, which were evaluated as possible predictors of individual differences in coping efficacy and negative changes associated with stressful life events. Table 1 shows the means and standard deviations of the demographic variables and the other measures used in this study. Personality. The subscales of internality, powerful others, and belief in chance from the Levenson Multidimensional Locus of Control Scale (Levenson, 1981), the Eysenck(1958)Neuroticism Scale, and an abridged version of the Social Desirability Scale (Crowne & Marlowe, 1964) were used as potentially important measures of personality disposition that could affect coping efficacy ratings and negative changes. Some evidence of the reliability of these measures was obtained through examination of their internal consistency. For internality, alpha = .63; for powerful others, alpha = .72; for belief in chance, alpha = .69; for neuroticism, alpha = .53; and for social desirability, alpha = .70. Social support. Social network measures were developed to assess the number of people in the person's immediate social environment who were a source of positive support or negative interchange (see Finch, Okun, Barrera, Zautra, & Reich, 1989). Examples of questions include the following: "In the past six months, who has spent time with you in social activities such as having dinner together or going to the movies?" "With whom have you confided in, or discussed personal worries—for example, worries about family, job, or yourself?" "Who has been critical of you or your behavior?" and "Who has broken promises of help to you, been neglectful, or let you down in some way?" Prior analyses of these social network measures yielded two uncorrelated and reliable variables of network size: positive social network size and negative social network size. Activity limitations. Level of activity limitations was assessed using the IADL Scale (Teresi et al, 1983). The internal consistency reliability for the IADL Scale was .95 for the whole sample. Stressful life events. The occurrence of both major and small undesirable life events was assessed for each participant. Major life events were assessed using a modified version of the Psychiatric Epidemiology Research Interview (PERI) Life Event Inventory developed by Dohrenwend, Krasnoff, Askenasy, and Dohrenwend (1978). The origi-
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ALEX J. ZAUTRA AND AMY B. WRABETZ
Table 1 Means and Standard Deviations of the Untransformed Variables
SD
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Variable Demographics Age Sex (% female) Education (% completed high school) Income (in dollars) % Married % Never married % Widowed Personality Internal! ty Powerful others Chance Neuroticism Social desirability Social support Positive social support Negative social ties Instrumental activities of Daily Living Scale Event Major desirable Small desirable Illness worsening Loss Major undesirable (excluding illness or loss) Coping effort Health efforts Loss efforts Coping efficacy Major health events Major loss events Small undesirable events Negative change % Major health event % Major loss events Psychological distress Future coping outcome Coping efficacy health events Coping efficacy loss events Coping efficacy small undesirable events Negative changes health events Negative changes loss events
70.47 78.00 76.70 12,766 35.80 1.60 52.40
5.50
— — $7,988 — — —
246 246 246 232 246 246 246
36.16 21.77 19.58 1.39 1.68
7.42 9.52 9.20
.25 .19
220 218 226 246 242
7.97
.55
4.64 1.03
245 245
4.56
6.28
245
.71
246 246 246 246
.39 17.91 1.25
.65 .98
8.66 1.67
.80 1.33
246
1.45 1.42
.26 .28
147 86
2.09 1.81 2.08
1.19 1.09
.90
147 86 199
.42 .23 1.87
.41 .26 .69
147 82 225
2.09 1.66
.93 .78
156 111
2.05
.67 .28 .15
224 157 110
.35 .09
nal inventory was modified by deleting items inappropriate to older adults and adding items more characteristic of the major challenges faced by older adults, based on epidemiological evidence of their frequency (Murrell, Morris, & Hutchins, 1984). The resulting checklist consisted of 70 possible major undesirable events, and respondents were asked to identify all events that had occurred in the past 6 months. Two categories of undesirable events were designated a priori to be probed in depth: (a) loss of a spouse, close friend, or relative through death or institutionalization (5 possible events) and (b) major personal illness or injury (24 possible events). Any loss or illness events that occurred within 6 months prior to the initial interview and between the subsequent eight monthly interviews were probed regarding the participant's coping efforts and coping efficacy, and any negative changes that occurred were assessed. The selection procedures assured us that there would be at least 62 respondents who had a significant social loss and at least 63 who had a
disabling illness. To increase the generalizability of our findings to samples that were not bereaved or not disabled, we expanded our sample to include those respondents with losses other than conjugal bereavement, such as death of a friend, and we did not limit the health event sample to only disabled participants with health downturns. Sample size increased accordingly. There were 147 respondents who reported coping with one or more health events and 82 respondents who provided complete coping data for one or more loss events. Thirtyeight respondents reported coping with both types of stressors. Small undesirable events were assessed using the Inventory of Small Life Events revised for older adults (ISLE; Zautra, Reich, & Guarnaccia, 1990). The ISLE included 82 undesirable events representing the primary areas of life concern, including family, work, household upkeep, finances, health and illness, and transportation. Participants were asked to choose the three most undesirable small life events that had occurred within 1 month of each interview. Probing of these three events included an assessment of coping efficacy. Unlike the probes for major events, coping efforts and negative changes were not assessed in depth because each small stressor by itself was thought to provoke only brief coping efforts and few negative changes. A short list of questions, not analyzed here, was used to focus the participant's attention on his or her responses to the specific stressor when making the efficacy ratings. Coping