5- Dimensionality of Coping and Its Relation to Depression

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DOI: 10.1037/0022-3514.58.3.499

ISSN: 0022-3514

Registro: 00005205-199003000-00011

Texto completo (PDF) 1234 K

Dimensionality of Coping and Its Relation to Depression

Autor(es):Rohde, Paul1,4; Lewinsohn, Peter M.1,2; Tilson,

Mark3; Seeley, John R.1

Nmero: Volume 58(3), March 1990, p 499511

Tipo de publicacin:[Personality Processes and Individual

Differences]

Editor:

1990 by the American Psychological

Association

Instituciones:

1Oregon Research Institute, Eugene

2University of Oregon

3Tualatin Valley Mental Health Center, Portland,

Oregon

4Correspondence concerning this article should

be addressed to Paul Rohde, Oregon Research

Institute, 1715 Franklin Boulevard, Eugene,

Oregon 97403.

This project was partially supported by National

Institute of Mental Health Grants MH35672 andMH41278.

Received August 30, 1988; Revision received

June 27, 1989; Accepted July 6, 1989

AbstractThe dimensionality of coping, as measured by 65 items from 3 commonly used instruments, and the relation of

coping and stress to concurrent and future depression were studied in a community sample of 742 older (>=50 years

old) adults. Measures of coping, stress, and depression were obtained at 2 time points over a 2-year period.

Depression was assessed by symptom checklist and by diagnostic interview. Three coping factorsCognitive

Self-Control, Ineffective Escapism, and Solace Seekingthat had adequate psychometric properties and accounted for

25% of the total item variance were identified. Ineffective Escapism was associated with current depression and had adirect and interactive effect on future depression, exacerbating the negative impact of stress rather than acting as a

buffer. Although Cognitive Self-Control was unrelated to either concurrent or future depression, Solace Seeking

significantly buffered the effect of stress in predicting a future diagnosis of depression. Stress and initial depression

level predicted both measures of future depression. Gender (being female) predicted the future diagnosis of

depression but not the increase of depressive symptoms.

In the last decade, the construct labeled coping has received considerable attention in the psychological

literature (e.g., Billings & Moos, 1981; Folkman & Lazarus, 1980; Lazarus, 1981; Pearlin & Schooler, 1978), most

frequently as a factor that mediates the relation between stress and physical or mental disorder. Although numerousstudies have reported a significant relation between stress and illness (e.g., Antonovsky, 1979; F. Cohen & Lazarus,

1979; B. P. Dohrenwend, 1979; Johnson & Sarason, 1978; Rabkin & Streuning, 1976) and more specifically, between

stress and depression (Billings & Moos, 1982, 1984; B. S. Dohrenwend & Dohrenwend, 1981; Folkman & Lazarus, 1986;

Ovid: Dimensionality of Coping and Its Relation to Depression. http://0-ovidsp.tx.ovid.com.columbus.uhu.es/spb/ovidweb.cgi

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Paykel, 1979), the predictive ability of stress on future disorder has generally been quite modest. Thus, the hypothesis

that coping is a mediator variable between stress and disorder is attractive, because it potentially explains the

persistent and theoretically troubling low magnitude of association between stress and disorder. It is hypothesized

that, given the same degree of stress, people who use more effective coping strategies will experience less disrupted

behavior and subsequently will experience less distress. An extensive literature has attempted to address this question

with mixed, often positive, results (e.g., Aldwin & Revenson, 1987; Mitchell, Billings, & Moos, 1982; Mitchell,

Cronkite, & Moos, 1983; Pearlin, Lieberman, Menagham, & Mullan, 1981).

In addition to the term coping, a number of conceptually similar constructssuch as competence(Goldfried &

D'Zurilla, 1969),problem-solving ability(D'Zurilla & Nezu, 1982; Heppner & Peterson, 1982), hardiness(Kobasa, 1979),

antidepressive behaviors(Rippere, 1976), and learned resourcefulness(Meichenbaum, 1977; Rosenbaum, 1980)have

also been introduced. As may be assumed from the variety of terms in this area, little agreement exists regarding the

optimal conceptualization of coping. Although many issues are still being actively debated, these terms have been

used by and large to describe behavioral and cognitive patterns used by people in the face of difficult and problematic

situations and will be considered in this article to represent the general domain of coping.

Although several interview protocols have been developed to measure coping (e.g., Brown & Harris, 1978;

Folkman & Lazarus, 1986), it most often has been measured with self-report questionnaires, such as the ProblemSolving Inventory (Heppner & Peterson, 1982), the Ways of Coping Questionnaire (Folkman & Lazarus, 1980), the

Self-Control Scale (Rosenbaum, 1980), the Coping Strategies Inventory (Tobin, Holroyd, & Reynolds, 1982), and the

MeansEnds Problem-Solving Procedure (Platt & Spivack, 1975). Although some effort has gone into verifying the

validity of these coping measures, such as the Self-Control Scale (Courey, Feuerstein, & Bush, 1982; Frankel &

Merbaum, 1982; Rosenbaum 1980; Rosenbaum & Rolnick, 1983), it may be suggested that in general, more effort is

needed to establish the construct validity of the numerous coping measures. In addition, the degree to which these

instruments measure the same underlying construct has received little study. An important assumption of the present

investigation is that many of the currently available instruments are indeed measures of a single underlying construct

(which may have several dimensions) and therefore that the combined use of items from various measures would

facilitate the assessment of the coping construct. In summary, although several self-report instruments have been

developed, numerous questions remain regarding the optimal measurement of coping.

