The relative influences of proactive coping skills, emotional distress and self-esteem on functioning and quality of life of schizophrenic patients

Nuno Rocha ab, Diana Salgado a, António Marques ab & Cristina Queirós b Purpose Purpose Persons with schizophrenia tend to fail using effective coping skills in order to adaptively face daily life stressors. There is evidence linking the use of active problem-solving coping skills to better functional outcomes. However, few studies attempted to analyze the impact of proactive coping skills in functioning and quality of life. The aim of this study was to examine the relative associations between proactive coping skills, emotional distress, self-esteem, functioning and quality of life (QOL) among people diagnosed with schizophrenia. aSchool of Allied Health Sciences, Porto Polytechnic Institute b Faculty of Psychology and Educational Sciences, University of Porto [email protected]; [email protected]; [email protected] XIV World Congress of Psychiatry XIV World Congress of Psychiatry Prague, Czech Republic, September 2008 The relative influences of proactive coping skills, emotional distress and self-esteem on functioning and quality of life of schizophrenic patients Bibliography F PCE U P FACULDADE DE PSICOLOGIA E DE CIÊNCIAS DA EDUCAÇÃO UNIVERSIDADE DO PORTO Lovibond, S. H. & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation; Greenglass, E., Schwarzer, R., Jakubiec, D., Fiksenbaum, L. & Taubert, S. (1999). The Proactive Coping Inventory (PCI): A Multidimensional Research Instrument. Paper presented at the 20th International Conference of the Stress and Anxiety Research Society. Cracow: Poland; Pais-Ribeiro, J., Honrado, A. & Leal, I. (2004). Contribuição para o Estudo da Adaptação Portuguesa das Escalas de Ansiedade, Depressão e Stress (EADS) de 21 itens de Lovibond e Lovibond. Psicologia, Saúde & Doenças, 5(2), 229-239.; Rocha, N., Queirós, C., Aguiar, S. & Marques, A. (2006). Life Skills Profile (LSP – 39): Portuguese Authorized Version . Porto: Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto. Santos, P. & Maia, J. (1999). Adaptação e análise factorial confirmatória da Rosenberg self-esteem scale com uma amostra de adolescentes: Resultados preliminares. In A. Soares, S. Araújo & S. Caires (Eds.), Avaliação psicológica: Formas e Contextos (Vol. 6, pp. 101-113). Braga: APPORT. Vaz-Serra, A., Canavarro, M., Simões, M., Pereira, M., Gameiro, S., Quartilho, M. et al. (2006). Estudos Psicométricos do Instrumento de Avaliação da Qualidade de Vida da Organização Mundial de Saúde (WHOQOL-Bref) para Português de Portugal. Psiquiatria Clínica, 27(1), 41-49. Table 1. Spearman correlations between coping and psychosocial functioning Participants: 23 Portuguese persons diagnosed with Schizophrenia (Age Md = 43.6, SD = 8.84; 61% males). Instruments: Life Skills Profile (Portuguese version by Rocha et al., 2006) was used to determine psychosocial functioning. This scale was completed by psychologists and occupational therapists who follow their patients over the years and have ample opportunity to observe and assess patient functioning in different community settings. The Life Skills Profile comprises 39 items, which can measure five key dimensions: self-care (grooming, hygiene, budgeting, food preparation, etc.); nonturbulence (degree of offensiveness, violence, intrusiveness, anger control, etc.); social contact (friendships, interpersonal interests and activities, etc.); communication (conversational skills, inappropriate gesturing, etc.); and responsibility (cooperativeness, responsibility regarding personal property and medication, etc.). World Health Organization Quality of Life Brief (Portuguese version by Vaz-Serra et al.,2006) was administered to assess the participant’s quality of life. The WHOQOL is a generic quality of life instrument that was designed to be applicable to people living under different circumstances, conditions and cultures, providing measurement on four domains: physical, psychological, social relationship and environment. The physical domain has questions related to daily activities, treatment compliance, pain and discomfort, sleep and rest, energy and fatigue. In the psychological domain, there are questions of positive and negative feelings, self-esteem, body image and physical appearance, personal beliefs and attention. The social relationship domain is related to personal relationships, social support and sexual activity. The environmental domain investigates safety, financial resources, health and social care, opportunities for acquiring new information, and participation in and opportunities for recreation and transportation. Proactive Coping Inventory (Greenglass, Schwarzer, Jakubiec, Fiksenbaum & Taubert, 1999) consists of seven scales and a total of 55 items which assess, on a cognitive and behavioral level, a way of coping based on resourcefulness, responsibility and vision. In this sense, proactive coping is distinguished from other coping