efforts. Each participant who reported the occurrence of a major illness or loss event was questioned further about the event, and separate scores on coping efforts were derived for each type of stressor. Probes included eight questions concerning how the person responded to the event, and specifically whether he or she did or did not do the following: (a) seek emotional support from others (loved ones, friends, etc.), (b) relax and try to forget about it, (c) take action to change things that bothered him or her about what happened, (d) express his or her feelings and emotions to someone about what happened, (e) accept what happened as something he or she could do nothing about, (f) seek advice from a friend or loved one, (g) try to get someone to help solve the problem, or (h) do something preventive to reduce the harmful effects if an event like this should happen again. Internal consistency reliability analyses suggested two types of coping efforts: active coping efforts (Items a, c, d, f, g, and h) and passive coping efforts (Items b and e). Because the passive items were negatively correlated with the active items, we formed a composite scale of coping efforts on the basis of the active and passive dimensions, with active items scored in the positive direction and passive items scored in the negative direction (e.g., Brown & Nicassio, 1987). The internal consistency reliability of coping efforts for illness events was .67, and the internal consistency reliability of coping efforts for loss events was .61. Coping efficacy. After inquiring about specific coping efforts, the interviewer asked participants to rate their coping efficacy. Thus, coping efficacy ratings were grounded in the specific events and the coping efforts used in response to those events. Coping efficacy scores for major illness events and major loss events were based on a single item that assessed the participant's level of satisfaction with how he or she responded to the event. Using a rating scheme similar to those of Aidwin and Revenson (1987) and Zautra et al. (1989), the participant rated his or her satisfaction on a 5-point scale ranging from very satisfied to very dissatisfied. The satisfaction rating was intended to provide an evaluation of how well the person rated his or her own efforts in general, rather than in terms of specific coping efforts. As shown in Table 1, the average efficacy ratings were mostly satisfied (2). Participants were not asked to rate their likelihood of future adjustment in coping with a major life event's recurrence, because the question was judged inappropriate for major loss events, such as conjugal bereavement. Coping efficacy scores for small events were based on the participant's level of satisfaction with his or her response to the event and the degree to which the person felt certain that he or she would be able to
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COPING SUCCESS adjust well to the negative aspects of the event should it recur (again rated on a 5-point scale ranging from very certain to very uncertain). The internal consistency reliability of coping efficacy for small events was .69. Separate scores were computed for future coping efficacy for major health events, major losses, and small events. These scores were derived from coping efficacy ratings averaged across eight of the nine remaining monthly interviews. Participants had to have coping efficacy ratings on at least one event after the initial interview to be included in these analyses. Negative changes. Negative changes were probed in relation to the occurrence of major illness or loss events, using a procedure developed by Lennon et al. (1990). Negative changes were assessed by asking the participant if changes lasting more than 1 week had occurred as a result of the event in the following 12 areas of the participant's life: employment, finances, social life, relationship with spouse, relationships with other family members, relationships with friends, household routine, recreational activities, health, sleeping patterns, eating patterns, and any other area of the participant's life not included above. The participant then rated on a 3-point scale whether each change that occurred was mainly good, mainly bad, or neutral. A negative change score was derived by dividing the number of areas in which change was primarily negative by the number of applicable areas of change. Not all areas of possible change were applicable to all participants. For example, changes in the relationship with spouse were omitted for those participants who were conjugally bereaved. As Table 1 shows, on the average, illness events led to negative changes in 42% of the applicable areas, and loss events led to negative changes in 23% of the applicable areas. As with the other coping measures, separate scores were computed for negative changes due to major health events and negative changes due to major losses. The internal consistency reliability for negative changes related to health events was .75, and the internal consistency reliability for negative changes related to loss events was .82. Separate scores were computed for future negative changes due to major health events and major losses reported in the next eight monthly interviews. Future negative changes were represented by the sum of negative changes across Months 2 through 9 for those participants with one or more negative events. Participants had to have negative change scores for at least one event after the initial interview to be included in these analyses. Psychological distress. Ratingsof psychological distress were based on three subscales of the Mental Health Inventory (Veil & Ware, 1983) and three subscales of the PERI Demoralization Scale (Dohrenwend, Shrout, Ehri, & Mendelsohn, 1980) that were identified as components of a latent construct of psychological distress on the basis of a confirmatory factor analysis of the sample (Zautra, Guarnaccia, & Reich, 1988). These subscales were Depression, Anxiety, and Suicidal Ideation from the Mental Health Inventory (Veil & Ware, 1983), and Confused Thinking, Anxiety/Dread, and Helplessness/Hopelessness from the PERI Demoralization Scale (Dohrenwend et al, 1980). The internal consistency reliability for the composite measure of psychological distress was .96. Levels of distress reported initially and at the 10th month were analyzed.