In spite of the unidimensionality implied by the term coping, researchers have recognized the potential factors of

this construct and have subsequently proposed various dimensions of coping. Several classifications of the

distinguishing factors or dimensions of coping have been suggested on theoretical grounds, such as problem-focused

versus emotion-focused coping (Lazarus & Folkman, 1984) and approach versus avoidance coping (Roth & Cohen, 1986;

Suls & Fletcher, 1985). For instance, Billings and Moos (1982)distinguished between appraisal-focused coping (e.g.,

reminding oneself that things could be worse), problem-focused coping (e.g., destroying an alcoholic spouse's liquor

supply), and emotion-focused coping (e.g., meditating). A second approach, which generally has used factor-analytic

procedures, addresses the issue of dimensionality on more empirical grounds (e.g., Aldwin & Revenson, 1987;

Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986; Frank et al., 1987). Using factor analysis, Parker and

Brown (1982)identified six coping factors, which they labeled Recklessness(e.g., break things), Socialization(e.g.,spend time with friends), Distraction(e.g., busy oneself with work), Problem Solving(e.g., think through the

problem), Passivity(e.g., read), and Self-Consolation(e.g., spend money on oneself). Thus, in addition to the role of

coping as a mediator of stress on disorder, the dimensionality and specific nature of coping clearly deserve attention.

Clarifying the dimensionality of coping is important in developing a better understanding of what people do under

stressful conditions. The most parsimonious assumption, perhaps, is that coping can be represented best as a single

factor. If that were the case, the mediator hypothesis would predict that people strong on this single factor would be

less affected by stressful events. On the other hand, if, as suggested by many, coping were best represented by more

than one dimension, the picture would become more complicated. In this second scenario, the various coping

dimensions might well differ in their relation between stress and disorder, with some dimensions having a strong

mediator role and others being irrelevant to that association. Such distinctions, if they exist, would greatly clarify ourtheoretical understanding of the relation between stress and disorder and would be useful in developing clinical

interventions for use by individuals in high-stress situations.


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As with the construct coping, many questions remain in the conceptualization and measurement of stress.

Although stress was measured initially primarily by life-change event scales (e.g., Holmes & Rahe, 1967), a number of

concepts such as daily hassles(Kanner, Coyne, Schaefer, & Lazarus, 1981), life strains(Pearlin & Schooler, 1978), and

microstressors(McLean, 1976; Monroe, 1983) have been used in attempting to assess ongoing strains and everyday

frustrations, in addition to major life events. The measurement of both discrete stressful events and ongoing strains

might provide the most comprehensive measure of stress. In addition, one increasing concern is the potential

confound between concurrent measures of stress and measures of psychological distress (B. S. Dohrenwend,Dohrenwend, Dobson, & Shrout, 1984; Lazarus, DeLongis, Folkman, & Gruen, 1985; Lloyd & Lishman, 1975).

Dohrenwend and colleagues (B. S. Dohrenwend et al., 1984) reported that several measures of stress assess not only

stressful events but also psychopathology, thus confounding a dependent variable (stress) with an independent

variable (psychological symptoms). In their review of this literature, Lazarus and his colleagues (Lazarus et al., 1985)

concluded that although some of the fusion between measures of stress and psychopathology most likely reflects the

true nature of these constructs, a longitudinal approach is required to clarify any temporal relation between stress

and disorder.

In regard to depression, we expected that individuals who reported more effective coping behaviors would

function more effectively and experience fewer depressive episodes. Several studies have reported that depressed

and nondepressed individuals differ in the frequency and types of coping behaviors they use. For example, depressedindividuals are reported to use less problem solving and more emotional discharge (Billings & Moos, 1984), wishful

thinking, avoidance, and emotional support seeking (Coyne, Aldwin, & Lazarus, 1981). Because of the potential

confound among concurrent measures of stress, coping, and depression, we were particularly interested in the ability

of stress and coping to predict future depression. Lewinsohn and Alexander (1983)found that scores on the

Self-Control Scale (a measure of learned resourcefulness; Rosenbaum, 1980) predicted future occurrence of

depression. People who reported low levels of learned resourcefulness and who were not depressed at the first

observation were more likely to develop an episode of depression at a later point during the course of the study.

Interestingly, in that study, learned resourcefulness had a direct impact on future depression; that is, this measure of

coping predicted a person's becoming depressed independent of his or her reported level of stress. In conclusion, we

expected that poor coping would be associated both with current depression and with the future occurrence of

depression in a nondepressed group.

The Present StudyThe present study is an attempt to address several of the previously mentioned issues. As part of a longitudinal,

prospective study aimed at the identification of risk factors for nonbipolar depression in the elderly (Lewinsohn,

Tilson, Rohde, & Seeley, 1988), 65 items assembled from three commonly used coping instruments were administered

to a cohort of 742 persons who were 50 years of age or older at two points of time (T1 and T2) over approximately a

2-year period. In addition to the assessment of coping, measures of demographic and stress variables were gathered (a

variety of other measures were also assessed but are not presented in the current report). Stress was assessed both by

major life events and by daily hassles. The presence of depression was assessed by a self-report questionnaire and a

diagnostic interview at T1 and T2 and at an intermediate casefinding phase (post-T1) of the study. On the basis of

diagnostic criteria, 96 subjects were judged to be depressed at T1, and 139 subjects were identified who, althoughnot clinically depressed at T1, developed a depressive episode during the course of the study. We referred to the

latter as Cases.