forms in that it incorporates and utilizes social and non-social resources; it employs visions of success; it uses positive emotional strategies; and it includes goal setting and tenacious goal pursuit. The seven scales of the Proactive Coping inventory are: the Proactive Coping Scale, the Reflective Coping Scale, Strategic Planning, Preventive Coping, Instrumental Support Seeking, Emotional Support Seeking and Avoidance Coping. Depression Anxiety Stress Scales (Portuguese version by (Pais-Ribeiro, Honrado & Leal, 2004) was used to obtain self-reported information of three related negative emotional states (emotional distress) of depression, anxiety and tension/stress. The version adopted for this study was the short-form version of Lovibond and Lovibond’s (1995) 42-item self-report measure. In this assessment, participants rated the extent to which they have experienced each symptom over the past week, on a 4-point severity/frequency scale. Rosenberg Self-Esteem Scale (Portuguese version by Santos & Maia, 1999) was used as a unidimensional self-report measure of global self-esteem. It consists of 10 statements related to overall feelings of self-worth or self-acceptance. The items are answered on a four-point scale ranging from strongly agree to strongly disagree. Data Analysis: Spearman correlationalanalysis were computed in the SPSS 15.0 in order to determine the relationships between variables. Methods Methods Proactive coping, reflective coping, strategic planning and preventive coping correlated positively with different dimensions of functioning and QOL. Avoidance coping wasn’t correlated with any functional outcome. We also didn’t found significant correlations between distress symptoms and functioning and QOL, excepting depressive symptoms, which were correlated with communication skills and social relationships. Stress symptoms significantly correlated with physical domain of QOL. Self-esteem was positively associated with several quality of life domains. We conclude that schizophrenic patients can positively influence their functional outcomes, QOL and well-being, if using proactive coping strategies and goal striving. These skills should be emphasized in psychosocial rehabilitation programs. Psychosocial Functioning Dimensions (LSP) Coping Dimensions (PCI) SC NT CS COM RESP TOT M(DP) 33,09(3,5) 43,26(3,1) 14,52(3,6) 19,96(2,5) 18,26(1,4) 129,09(8,0) Proactive Coping 37,52(8,5) 0,447* 0,046 0,395 0,484* 0,000 0,526** Reflexive coping 32,52(7,8) 0,541** 0,185 0,344 0,211 0,207 0,574** Strategic Planning 10,78(2,9) 0,444* -0,102 0,371 0,245 -0,038 0,380 Preventive Coping 28,43(6,9) 0,523** 0,047 0,174 0,610** 0,133 0,541** Instrumental Support Seeking 22,91(6,3) -0,028 0,189 0,175 0,190 0,120 0,139 Emotional Support Seeking 14,13(3,3) 0,123 0,190 0,241 0,426* 0,246 0,339 Avoidance Coping 8,43(2,0) 0,006 -0,022 0,242 -0,180 -0,110 0,053 SC – Self-care; NT - Nonturbulence; SC – Social Contact; COM - Communication; RESP - Responsibility; TOT: LSP total score *p < 0.05 ** p < 0,01 Psychosocial Functioning Dimensions (LSP) SC SC SC SC SC SC M(DP) 33,09(3,5) 43,26(3,1) 14,52(3,6) 19,96(2,5) 18,26(1,4) 129,09(8,0) Stress 6,96(5,0) -0,191 -0,265 -0,182 -0,257 -0,145 -0,351 Anxiety 5,35(4,6) -0,139 -0,345 -0,060 -0,013 -0,267 -0,222 Depression 7,30(4,6) -0,269 -0,067 -0,251 -0,423* -0,152 -0,369 Self-esteem 26,78(5,4) 0,292 0,064 0,079 0,40410,080 0,317 SC – Self-care; NT - Nonturbulence; SC – Social Contact; COM - Communication; RESP - Responsibility; TOT: LSP total score *p < 0.05 ** p < 0,01 1p < 0,06 Table 2. Spearman correlations between emotional distress, self-esteem and psychosocial functioning Coping Dimensions (PCI) Quality of life WHOQOL-Bref DomPH DomPS DomSR DomE M(DP) 54,50(19,5) 53,44(18,0) 45,65(21,0) 50,27(14,7) Proactive Coping 37,52(8,5) 0,268 0,570** 0,416* 0,251 Reflexive coping 32,52(7,8) 0,201 0,485* 0,271 0,122 Strategic Planning 10,78(2,9) 0,426* 0,518* 0,415* 0,200 Preventive Coping 28,43(6,9) 0,109 0,283 0,211 -0,004 Instrumental Support Seeking 22,91(6,3) 0,119 0,122 0,162 -0,139 Emotional Support Seeking 14,13(3,3) 0,202 0,178 0,115 -0,017 Avoidance Coping 8,43(2,0) 0,132 0,231 -0,113 -0,006 DomPH – Physical domain; DomPS – Psychological domain; DomSR – Social relationship domain; DomE – Environmental domain *p < 0.05 ** p < 0,01 Table 3. Spearman correlations between coping and quality of life Results and Conclusions Results and Conclusions Quality of life WHOQOL-Bref DomPH DomPH DomPH DomPH M(DP) 54,50(19,5) 53,44(18,0) 45,65(21,0) 50,27(14,7) Stress 6,96(5,0) -0,357 -0,513* -0,138 -0,282 Anxiety 5,35(4,6) -0,352 -0,4091-0,233 -0,287 Depression 7,30(4,6) -0,363 -0,360 -0,539** -0,283 Self-esteem 26,78(5,4) 0,395 0,478* 0,731** 0,309 DomPH – Physical domain; DomPS – Psychological domain; DomSR – Social relationship domain; DomE – Environmental domain *p < 0.05 ** p < 0,01 1p < 0,06 Table 4. Spearman correlations between emotional distress, self-esteem and quality of life Supported by a FACC Grant