Results
805
to be the most stable characteristics of the person and his or her social relations were entered first. Only the demographic factors that significantly predicted coping efficacy (p < .10) were left in the equation when the personality and social support variables were entered at the second step, and only the significant predictors from the first two steps remained in the equation when events were entered at the final step.' Table 2 presents these results. As expected, persons with higher coping efficacy ratings for health downturns tended to have lower levels of functional impairment. Coping efficacy related to major losses was significantly predicted by internality. The occurrence of major desirable life events was marginally associated with lower levels of coping efficacy with losses. Coping efficacy related to small life events was significantly predicted by income, internal locus of control, and lower levels of negative social ties. Table 2 also presents the predictors of negative changes for health and loss events. As with coping efficacy, different predictors of negative change scores were found for losses versus health downturns. Negative changes related to serious health downturns were significantly greater for female participants, for participants with lower income levels, for those with higher levels of negative social ties, and for those with greater functional impairment. Negative changes due to major losses were greater for younger and widowed participants, for those with a greater belief in chance, and for those who reported fewer small desirable events or more illness-worsening events. Correlations between future coping success and these same variables were also examined. Associations that were reproduced longitudinally are shown in Table 2. Functional limitation was again associated with coping success with health effects, income was again associated with better success in coping with health and small stressors, and internality was again related to coping efficacy with small events. Negative ties did not predict future coping success. Moreover, none of the predictors of initial coping success with loss events were also predictors of future coping success with loss events. Prediction of Psychological Distress To determine whether coping success would predict psychological distress when controlling for related factors, we used residualized scores of coping efficacy and negative changes to remove variance shared with significant and marginally significant predictors of those measures (see Table 2). These residualized scores for coping success, along with active coping efforts, were then entered into regressions predicting psychological distress. Separate analyses were performed for the subsample of participants coping with serious health downturns (see Table 3) and for those coping with major losses (see Table 4). Lower levels of coping efficacy with small events were significantly associated with psychological distress for those coping
Correlates of Coping Success To identify the significant predictors of coping efficacy and negative change, hierarchical regressions were performed on each of the five measures of coping success. The following measures were entered in three separate steps: (a) demographics; (b) personality, social support, and IADL; and (c) event measures. Order of entry was controlled such that those variables assumed
1
Note that for the third step of each multiple regression, only events not related to the event being coped with were included in the multiple regression. Thus, if the criterion variable was coping efficacy related to loss events, then loss events were not included in the equation, or if the criterion variable was coping efficacy related to health events, then illness-worsening events were not included in the equation.
806
ALEX J. ZAUTRA AND AMY B. WRABETZ Table 2 Predictors of Coping Efficacy and Negative Changes Coping With Major Losses or Serious Health Downturns Coping efficacy (0)
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Variable Demographic Age Sex Education Income Married Never married Widowed Personality Internality Powerful others Chance Neuroticism Social desirability Social support Positive social support Negative social ties Instrumental Activities of Daily Living Scale Events Major desirable Small desirable Illness worsening Loss Major undesirable (excluding illness or loss) R*
Health events (n - 115)
Loss events (n = 75)
Negative changes (8) Small events ( « = 173)
Health events (n = 115)
Loss events ( « = 72)
-.53** .20** .20"*
-.18"
.23*
.31**
.17" .25*
-.17* -.16'*
.18*
.40-** -.21b -.22* .27"
.02*
.14"
.11"
.29**
.37**
Note. Only variables with p < . 10 enter into the regression equation. •These predictors also correlated significantly with coping success scores obtained in interviews conducted in Months 2-9. b p < . 10. *p
Copyright 1991 by the American Psychological Association Inc. 0022-3514/9I/J3.00
Coping Success and Its Relationship to Psychological Distress for Older Adults Alex J. Zautra and Amy B. Wrabetz
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Arizona State University
The role of coping success on psychosocial distress was investigated in 147 older adults who experienced a major health problem and 82 older adults who reported a major loss in the past 6 months. Home interviews provided data on satisfaction with coping efforts and negative changes associated with events. Significant predictors of coping success were identified and controlled for in subsequent analyses predicting mental health. Efficacy in coping with loss was associated with less psychological distress. Coping efficacy interacted with coping efforts in predicting distress for those with health downturns; efficacy in coping was associated with less distress only for those who were actively engaged in coping. Analyses of longitudinal data replicated the cross-sectional findings for coping with loss.