With this data set, we were able to examine a number of important questions. First, we used factoring procedures

to explore the dimensionality of coping as measured by the 65 items. Second, we examined the relation of coping (as

measured both by the original scales and by newly developed factors) with demographic variables and concurrent

depression. Third, because of the longitudinal design of the study, we were able to investigate the direct versus

interactive effects of coping and stress in predicting the future occurrence of depression.

Method

ParticipantsSubjects were recruited between May 1982 and November 1983 through announcements inviting participation in

psychological research. A total of 4,133 individuals over the age of 50 residing in EugeneSpringfield, Oregon (N=

34,633) were randomly selected from a list of licensed drivers and were sent a letter that described the general nature


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of the study (i.e., psychological research regarding life satisfaction, health, and aging) and that informed them that

they would be telephoned and given further information. Follow-up phone calls were made within 2 weeks of the date

of the original mailing, to a randomly selected sample of 2,662. Of those called, 259 (9.7%) either were ill or had

moved out of the area, 849 (31.9%) declined to participate, and 1,554 (58.4%) agreed to participate in the study.

Those who agreed to participate were asked to complete an extensive self-report questionnaire and come to the

University of Oregon Psychology Clinic for a diagnostic interview within 2 weeks of returning the questionnaire. A

total of 1,008 subjects completed both procedures. (The remaining 546 chose to complete either the questionnaire orthe interview, and we do not discuss them in the present study). Of the 1,008 subjects, 742 (73.6%) continued with

complete participation in the entire study until its conclusion in March 1986. These 742 individuals constituted the

reference sample for the present study. Inspection of the demographic characteristics of the 742 subjects revealed

that individuals who participated in the study differed somewhat from the U.S. Census Bureau data for the Eugene

Springfield area. Compared with the general population, participants were better educated and more likely to be

women. Comparison of the initial 1,008 subjects with the 742 who completed the entire study revealed that older

individuals were more likely to discontinue participation; no other assessed demographic differences were associated

with attrition. Subjects received no financial reimbursement for participating in the study (except for occasional

reimbursement of transportation costs) and signed a statement of informed consent, which assured confidentiality.

Longitudinal DesignData were collected on psychopathology, depressive symptomatology, demographic characteristics, and the

psychosocial variables of interest at multiple assessments. T1 occurred between May 1982 and November 1983 and was

defined as the date on which the subject completed both the questionnaire and the diagnostic interview. Subjects

were interviewed within approximately 2 weeks after returning the questionnaire, so that self-report data and

interview-based data essentially were obtained concurrently. T2 occurred between November 1984 and March 1986

and was defined as the date that the subject was readministered the self-report questionnaire and was reinterviewed.

The average time that elapsed between T1 and T2 was 2.4 years. Additionally, to identify subjects who became

depressed between T1 and T2, we implemented case-finding procedures, as described in the next section.

Case Finding

Our goal was to record all episodes of depression and other psychopathology that occurred between T1 and T2. Toidentify individuals who became depressed after T1, subjects were mailed the Center for Epidemiological Studies

Depression Scale (CESD; Radloff, 1977) approximately every 2 months. The CESD is a self-report measure that

assesses the frequency of occurrence of 20 depressive symptoms. Completion rates were high, averaging 80% (of the

1,008 T1 subjects) across the nine mailings. Any subject who was not diagnosed as depressed at T1 and scored above

11 on any CESD administrations in the post-T1 phase was considered for a post-T1 follow-up interview to determine

whether they had become depressed. Twenty-five percent of the returned CESD questionnaires had scores above 11.

Because of administrative and financial constraints, not all subjects with elevated CESD scores were interviewed

during the post-T1 phase. Higher priority was given to subjects with higher CESD scores. Six hundred post-T1

interviews were conducted with 386 subjects (38.3%) from the T1 sample (55.4% of the 386 subjects had multiple

post-T1 interviews). The mean CESD score for the 386 subjects was 18.97 (SD= 5.99, range-1247). These procedures

identified 105 Cases, who were judged to have experienced a diagnosable episode of depression that began after T1.

During the T2 phase of the study, 749 of the T1 subjects (74.2%) again were interviewed and were administered

the self-report measures that were assessed at T1. Resource constraints prevented follow-up of the entire T1 sample.

Therefore, highest priority for T2 interviews was given to subjects (a) who had been depressed at T1, (b) who had

become depressed at any time during the post-T1 period (i.e., Cases), (c) who had a past history of depression, or (d)

who reported an elevated level of depressive symptoms on the final post-T1 CESD questionnaire. These criteria

identified 391 subjects. A random sample of 358 (66.3%) of the 540 T1 subjects who had reported no evidence of past

or current depression were also reinterviewed as control subjects. This resulted in a total of 749 subjects who were

assessed at T2. It is important to note that the mean T1 and T2 CESD scores were not significantly different. Data for

7 subjects were excluded from analyses because of missing data, evidence of organic disorder, or evidence of deviant

or random responding to questionnaire items; thus, 742 subjects were left as the reference sample. In addition to the105 Cases identified in the post-T1 phase, T2 interview procedures identified 41 Cases. Seven Cases from the post-T1

phase were lost before T2 follow-up (2 were deceased, 1 refused to participate, and 4 could not be located).

Therefore, complete data for 139 individuals who became depressed after T1 were available for subsequent analyses.


