Document View

This study examined the relation between coping and depression in a sample of 50 (38 women, 12 men) individuals recently diagnosed with multiple sclerosis (MS). A semi-structured interview was used to assess how individuals coped with the onset of disabling illness, and to assess depressive symptomatology. According to DSM-III-R criteria, 18 participants were diagnosed with major depression, 11 were diagnosed with adjustment disorder with depressed mood, and 21 did not satisfy the criteria for any affective disorder. Interview results indicated that nondepressed participants were more likely to use present focus and avoidance/denial strategies to deal with illness onset than participants with major depression or adjustment disorder. Discussion addresses why these strategies may be an adaptive means of dealing with the onset of MS. Numerous investigations have shown that individuals diagnosed with chronic illness are at high risk for the development of depressive symptoms (see Rodin, Craven, & Littlefield, 1991, for a review). There are also indications that coping may be an important determinant of depression in individuals with chronic illness (Felton, & Revenson, 1984; Folkman, Chesney, Pollack, & Coates, 1993; Lazarus & Folkman, 1986; Quinn, Fontana, & Reznikoff, 1987; Rosenstiel & Keefe, 1983). The primary aim of the present research was to examine the relation between coping and depression in individuals recently diagnosed with multiple sclerosis. MULTIPLE SCLEROSIS AND DEPRESSION Multiple sclerosis (MS) is the most common neurological illness affecting young and middle aged adults. MS is characterized by the demyelination of nerve fibre tracts in the central nervous system leading to a variety of sensory and motor disturbances. These may include weakness, fatigue, loss of coordination, loss of sensation, incontinence, sexual dysfunction, and visual problems (Sibley, 1990). While the exact nature and rate of physical deterioration is difficult to predict, the natural course of MS is reflected in the progressively decreased capacity for physical activity (Sibley, 1990; Weinshenker & Ebers, 1987). Although there have been few controlled studies, research suggests that the degree of depressive sympto-matology in MS patients is higher than that observed in the general population (Dalos, Rabins, Brooks, & O'Donnell, 1983; McIvor, Riklan, & Reznikoff, 1984). Studies using standard diagnostic criteria for depression have reported prevalence rates of depression in samples of MS patients ranging from 25% to 54% (Joffe, Lippert, Gray, Sawa, & Horvath, 1987; Minden, Orav, & Reich, 1987; Minden & Schiffer, 1990; Sullivan, Weinshenker, Mikail, & Edgley, 1995). Studies examining the disease-related correlates (e.g., disease severity, illness duration) of depression in patients with MS have yielded equivocal findings. While some studies have reported a positive correlation between disease severity and depressive symptoms (McIvor et al., 1984; Zeldow & Pavlou, 1984), other studies have failed to demonstrate this relation (Dalos et al., 1983; Maybury & Brewin, 1984). Most studies have failed to show a significant relation between illness duration and depressive symptoms (McIvor et al., 1984; Minden et al., 1987; Whitlock & Siskind, 1980). Due to the lack of systematic relation between disease-related variables and depression in patients with MS, there has been increased interest in examining the potential role of psychosocial factors in determining risk for depression (Devins & Seland, 1987). COPING WITH MULTIPLE SCLEROSIS There are indications that the manner in which individuals attempt to cope with MS may be one of the determinants of presence or absence of depressive symptoms (Brooks & Matson, 1982; Devins & Seland, 1987). Coping generally 05/03/2007 11:58 AM Document View Page 3 of 10 http://proquest.umi.com/pqdlink?vinst=PROD&fmt=3&startpage=-1&...e=PQD&rqt=309&TS=1178207700&clientId=10843&cc=1&TS=1178207700 refers to the strategies individuals use to minimize the negative impact of life stressors on their psychological wellbeing (Coyne, Aldwin, & Lazarus, 1981; Lazarus & Folkman, 1984; Pearlin & Schooler, 1978). A large body of research has shown that, for individuals with and without chronic illness, the use of emotion-focused coping strategies (e.g., strategies aimed at managing emotional reactions to stressful situations) is associated with higher levels of depressive symptomatology (Billings & Moos, 1981, 1984; Bombardier, D'Amico, & Jordan, 1990; Coyne et al., 1981; Holahan & Moos, 1987; Rosenstiel & Keefe, 1983; Sullivan & D'Eon, 1990). The relation between problem-focussed coping (e.g., strategies directly aimed at managing the stressful situation) and depression has been less clear (Lazarus, 1993; Coyne & Gottlieb, in press). It has been suggested that the stresses associated with the onset of a debilitating illness may differ in significant ways from the day-to-day stresses of a long-standing illness (Lyons, Sullivan, Ritvo, & Coyne, 1995; Shontz, 1975). For example, the