A number of investigators have suggested that an individual's coping response plays a critical role in shaping the meaning and impact of stressful life events. Lazarus (1966) was among the first to recognize the importance of studying responses to stress and to develop a transactional framework to study the person's role in appraisal of and active defense against threats or harm associated with stressors. This pioneering work has been followed by several studies that have further elucidated and clarified the underlying processes (e.g., Folkman & Lazarus, 1980; Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). Within this framework, coping is seen as a dynamic process of purposeful efforts focused on the resolution of difficulties that place demands on the organism for adjustment. To examine coping processes fully, Elliott and Eisdorfer (1982) proposed that life stress transactions may be usefully partitioned into three interrelated yet distinct components: the stressor itself, the person's response or efforts to cope, and the outcome of that sequence of stress occurrence and response. The first two of these components continue to be studied in some detail; only a few studies thus far have addressed the importance of the person's evaluation of his or her efforts to cope with specific events (Aldwin & Revenson, 1987; Lennon, Dohrenwend, Zautra, & Marbach, 1990). There is good reason, however, to suspect that research on coping would benefit from more attention to the role of perceptions of coping success in the maintenance of psychological
that cannot be explained by individual differences in global personality traits, such as neuroticism. Folkman, Lazarus, Gruen, and DeLongis (1986), for example, found that appraisals of the changeability of a specific stressful situation were only weakly associated with a general sense of mastery. Second, a transactional approach posits that the person's interpretations of events play a unique role in adaptation to life stressors. Therefore, perceptions of one's own coping success should contribute to the prediction of overall distress beyond other indicators of individual differences in coping ability and outcome. In the present study, we examine evidence that measures of coping success with specific events add to our understanding of the processes of adaptation to stress. Two questions are addressed: (a) What characteristics of the person, situation, or both predict coping success? and (b) Does greater success in coping with specific stressors add uniquely to the prediction of mental health? Recent empirical studies indicate two fruitful ways of measuring successful outcomes: (a) self-evaluations of coping efficacy and (b) the absence of lasting negative life changes reported after the occurrence of a major stressor. Coping efficacy refers to subjective assessments of the outcome of the coping process. In their investigations of phobic reactions, Bandura and Adams (1977) showed that self-efficacy expectations predicted approaches to the feared object beyond the person's level of anxiety, suggesting that subjective estimates of efficacy in coping play an important role in the regulation of future behavior beyond objective evidence of a successful coping outcome. Coping efficacy has been assessed somewhat differently than self-efficacy. In two recent studies (Aldwin & Revenson, 1987; Zautra et al, 1989) coping efficacy was operationally defined as ratings made by respondents of their success in coping with specific life stressors. These assessments did not include efficacy assessments for each specific behavior thought to encompass the person's coping efforts, as in Bandura and Adams's (1977) work. Nevertheless, the studies share an interest in examining the utility of self-evaluations of past efforts and future expectations of successfully coping with a potentially distressing situation.
well-being. Indeed, two premises of a transactional approach are tested when research focuses on subjective appraisals of coping success. First, responses to specific events are expected to provide evidence of the quality of the person's transactions
Portions of this research were presented at the 96th Annual Convention of the American Psychological Association, Atlanta, Georgia, August 1988, and at the Second Biennial Conference on Community Research and Action, East Lansing, Michigan, June 1989. Correspondence concerning this article should be addressed to Alex J. Zautra, Department of Psychology, Arizona State University, Tempe, Arizona 85287-1104. 801
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ALEX J. ZAUTRA AND AMY B. WRABETZ
There is some evidence that the value of self-efficacy judgments in coping with life stress may depend on how much effort the person expended in attempting to cope. Aldwin and Revenson (1987) found that coping efforts interacted with efficacy to predict mental health; certain types of active coping were positively associated with adjustment only when the person rated his or her own efficacy as high. Thus, knowledge of how a person copes with a stressor may be important when evaluating the contribution of self-evaluations of those coping efforts. A second way of assessing coping success is to identify how widespread the negative effects of the event have become. From that assessment, we may infer how successful the person was in adapting to the event. Lennon et al. (1990) used this method to assess coping successes of myofascial pain patients. They asked each person to identify negative changes in major areas of life (social, family, economic, etc.) lasting a week or more that resulted from the stressful life experience. They found that negative changes were reported more frequently as consequences of major stressors by chronic pain patients than by controls and that those changes were associated with reports of greater psychological distress. An awareness of negative consequences may lead respondents to lower their ratings of coping efficacy, so it would be of value to know whether coping efficacy was associated with psychological well-being independent of negative change. This method of analysis would be analogous to Bandura and Adams's (1977) studies in which efficacy judgments were tested to see whether they predicted future success beyond the contribution of other, more objective estimates of coping success. Predictors of Coping Success The relationship between the two measures of coping success and other, more stable individual differences in personality and social situation deserves attention for two reasons. First, it may be valuable to identify those individual attributes associated with coping success. Individual differences in coping success may arise from a number of sources, including background differences in education, age, and the tendency to give socially desirable responses, as well as more