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Note that only a few of the 139 Cases developed their first depressive episode during the course of this study; the

majority of these subjects had a past history of depression. The important fact is that all of the Cases were not

clinically depressed at T1.

Diagnostic Classifications

The diagnosis of depression and other psychopathological syndromes was based on information gathered from

participants in 2-hr semistructured interviews, using the Schedule for Affective Disorders and SchizophreniaLifetime(SADSL; Endicott & Spitzer, 1978) for T1 and using the Schedule for Affective Disorders and SchizophreniaChange

(SADSC; Spitzer & Endicott, 1977) for post-T1. At T2, the Longitudinal Interval Follow-Up Evaluation (LIFE; Shapiro &

Keller, 1979) was conducted. The LIFE interview provided detailed information about the longitudinal course of

psychiatric symptoms and disorders since the last (T1 or post-T1) interview, with rigorous criteria for recovery from a

disorder. Decision rules specified by the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robins, 1978) were

used to combine information obtained through the interviews into specific RDC nosological categories.

Diagnostic interviewers were a carefully selected group of graduate and advanced undergraduate students

enrolled in a yearlong didactic and experiential diagnostic interviewing course. The training procedure was an

extension and modification of the training model proposed by Gibbon, McDonald-Scott, and Endicott (1981), with

additional training regarding the interviewing of elderly subjects. The SADSRDC procedure has been shown to be arelatively reliable and valid method of making retrospective diagnoses of psychiatric disorders for both psychiatric

patients and nonpatient samples, with measures of reliability generally exceeding .80 (Mazure & Gershon, 1979;

Spitzer et al., 1978). Interviewers were unaware of questionnaire data, subject selection procedure, and the specific

hypotheses under investigation. Interrater reliability of diagnosis was evaluated by means of the kappa statistic ( J.

Cohen, 1960). On the basis of joint ratings, the kappa coefficient was .81 for 193 T1 SADSL interviews, .81 for 101

post-T1 SADSC interviews, and .82 for 147 T2 LIFE interviews. All kappas indicated an acceptable level of reliability

for the diagnoses.

Four subject groups were of interest in the present study. First, we were interested in the general sample of

individuals who participated in the entire study. Three additional groups were also of interest on the basis of

information gathered in the diagnostic interviews: individuals who were depressed at T1; individuals who becamedepressed after T1 (Cases); and control group individuals, who reported no past or current depressive episodes at

both T1 and T2. Table 1 contains demographic information for the four groups of subjects.


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Table 1 No caption available.

Assessment of Sociodemographic Variables

Subjects reported their sex, age, marital status (married, divorced/ separated, widow/widower, or never

married), educational level (eighth grade, high school, some college/vocational school, college degree, or

professional degree), and employment status (employed, unemployed and seeking, or retired).

Assessment of Coping Behaviors

Several frequently used measures of coping were inspected by three psychologists (P. M. Lewinsohn, M.

Hautzinger, and L. Teri). Items were selected from the various measures in an attempt to represent a wide variety of

coping behaviors but at the same time to avoid redundancy and excessive length.

Self-control behaviors

Because of its extensive prior use and reported psychometric soundness, the entire Self-Control Scale

(Rosenbaum, 1980) was selected. This instrument was developed as a measure of learned resourcefulness

(Meichenbaum, 1977; Rosenbaum, 1980), which refers to the acquired repertoire of behavioral and cognitive skills

used by people to regulate internal events, such as emotions and cognitions, that might otherwise interfere with the

smooth execution of a target behavior (Rosenbaum, 1980). The measure consists of 36 items that describe (a) use of

cognitions and self-statements to control emotional and physiological responses, (b) application of problem-solving

strategies, (c) ability to delay immediate gratification, and (d) perceived self-efficacy. Each item consists of a

statement used to describe people. Subjects were asked to describe yourself according to these characteristics, by

checking the description which best applies to you using a 6-point scale. Testretest reliability from T1 and T2 of the

Self-Control Scale was .76 (p


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microstressors. This measure, called total stress, was developed so that the final numbers of analyses would not be

overwhelming; it is described later in this article.

Macrostress

We measured macrostressors, or major life events, at T1 and T2 with a subset of 18 items from the Social

Readjustment Rating Scale (Holmes & Rahe, 1967). The 18 items were selected on the basis of applicability to an older

sample. In addition, items were deleted from the original scale if they represented a symptom of depression (e.g.,Change in eating or sleeping habits). Individuals rated whether they had experienced each of the 18 events during

the past 6 months, and a total macrostress score was computed that was based on the average frequency of the 18

events. The measure of item homogeneity was seen as inappropriate, given the nature of the items.

Microstress

We assessed microstressors, or ongoing hassles, at T1 and T2 with 44 items from the Unpleasant Events Schedule

(Lewinsohn, Mermelstein, Alexander, & MacPhillamy, 1983). Items were selected on the basis of applicability to an

older sample and previously reported association with depression (Lewinsohn et al., 1983). The items describe

aversive experiences that are part of everyday life (e.g., Having arguments with spouse; Having to do things I do

not like to do). Subjects rated these events on a 3-point scale in terms of frequency of occurrence during the past 30

days. A total microstress score, which was based on the average frequency of all 44 events, was computed.Coefficient alpha at T1 was .85, and the T1T2 correlation was .68 (p


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.04, ns).