diagnosis of MS is likely to signal major changes in lifestyle including threats of reduced physical abilities, loss of employment, financial insecurity, loss of independence and changes to interpersonal roles (Edgley, Sullivan & Dehoux, 1991; Lyons et al., 1995). The individual diagnosed with MS must struggle with the reality of being diagnosed with an incurable debilitating disease, even though in the early stages of the illness, the individual may suffer from little or no functional impairment (Matson & Brooks, 1977; Brooks & Matson, 1982; Shontz, 1975). The early stages of MS are marked by the threat of loss, while in more advanced stages of the illness, coping with actual loss may become the primary focus (Lyons et al., 1995; Sullivan, Edgley, Mikail, Dehoux & Fisher, 1993). Shontz (1975) described a pattern of response to the onset of debilitating illness characterized by competing tendencies to confront and to retreat from the reality of disability. In Shontz' model, denial is considered an adaptive strategy if it prevents the individual from becoming overwhelmed with the stress of illness and disability. Denial may function as a regulating mechanism allowing for the gradual management of threat (Horowitz, 1976; Roth & Cohen, 1986; Shontz, 1975). In the early stages of illness, denial may provide the individual with the needed time to assimilate threatening information about illness and disability, and consider alternatives for coping. Shontz' (1975) position on the adaptive value of denial contrasts with that of more recent models that suggest that avoidance and denial are maladaptive methods of dealing with stress (e.g., Lazarus & Folkman, 1984). Little is known about the strategies that individuals invoke to deal with the onset of multiple sclerosis, or how these strategies influence the probability of the precipitation of a major depressive episode. The elucidation of a relation between coping and depression following the diagnosis of MS may have significant clinical implications. Determination of coping strategies that are associated with depression may permit early identification of individuals at risk for development of depression. In turn, the early identification of individuals who are at risk for developing major depression would allow for a more proactive approach to treatment, allowing for timely implementation of interventions aimed at facilitating adjustment to disability. The method of assessing coping during the early stages of illness also deserves consideration. The bulk of research on coping and emotional distress has proceeded by requiring participants to complete checklist measures of coping and self-report measures of depressive symptomatology. However, reliance on checklist measures to assess coping has recently been the target of pointed criticism (Coyne & Gottlieb, in press; Stone, Greenberg, Kennedy-Moor, & Newman, 1991; Sullivan & D'Eon, 1990; Tunks & Bellissimo, 1988). Stone et al. (1991) have argued that many of the items included in checklist measures of coping are not applicable to many of the stresses that individuals experience. It has also been argued that checklist coping scales frequently contain items that are confounded with symptoms of depression thus rendering observed relations between coping and depression difficult to interpret (Stanton, DanoffBurg, Cameron, & Ellis, 1994; Sullivan & D'Eon, 1990). Interview methods of assessing coping have been advocated as one way of circumventing the shortcomings of checklist coping scales (Coyne & Downey, 1991; Coyne & Gottlieb, in press). It has been suggested that through carefully conducted interviews, the issues of confounded or redundant measurement can be minimized, and that interview methods may be less constrained by theory-driven apriori determination of relevant coping dimensions (Coyne & Gottlieb, in press). Additionally, it has been suggested that interview methods are less likely to be influenced by error variance contributed by items that bear little relation to the stressor that is being studied (Brown & Harris, 1978; Coyne & Gottlieb, in press). The present study examined the relation between coping and depression in individuals recently diagnosed with MS. On the basis of Folkman and Lazarus' (1984) model of stress and coping, the prediction was that reports of avoidance or denial strategies would be more common in individuals with a diagnosis of major depression than in nondepressed individuals, and that the use of active cognitive or behavioral problem-focused coping strategies (e.g., information 05/03/2007 11:58 AM Document View Page 4 of 10 http://proquest.umi.com/pqdlink?vinst=PROD&fmt=3&startpage=-1&...e=PQD&rqt=309&TS=1178207700&clientId=10843&cc=1&TS=1178207700 seeking, positive thinking) would be more common in nondepressed than depressed individuals. On the basis of Shontz' (1975) model of adaptation to chronic illness, the prediction was that reports of avoidance or denial strategies would be less common in individuals with a diagnosis of major depression than in nondepressed individuals.