central personality variables, such as neuroticism and internal locus of control. The presence of supportive social ties and the relative absence of negative social ties may also affect coping success (Manne & Zautra, 1989); other stressful events may diminish resources, whereas the occurrence of desirable events may enhance efficacy-related efforts. However, if perceptions of coping success are to contribute uniquely to an understanding of a person's coping and adaptation to stress, they should not be fully accounted for by other individual differences in background, personality, or social situation. Thus, we would expect only modest relationships between coping success and this set of explanatory variables. A second reason to identify those variables associated with coping success is to control for their effects on mental health when analyzing the contribution of coping success. This reduces the likelihood of spurious associations between measures of coping success and mental health outcomes. The issue is essentially one of incremental validity; There is some evidence from McCrae and Costa (1988) to suggest that measures of
coping efficacy would not add to the prediction of psychological distress beyond dispositional measures. Coping Success With Different Stressors The coping process may also depend greatly on the nature of the threat posed by the stressor. Life events are heterogeneous in both magnitude and content. The level and nature of the stressful experience are likely to be especially important in the study of coping. Chronic life stressors, such as a disabling illness, impose repeated demands for coping with the everyday life consequences of these conditions. Ratings of coping success for these stressors may be influenced by the need of participants to defend their self-esteem in the face of repeated occurrence of stress. Acute stressors, such as a loss of a spouse, on the other hand, may place demands on coping that are exacting but of a very different sort. Daily life may not be disturbed, but the person's image of his or her life course may be profoundly altered. Finally, some stressors are recurrent everyday events, and a person may cope well with major crises but be hopelessly entangled in mundane events. To examine the role of coping success across different life stress contexts, separate coping scores must be obtained for each type of life stress event. In the present investigation, coping with three types of events was examined: major health downturns, major social losses, and small events. Study Overview We investigated coping success through a study of older adults between the ages of 60 and 80 years. Our selection procedures assured that an adequate number of participants would have experienced either a significant social loss or a major health downturn from a chronic illness. Half of the sample was selected because of recent stressful events of two kinds: a conjugal bereavement or a worsening of a disabling illness or injury. The other half of the sample consisted of participants who were neither disabled nor recently conjugally bereaved. The participants were interviewed monthly for 10 months concerning the nature of events that had occurred, how they coped with those events, and their level of psychological distress. We formulated two general hypotheses prior to analysis of these data. First, we expected coping success, as evidenced by efficacy judgments and reports of negative change, to be predicted only in part by individual differences in personal disposition and social situation. Specific predictions were not made, with the exception of our expectation that those participants who had suffered the loss of a spouse and those participants who were disabled by health problems would report more negative changes associated with stressful events than participants who were without those difficulties. Second, we expected that coping success with life events would be associated with less psychological distress even when controlling for all its predictors. In this second set of analyses, we reasoned that the effects of coping efficacy and negative changes might depend on the type of stress encountered. We were also interested in examining whether the effects of coping efficacy on distress depended on the extent of coping efforts, as found by Aldwin and Revenson(1987).
COPING SUCCESS Last, we related subsequent reports of coping success to changes in psychological distress from the 1st to the 1 Oth month of the study. This analysis was a prospective one. The tests provided a means of probing the replicability of findings obtained from analyses of the first wave of data. They further evaluated the plausibility of causal relations between perceptions of coping success and psychological status. It was conceivable that perceptions of coping success, particularly efficacy judgments,
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were actually the result of psychological functioning rather than the cause. By controlling for initial psychological distress among participants and by testing to see whether coping with subsequent events would predict changes in distress, the study could probe the presumed temporal order of relations between successful adaptation to specific stressors and overall mental health.
Method Subjects Respondents were 246 noninstitutionalized adults between the ages of 60 and 80 years who reported coping with one or more stressful events. Participants were prescreened to fall into one of three groups: (a) participants who were conjugally bereaved within 4 to 6 months of the initial screening and who were not disabled (« = 62); (b) participants who were functionally disabled, who suifered from an illness or injury or the worsening of an existing physical condition within 3 months of initial screening, and who were not recently bereaved (n = 63); and (c) participants who were not bereaved within 2 years of initial screening, who were not functionally disabled, and who had not been disabled for the year prior to initial screening (n = 121). The choice of a 4- to 6-month window for interviews with the conjugally bereaved was established to reduce the intrusiveness of the interviewers in the lives of these older adults at a time of intense grief. Functional disability was assessed with self-reported activity limitation using the Instrumental Activities of Daily Living (IADL) Scale (Teresi, Golden, Gurland, Wilder, & Bennett, 1983). To be classified as disabled, a person had to report 7 or more limitations in daily activity from a scale of 22 possible limitations. According to the scale developers, such a score signifies moderate or high levels of impaired functioning. Also, respondents who evidenced signs of dementia during screening and the initial interviews by not being able to state their address were excluded from the study.