Factor 3, which contained 10 items and accounted for 5.8% of the total item variance, was labeled Solace

Seeking. All of the items in this factor were from the effective antidepressive behaviors. Items that loaded highest on

Factor 3 included the following: Plan something pleasant (.69), Spend time with friends (.67), Do something

enjoyable (.64), Spend time with a relative or a close friend (.60), and Do something to restore your pride (.59).

Internal consistency at T1 and T2 was .80 and .83, respectively, and testretest reliability was .53 (p


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Unexpectedly, gender was not predictive of an increase in reported depression symptoms. Conversely, CESD atT1 was highly predictive of the final CESD score, as was the main effect of T1 total stress. Individuals who reported

more symptoms of depression or stressful events and hassles at T1 were more likely to report an increase in depressive

symptoms at the future assessment.

Of the three coping factors, only Ineffective Escapism significantly predicted an increase in symptoms of

depression. This coping factor had both a significant main effect and significant interaction with stress, although the

use of Ineffective Escapism was not a buffer against stress. Instead, the use of these avoidant, passive, and reckless

coping behaviors represented a vulnerability. Individuals who reported more use of behaviors within this factor were

more likely to be negatively affected by stress.

Corroborating results were obtained in regressions using the four original coping scales. The Self-Control Scalehad a significant main effect in predicting future CESD scores. Although items from the Self-Control Scale had loaded

on both Factors 1 and 2, one may assume that only the apparently unhelpful items of this scale that were contained in

Factor 2 (e.g., I cannot avoid thinking about mistakes I have made in the past and If I had the pills with me, I would

take a tranquilizer whenever I felt tense and nervous) contributed to the scale's ability to predict future depression

symptoms, because Factor 1 (which contained many apparently helpful Self-Control Scale behaviors) was unrelated to

increased future CESD scores. Both ineffective antidepressive behaviors and passivity behaviors had additive and

interactive effects in predicting an increase in future CESD scores. Again, instead of acting as a buffer, frequent use

of these coping behaviors represented a vulnerability that exacerbated the negative impact of stress. Effective

antidepressive behaviors at T1 were unrelated to increased depressive symptoms.

Role of Coping in Predicting a Diagnosis of DepressionWe used similar hierarchical multiple regression procedures to predict the development of a depression diagnosis

after T1. Gender, CESD scores, and total stress scores at T1 were entered first, followed by one of the coping

measures and its interaction with total stress. Results appear in Table 3.


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As anticipated, gender, T1 CESD scores, and total stress scores each were highly predictive of the future

diagnosis of depression. Such results replicate the generally accepted findings that women, individuals reportingsubclinical dysphoria, and those reporting high levels of stress are at elevated risk for a future diagnosis of depression.

In addition to gender, T1 CESD scores, and total stress scores, both Ineffective Escapism and Solace Seeking

significantly contributed to predicting the future diagnosis of depression. As it did in predicting future CESD scores,

Ineffective Escapism represented a vulnerability, especially in the presence of increased levels of stress. Use of these

coping behaviors increased the likelihood of a person's being diagnosed as depressed, especially when the individual

had reported high levels of stress. On the other hand, Solace Seeking significantly mediated the impact of stress,

decreasing the likelihood of a person's becoming depressed. Individuals who reported spending time with others and

engaging in enjoyable activities were less likely to be diagnosed as depressed later, given high levels of stressful

events in their lives.

Regression procedures using the four original coping measures provided further insight into the role of coping.

Although the Self-Control Scale did not mediate the impact of stress, it was independently predictive of future

depressive episodes. We assumed that primarily the apparently bad coping behaviors of the Self-Control Scale were

most predictive of future depressive episodes, rather than was the entire scale, because Factor 1 had no significant

relation to the future diagnosis of depression. Review of the other two original scales that constituted Factor 2

indicated that ineffective antidepressive behaviors had a significant main effect and that passivity behaviors had a

significant interaction with stress. As seen before, reported use of these coping behaviors represented an increased

vulnerability to stress, rather than a buffer. Use of effective antidepressive behaviors did not predict subsequent

depression, which is noteworthy because the Solace Seeking factor (formed exclusively of items from effective

antidepressive behaviors) had significantly mediated the impact of stress in relation to future depressive episodes.

Because the three-factor solution accounted for only 25% of the total item variance, we computed a fourth,

residual factor from the 17 items that had not been assigned to one of the other three factors. As expected, the


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coefficient alpha of the residual factor was somewhat low (.54), and it was significantly correlated with each of the

other three factors, especially with Factor 2. Although the residual factor had a significant main effect for predicting

future increases in CESD score, F(4, 759) = 4.68,p= .031, and future diagnosis, F(4, 626) = 8.84,p= .003, when it was

entered in combination with Ineffective Escapism, the residual factor accounted for no additional variance.

Further Analysis of Maladaptive Escapism in Predicting Depression

Of the three coping factors in the present study, Ineffective Escapism (Factor 2) was most strongly associatedwith becoming depressed. For this reason, we used stepwise multiple regression procedures to examine the specific

items within Factor 2 that were most predictive of future depression. Using the criteria of a significant (p


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Much debate has focused on the adequate measurement of stress. In the present study, we measured stress by

frequency counts of major stressful life events and daily microstressors. Some researchers have argued that measures

of stress should quantify the perceived impact or cognitive appraisal of threat, in addition to the simple fact of

occurrence (Hammen, Marks, Mayol, & deMayo, 1985). Others have noted the possible confound between events and

psychopathologynamely, that psychopathology may be a cause, as well as a consequence, of adverse life events

(Depue & Monroe, 1986). For example, varying degrees of depression might bias an individual's report of stress,

particularly the report of more ongoing hassles. One interpretation of the high internal consistency of microstress inthe present study is that the measure was confounded with psychopathology. Because stress could have been

confounded with concurrent depression, the longitudinal design of the present study was especially important.