Sampling Procedure To recruit participants, a broad range of contacts was established throughout communities adjacent to the university. Initially, we focused on institutions where independently living bereaved and disabled older adults might be found, such as senior citizen centers, retirement villages, home health care organizations, and hospices. Of these, 13 organizations were enlisted. We also obtained clearance to identify prospective bereaved participants from vital statistics records, and we contacted these residents directly. Of 62 bereaved participants, 43 were selected from those records. Control participants were obtained through agency-assisted recruitment, participant and interviewer referrals, and neighborhood canvassing. In the canvassing efforts, neighborhoods where either bereaved or disabled participants had been identified were chosen (including approximately 20 mobile home parks). After the initial contact, we conducted a formal screening interview to assess whether each person fit into one of the four designated groups. Of the 710 residents who were contacted, 160 (23%) refused to
803
participate, and 281 agreed to participate but did not meet screening criteria, resulting in a final sample of 269 older adults. Twenty-three participants who were enrolled in the study (1 disabled participant and 22 controls) were eventually excluded from the study because they did not report a major loss or a significant health downturn at the time of the initial interview. After they were accepted into the study, participants were assigned to a trained female older adult interviewer, who interviewed them once a month for 10 months. Participants were paid $30 over the course of the 10 interviews. The initial and 10th interviews were in person, generally in the participant's home, and lasted approximately 2'h hours. The 2nd through 9th interviews were conducted by telephone and lasted approximately l/i hour. The interviewers obtained information regarding demographics (1st interview only), social network, life events, coping efforts, coping efficacy, and negative changes. Subsequent to each interview, participants completed and mailed in take-home packets, which contained the personality (1st interview only) and mental health measures. The results reported here pertain to data collected in the 1st interview on demographic, personality, and social characteristics, and stressful life events; data collected in the first 9 interviews on coping efforts, coping efficacy, and negative changes; and data collected in the 1st and 10th interviews on psychological distress.
Measures Demographic variables. Extensive background data were collected on each participant, including age, sex, income, education, and marital status, which were evaluated as possible predictors of individual differences in coping efficacy and negative changes associated with stressful life events. Table 1 shows the means and standard deviations of the demographic variables and the other measures used in this study. Personality. The subscales of internality, powerful others, and belief in chance from the Levenson Multidimensional Locus of Control Scale (Levenson, 1981), the Eysenck(1958)Neuroticism Scale, and an abridged version of the Social Desirability Scale (Crowne & Marlowe, 1964) were used as potentially important measures of personality disposition that could affect coping efficacy ratings and negative changes. Some evidence of the reliability of these measures was obtained through examination of their internal consistency. For internality, alpha = .63; for powerful others, alpha = .72; for belief in chance, alpha = .69; for neuroticism, alpha = .53; and for social desirability, alpha = .70. Social support. Social network measures were developed to assess the number of people in the person's immediate social environment who were a source of positive support or negative interchange (see Finch, Okun, Barrera, Zautra, & Reich, 1989). Examples of questions include the following: "In the past six months, who has spent time with you in social activities such as having dinner together or going to the movies?" "With whom have you confided in, or discussed personal worries—for example, worries about family, job, or yourself?" "Who has been critical of you or your behavior?" and "Who has broken promises of help to you, been neglectful, or let you down in some way?" Prior analyses of these social network measures yielded two uncorrelated and reliable variables of network size: positive social network size and negative social network size. Activity limitations. Level of activity limitations was assessed using the IADL Scale (Teresi et al, 1983). The internal consistency reliability for the IADL Scale was .95 for the whole sample. Stressful life events. The occurrence of both major and small undesirable life events was assessed for each participant. Major life events were assessed using a modified version of the Psychiatric Epidemiology Research Interview (PERI) Life Event Inventory developed by Dohrenwend, Krasnoff, Askenasy, and Dohrenwend (1978). The origi-
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ALEX J. ZAUTRA AND AMY B. WRABETZ
Table 1 Means and Standard Deviations of the Untransformed Variables
SD
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Variable Demographics Age Sex (% female) Education (% completed high school) Income (in dollars) % Married % Never married % Widowed Personality Internal! ty Powerful others Chance Neuroticism Social desirability Social support Positive social support Negative social ties Instrumental activities of Daily Living Scale Event Major desirable Small desirable Illness worsening Loss Major undesirable (excluding illness or loss) Coping effort Health efforts Loss efforts Coping efficacy Major health events Major loss events Small undesirable events Negative change % Major health event % Major loss events Psychological distress Future coping outcome Coping efficacy health events Coping efficacy loss events Coping efficacy small undesirable events Negative changes health events Negative changes loss events
70.47 78.00 76.70 12,766 35.80 1.60 52.40
5.50
— — $7,988 — — —
246 246 246 232 246 246 246
36.16 21.77 19.58 1.39 1.68
7.42 9.52 9.20
.25 .19
220 218 226 246 242
7.97
.55
4.64 1.03
245 245
4.56
6.28
245
.71
246 246 246 246
.39 17.91 1.25
.65 .98
8.66 1.67
.80 1.33
246
1.45 1.42
.26 .28
147 86
2.09 1.81 2.08
1.19 1.09
.90
147 86 199
.42 .23 1.87
.41 .26 .69
147 82 225
2.09 1.66
.93 .78
156 111
2.05
.67 .28 .15
224 157 110
.35 .09
nal inventory was modified by deleting items inappropriate to older adults and adding items more characteristic of the major challenges faced by older adults, based on epidemiological evidence of their frequency (Murrell, Morris, & Hutchins, 1984). The resulting checklist consisted of 70 possible major undesirable events, and respondents were asked to identify all events that had occurred in the past 6 months. Two categories of undesirable events were designated a priori to be probed in depth: (a) loss of a spouse, close friend, or relative through death or institutionalization (5 possible events) and (b) major personal illness or injury (24 possible events). Any loss or illness events that occurred within 6 months prior to the initial interview and between the subsequent eight monthly interviews were probed regarding the participant's coping efforts and coping efficacy, and any negative changes that occurred were assessed. The selection procedures assured us that there would be at least 62 respondents who had a significant social loss and at least 63 who had a
disabling illness. To increase the generalizability of our findings to samples that were not bereaved or not disabled, we expanded our sample to include those respondents with losses other than conjugal bereavement, such as death of a friend, and we did not limit the health event sample to only disabled participants with health downturns. Sample size increased accordingly. There were 147 respondents who reported coping with one or more health events and 82 respondents who provided complete coping data for one or more loss events. Thirtyeight respondents reported coping with both types of stressors. Small undesirable events were assessed using the Inventory of Small Life Events revised for older adults (ISLE; Zautra, Reich, & Guarnaccia, 1990). The ISLE included 82 undesirable events representing the primary areas of life concern, including family, work, household upkeep, finances, health and illness, and transportation. Participants were asked to choose the three most undesirable small life events that had occurred within 1 month of each interview. Probing of these three events included an assessment of coping efficacy. Unlike the probes for major events, coping efforts and negative changes were not assessed in depth because each small stressor by itself was thought to provoke only brief coping efforts and few negative changes. A short list of questions, not analyzed here, was used to focus the participant's attention on his or her responses to the specific stressor when making the efficacy ratings. Coping efforts. Each participant who reported the occurrence of a major illness or loss event was questioned further about the event, and separate scores on coping efforts were derived for each type of stressor. Probes included eight questions concerning how the person responded to the event, and specifically whether he or she did or did not do the following: (a) seek emotional support from others (loved ones, friends, etc.), (b) relax and try to forget about it, (c) take action to change things that bothered him or her about what happened, (d) express his or her feelings and emotions to someone about what happened, (e) accept what happened as something he or she could do nothing about, (f) seek advice from a friend or loved one, (g) try to get someone to help solve the problem, or (h) do something preventive to reduce the harmful effects if an event like this should happen again. Internal consistency reliability analyses suggested two types of coping efforts: active coping efforts (Items a, c, d, f, g, and h) and passive coping efforts (Items b and e). Because the passive items were negatively correlated with the active items, we formed a composite scale of coping efforts on the basis of the active and passive dimensions, with active items scored in the positive direction and passive items scored in the negative direction (e.g., Brown & Nicassio, 1987). The internal consistency reliability of coping efforts for illness events was .67, and the internal consistency reliability of coping efforts for loss events was .61. Coping efficacy. After inquiring about specific coping efforts, the interviewer asked participants to rate their coping efficacy. Thus, coping efficacy ratings were grounded in the specific events and the coping efforts used in response to those events. Coping efficacy scores for major illness events and major loss events were based on a single item that assessed the participant's level of satisfaction with how he or she responded to the event. Using a rating scheme similar to those of Aidwin and Revenson (1987) and Zautra et al. (1989), the participant rated his or her satisfaction on a 5-point scale ranging from very satisfied to very dissatisfied. The satisfaction rating was intended to provide an evaluation of how well the person rated his or her own efforts in general, rather than in terms of specific coping efforts. As shown in Table 1, the average efficacy ratings were mostly satisfied (2). Participants were not asked to rate their likelihood of future adjustment in coping with a major life event's recurrence, because the question was judged inappropriate for major loss events, such as conjugal bereavement. Coping efficacy scores for small events were based on the participant's level of satisfaction with his or her response to the event and the degree to which the person felt certain that he or she would be able to
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COPING SUCCESS adjust well to the negative aspects of the event should it recur (again rated on a 5-point scale ranging from very certain to very uncertain). The internal consistency reliability of coping efficacy for small events was .69. Separate scores were computed for future coping efficacy for major health events, major losses, and small events. These scores were derived from coping efficacy ratings averaged across eight of the nine remaining monthly interviews. Participants had to have coping efficacy ratings on at least one event after the initial interview to be included in these analyses. Negative changes. Negative changes were probed in relation to the occurrence of major illness or loss events, using a procedure developed by Lennon et al. (1990). Negative changes were assessed by asking the participant if changes lasting more than 1 week had occurred as a result of the event in the following 12 areas of the participant's life: employment, finances, social life, relationship with spouse, relationships with other family members, relationships with friends, household routine, recreational activities, health, sleeping patterns, eating patterns, and any other area of the participant's life not included above. The participant then rated on a 3-point scale whether each change that occurred was mainly good, mainly bad, or neutral. A negative change score was derived by dividing the number of areas in which change was primarily negative by the number of applicable areas of change. Not all areas of possible change were applicable to all participants. For example, changes in the relationship with spouse were omitted for those participants who were conjugally bereaved. As Table 1 shows, on the average, illness events led to negative changes in 42% of the applicable areas, and loss events led to negative changes in 23% of the applicable areas. As with the other coping measures, separate scores were computed for negative changes due to major health events and negative changes due to major losses. The internal consistency reliability for negative changes related to health events was .75, and the internal consistency reliability for negative changes related to loss events was .82. Separate scores were computed for future negative changes due to major health events and major losses reported in the next eight monthly interviews. Future negative changes were represented by the sum of negative changes across Months 2 through 9 for those participants with one or more negative events. Participants had to have negative change scores for at least one event after the initial interview to be included in these analyses. Psychological distress. Ratingsof psychological distress were based on three subscales of the Mental Health Inventory (Veil & Ware, 1983) and three subscales of the PERI Demoralization Scale (Dohrenwend, Shrout, Ehri, & Mendelsohn, 1980) that were identified as components of a latent construct of psychological distress on the basis of a confirmatory factor analysis of the sample (Zautra, Guarnaccia, & Reich, 1988). These subscales were Depression, Anxiety, and Suicidal Ideation from the Mental Health Inventory (Veil & Ware, 1983), and Confused Thinking, Anxiety/Dread, and Helplessness/Hopelessness from the PERI Demoralization Scale (Dohrenwend et al, 1980). The internal consistency reliability for the composite measure of psychological distress was .96. Levels of distress reported initially and at the 10th month were analyzed.