Measuring coping and stress at T1, before the occurrence of future depression, greatly reduced this potential

confound. In addition, the fact that total stress at T1 predicted both measures of future depression after we

controlled for T1 depression level represented a strong argument for the construct validity of the stress measure. We

were therefore quite confident in our measurement of stress.

A final limitation to the generalizability of our findings involved the nonrandom selection of subjects because of

voluntary participation. Although our situation was not ideal, the study sample was large, participation rates were

high, and the demographic distribution was roughly similar to the general over-age-50 population. Attrition in the

study was generally low and tended to be random, with the one noted exception that older individuals were morelikely to discontinue. Therefore, the sample was judged to be more than adequate for testing the hypotheses of

interest, with the caveat that results may not be as readily generalizable to younger or less well educated samples.

Although we have acknowledged several limitations, the present study had several important positive features.

The large sample of community residents enhanced the generalizability of results, as compared with clinical or student

samples. The prospective, longitudinal design allowed a truly predictive analysis of coping and future depression; data

regarding coping and stress at T1 were uncontaminated by future depression. In addition, the readministration of T1

measures at T2 allowed for cross-validation of the factor analyses. Finally, depression was not measured solely by a

self-report symptom scaleas is often truebut was additionally assessed by rigorous diagnostic criteria. This provided

a comparison of results with the two different outcome measures, thus increasing our confidence when results were

the same for both measures of depression. The data set was seen as impressive for a number of reasons and as quiteadequate to address the present issues.

Dimensionality of Coping

The three factors identified by our analyses were psychometrically robust and meaningful. The factors were

reasonably independent and had good internal consistency (item homogeneity). They showed considerable stability

over time and were consistent under cross-validation at T2. The factors were also psychologically interpretable, falling

into three broad domains: (a) problem solving and cognitive self-control, (b) passivity and avoidant behaviors, and (c)

spending time with others and engaging in enjoyable activities. Although not ideal, the three-factor solution appeared

optimal.

All three coping factors were associated with gender (women used more Cognitive Self-Control and SolaceSeeking, but men used more Ineffective Escapism); none were related to age. In comparison, Parker and Brown

(1982)reported that women used more self-consolation which is related to Solace Seeking in the present study. They

also reported several age differences: Younger people reported more reckless behaviors and less use of distraction

and passivity. The meaning of the various gender differences in the current study is unclear; results need to be

replicated. One explanation for the lack of age effects in the present study is that only older subjects (50 or more

years old) were involved, thus restricting the age range.

Results of the present study were broadly consistent with the results of other factor-analytic studies of coping.

Although specific factor solutions varied across studies, the dimensions of coping that have been identified thus far

include various forms of cognitive self-control (e.g., reappraisal, self-distraction, cognitive problem solving, and

positive self-talk); social support seeking (e.g., emotional support, social activity, and help seeking); instrumentalproblem-solving behavior; seeking compensatory relief; and relatively maladaptive responses (e.g., wishful thinking,

self-blame, escapism, catastrophic thinking, and self-denigration). The coping factors variously reported by Folkman

and Lazarus (1988), Parker and Brown (1979), Billings and Moos (1982), and Aldwin and Revenson (1987)generally


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consisted of subsets of these many dimensions. Of course, the different coping factors obtained depended on, among

other things, the initial items included in analyses, the response formats, and the situations addressed by the subjects

(e.g., a specific stressful event, general personality descriptions, and interpersonal stress events). Clearly, although a

good deal of consensus exists regarding the dimensionality of coping, it would be premature to suggest that a

definitive answer has been reached.

We had assumed that the three selected instruments measured the same underlying construct. However, thisassumption was not supported by the results. Cognitive Self-Control (Factor 1) and Solace Seeking (Factor 3) were

constructed exclusively from self-control behaviors and effective antidepressive behaviors, respectively. On the other

hand, Ineffective Escapism (Factor 2) contained items from self-control behaviors, ineffective behaviors, and passivity

behaviors. Thus, Factor 2 appeared to assess an underlying factor contained within all the instruments, namely, poor

coping.

Both the present findings and work by other researchers suggest that coping is a multidimensional construct that

is not adequately represented by a single score. This is true even if one ignores variance that is due to varying item

pools and differing targets of coping (e.g., stressful situations vs. stressful interpersonal encounters). One concern is

that only 25% of the total item variance was accounted for by the three factors; 13 coping factors would have been

required to account for 50% of the item variance. The total item pool was thus quite heterogeneous. In conclusion,our factor results appeared to be relatively consistent with other reported findings in suggesting that coping behaviors

consist of a somewhat heterogeneous pool of behaviors.

Coping and Concurrent Depression

The three T1 coping factors were examined in relation to T1 depression, as assessed with two measures of

depression: T1 CESD score and T1 diagnosis (0 = never mentally ill, 1 = depressed at T1). Ineffective Escapism was

significantly associated with both measures of T1 depression; more use of the behaviors in this factor was associated

with higher levels of depression. Neither Cognitive Self-Control nor Solace Seeking was significantly associated with

either measure of T1 depression. The nonsignificant results for these two factors were somewhat unexpected,

although not completely inconsistent with previous research.

Several studies have reported similar findings that relate coping to concurrent depression. Coyne et al.

(1981)reported that depressed individuals used more wishful thinking and avoidance (both related to Ineffective

Escapism) in addition to more emotional support seeking (in relation to Solace Seeking). Folkman and Lazarus

(1986)compared depressed adults (on the basis of five CESD scores) to nondepressed controls. The depressed

subjects in their study tended to use more escapeavoidance, confrontive coping, responsibility acceptance,

self-control, and social supportseeking behaviors. The depressed group did not differ from controls on coping

behaviors labeled distancing, planful problem solving, andpositive reappraisal. It is interesting that most studies

(including the present) found more coping behaviors that increased the likelihood of depression (as opposed to

behaviors that decreased the likelihood of, or prevented, depression). Exceptions to this pattern include Billings and

Moos (1984), who reported more emotional discharge and less problem solving for depressed individuals, and Parker

and Brown (1982), who reported less socialization and distraction seeking for depressed individuals, along with morepassivity. As can be seen, the coping behaviors reported by other researchers to increase with concurrent depression

tended to be similar or identical to behaviors contained within Ineffective Escapism in the present study.

Coping and Future Depression

We examined the relations of gender, stress, and coping to future depression, as measured both by an increase in

reported depressive symptoms and by a diagnosis of depression. The independent effects of coping on future

depression were assessed by first entering gender, T1 CESD, and total stress into a series of multiple regressions,

followed by the direct effect of coping and the interaction of coping and total stress. The longitudinal design provided

an examination of the causal directionality of coping and depression (i.e., whether coping had a direct or interactive

impact on future depression, independent of prior depression level).

Although not of primary concern in the present study, several interesting findings deserve mention. First, the

present results add to the small but growing number of prospective studies in which stress predicts future depression

(e.g., Kaplan, Roberts, Camacho, & Coyne, 1987; Lewinsohn, Hoberman, & Rosenbaum, 1988; O'Hara, Neunaber, &


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Zekoski, 1984). Second, we wish to highlight the finding that mild depression (elevated CESD score without a

diagnosable depressive disorder) at T1 clearly predicted the future increase in CESD score and the development of a

diagnosed episode of depression. These findings provide additional support to the growing recognition of chronic

subsyndromal dysthymia as a risk factor for depressive episodes (Anashensel, 1985; Depue & Monroe, 1986; Lewinsohn,

Hoberman, & Rosenbaum, 1988).

Finally, female gender predicted the future development of a diagnosis of depression but did not predict anincrease in depression symptoms, as measured by the CESD, a finding that replicates results reported from our earlier

work (Lewinsohn, Hoberman, & Rosenbaum, 1988). This rather intriguing finding, if replicated by other investigators,

deserves further study aimed at clarifying the precise nature of the vulnerability that predisposes women to

diagnosable episodes of depression (Weissman & Klerman, 1977). The two measures of depression (CESD and

diagnosis) were included to measure the same underlying construct (i.e., depression), providing a multimethod cross-

validation of findings. That gender predicted only one of the depressive measures underscores the fact that formal

interviewer-derived diagnoses using rigorous criteria and self-report symptom scales measure the use of similar but

not identical constructs.

Of the three coping factors, Ineffective Escapism (Factor 2) had the strongest association with future depression,

both directly and interactively predicting future depression. Subjects who reported greater use of the passive,avoidant, or reckless behaviors within this factor were more likely to become depressed, as measured both by

increased self-reported dysphoria and interview diagnosis. The interactive impact of this factor was significant but did

not represent a buffer. Instead, given an elevated amount of stress, subjects who reported more use of Ineffective

Escapism behaviors were more likely to become depressed. Thus, use of the behaviors in Factor 2 exacerbated one's

vulnerability to stress, instead of acting as a stress buffer.

In general, the items within Ineffective Escapism that were most associated with future depression reflected a

feeling of helplessness, uncontrollable negative ruminations, and nervousness. All of these behaviors suggested that

feeling inadequate about one's personal resources increased the likelihood of both being and becoming depressed.

We had assumed that some subset of coping behaviors would represent a buffer against stress; however, supportfor this supposition was weak. Cognitive Self-Control (Factor 1) had no significant relation to either measure of future

depression. On the other hand, Solace Seeking was unrelated to increases in CESD scores but did significantly buffer

the impact of stress on developing a future diagnosis of depression. These findings were somewhat consistent with the

results of other studies in which positive coping behaviors had both direct effects (Felton & Revenson, 1987; Felton,

Revenson, & Hinrichsen, 1984; Mitchell & Hodson, 1983) and interactional or buffer effects (Martin & Lefcourt, 1983;

Pearlin et al., 1981). One possible interpretation for the weak or nonsignificant effects of positive coping in the

present study is that engagement in behaviors that are generally negatively valued (e.g., behaviors in the Ineffective

Escapism factor) constitutes a vulnerability but engagement in positive-valued behaviors (e.g., Cognitive Self-Control

and Solace Seeking) does not confer an immunity. In other words, the presence of maladaptive coping behaviors in

the person's repertoire is much more relevant to predicting depression than the presence of those behaviors that have

traditionally been used to define coping.

Of the original coping scales, most of our attention is directed to the Self-Control Scale, which was used in its

entirety. Although this measure did not mediate the impact of stress, the Self-Control Scale had a direct effect in

predicting both future increases in depressive symptoms and the diagnosis of depression. It was assumed that the

apparently unhelpful items within this scale were most strongly predictive of future depression because the positive

items (which generally loaded on the Cognitive Self-Control factor) were predictive neither of increased CESD scores

nor of depressive diagnoses.