Results
805
to be the most stable characteristics of the person and his or her social relations were entered first. Only the demographic factors that significantly predicted coping efficacy (p < .10) were left in the equation when the personality and social support variables were entered at the second step, and only the significant predictors from the first two steps remained in the equation when events were entered at the final step.' Table 2 presents these results. As expected, persons with higher coping efficacy ratings for health downturns tended to have lower levels of functional impairment. Coping efficacy related to major losses was significantly predicted by internality. The occurrence of major desirable life events was marginally associated with lower levels of coping efficacy with losses. Coping efficacy related to small life events was significantly predicted by income, internal locus of control, and lower levels of negative social ties. Table 2 also presents the predictors of negative changes for health and loss events. As with coping efficacy, different predictors of negative change scores were found for losses versus health downturns. Negative changes related to serious health downturns were significantly greater for female participants, for participants with lower income levels, for those with higher levels of negative social ties, and for those with greater functional impairment. Negative changes due to major losses were greater for younger and widowed participants, for those with a greater belief in chance, and for those who reported fewer small desirable events or more illness-worsening events. Correlations between future coping success and these same variables were also examined. Associations that were reproduced longitudinally are shown in Table 2. Functional limitation was again associated with coping success with health effects, income was again associated with better success in coping with health and small stressors, and internality was again related to coping efficacy with small events. Negative ties did not predict future coping success. Moreover, none of the predictors of initial coping success with loss events were also predictors of future coping success with loss events. Prediction of Psychological Distress To determine whether coping success would predict psychological distress when controlling for related factors, we used residualized scores of coping efficacy and negative changes to remove variance shared with significant and marginally significant predictors of those measures (see Table 2). These residualized scores for coping success, along with active coping efforts, were then entered into regressions predicting psychological distress. Separate analyses were performed for the subsample of participants coping with serious health downturns (see Table 3) and for those coping with major losses (see Table 4). Lower levels of coping efficacy with small events were significantly associated with psychological distress for those coping
Correlates of Coping Success To identify the significant predictors of coping efficacy and negative change, hierarchical regressions were performed on each of the five measures of coping success. The following measures were entered in three separate steps: (a) demographics; (b) personality, social support, and IADL; and (c) event measures. Order of entry was controlled such that those variables assumed
1
Note that for the third step of each multiple regression, only events not related to the event being coped with were included in the multiple regression. Thus, if the criterion variable was coping efficacy related to loss events, then loss events were not included in the equation, or if the criterion variable was coping efficacy related to health events, then illness-worsening events were not included in the equation.
806
ALEX J. ZAUTRA AND AMY B. WRABETZ Table 2 Predictors of Coping Efficacy and Negative Changes Coping With Major Losses or Serious Health Downturns Coping efficacy (0)
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Variable Demographic Age Sex Education Income Married Never married Widowed Personality Internality Powerful others Chance Neuroticism Social desirability Social support Positive social support Negative social ties Instrumental Activities of Daily Living Scale Events Major desirable Small desirable Illness worsening Loss Major undesirable (excluding illness or loss) R*
Health events (n - 115)
Loss events (n = 75)
Negative changes (8) Small events ( « = 173)
Health events (n = 115)
Loss events ( « = 72)
-.53** .20** .20"*
-.18"
.23*
.31**
.17" .25*
-.17* -.16'*
.18*
.40-** -.21b -.22* .27"
.02*
.14"
.11"
.29**
.37**
Note. Only variables with p < . 10 enter into the regression equation. •These predictors also correlated significantly with coping success scores obtained in interviews conducted in Months 2-9. b p < . 10. *p