The findings in this study suggest that currently depressed individuals use more negative or maladaptive coping

behaviors and that these same coping behaviors are predictive of future depression. Findings such as these support

Felton and Revenson's (1984)suggestion that a mutually reinforing causal cycle exists between poor mental health andmaladaptive coping; poor mental health predicts maladaptive coping as maladaptive coping predicts poor mental

health. Perhaps such ineffective coping behaviors are partially responsible for the increased likelihood of formerly

depressed individuals, compared with neverdepressed controls, to become depressed in the future (Amenson &


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Lewinsohn, 1981; Keller, Shapiro, Lavori, & Wolfe, 1982).

Coping research has been used in attempts to understand which behaviors decrease the negative impact of stress,

but what has more frequently been found are behaviors that exacerbate the effects of stress. Results of the present

study only provide marginal support for the buffer hypothesis that good coping protects one against the

depressogenic effects of stress. In only one of four analyses did positive coping behaviors (Solace Seeking) mediate

the effects of stress on future depression. Much stronger evidence suggested that higher levels of IneffectiveEscapism (Factor 2) amplified the relation between higher stress levels and future depression (as measured by both

self-reported dysphoria and diagnosed depression). In contrast to a buffer effect, Ineffective Escapism thus seems to

create an increased vulnerability to the effects of stress. Perhaps poor coping behaviors are more easily measured, in

comparison with the assessment of effective coping. A second possibility is that no consistently effective coping

behaviors truly exist. Pearlin and Schooler (1978)suggested that a varied coping repertoire was much more important

than any one particular coping strategy.

Another possible explanation for the negative findings in regard to Cognitive Self-Control and the weak findings

for Solace Seeking may be that a more precise match is required between the positive coping behaviors executed by

an individual and the specific types of coping demanded by the specific stressful situation (Pearlin & Schooler, 1978).

In the present study, as in other similar studies, coping behaviors were measured as if they represented a general skillthat facilitates the person's ability to deal with any stressful situation. It is possible that a more specific detailing of

the type of situation (or stressor) with which the person has to cope is required, to illuminate the relation between

the positive aspects of coping and stress. For instance, research on how patients cope with chronic pain (Copp, 1974;

Tan, 1982; Turk & Genest, 1979) has shown that a number of successful cognitive and behavioral strategies, such as

attempting to ignore or to reinterpret pain sensations or involving one-self in a distracting activity, are present.

Therefore, many of the coping behaviors measured in the present study would be unrelated to effectively dealing

with this specific type of stressor. It seems reasonable to assume the same of other stressful events. If this assumption

were correct, future research might be directed at people who have recently, or who will soon, experience a specific

stressor (e.g., loss of a job, birth of a baby, or recovery from a heart attack). Attempts could then be made to sample

and measure the specific types of coping behaviors that people engage in, with the goal of identifying those behaviors

that serve to increase or to decrease the likelihood of the person's developing a disorder in the situation. As is oftenthe case in science, questions that initially appear to be reasonably straightforward become increasingly more

complex as they are examined.

ReferencesAldwin, C. M., & Revenson, T. A. (1987). Does coping help? A reexamination of the relation between coping and

mental health.Journal of Personality and Social Psychology, 53, 337348. [Context Link]

Amenson, C. S., & Lewinsohn, P. M. (1981). An investigation into the observed sex difference in prevalence of

unipolar depression.Journal of Abnormal Psychology, 90, 113. Texto Completo OVID [Context Link]

Anashensel, C. S. (1985). The natural history of depressive symptoms: Implications for psychiatric epidemiology. In J.R. Greenley (Ed.), Research in community and mental health (Vol. 5, (pp. 4575). Greenwich, CT: JAI Press.

[Context Link]

Antonovsky, A. (1979). Health, stress, and coping. San Francisco: Jossey-Bass. [Context Link]

Billings, A. G., & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the stress of life

events.Journal of Behavioral Medicine, 4, 139157. [Context Link]

Billings, A. G., & Moos, R. H. (1982). Psychosocial theory and research on depression: An integrative framework and

review. Clinical Psychology Review, 2, 213237. Texto Completo [Context Link]

Billings, A. G., & Moos, R. H. (1984). Coping, stress, and social resources among adults with unipolar depression.

Journal of Personality and Social Psychology, 46, 877891. [Context Link]


15 de 21 20/01/2009 23:29


16/21

Brown, G., & Harris, T. (1978). Social origins of depression: A study of psychiatric disorder in women . New York:

Free Press. [Context Link]

Cohen, F., & Lazarus, R. S. (1979). Coping with the stresses of illness. In G. C. Stone, F. Cohen, & N. E. Adler (Eds.),

Health psychology(pp. 217254). San Francisco: Jossey-Bass. [Context Link]

Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20,3746. [Context Link]

Copp, L. A. (1974). The spectrum of suffering.American Journal of Nursing, 74, 491495. [Context Link]

Courey, L., Feuerstein, M., & Bush, C. (1982). Self-control and chronic headache.Journal of Psychosomatic

Research, 26, 519526. Texto Completo Enlaces Bibliograficos [Context Link]

Coyne, J., Aldwin, C., & Lazarus, R. S. (1981). Depression and coping in stressful episodes.Journal of Abnormal

Psychology, 90, 439447. Texto Completo OVID [Context Link]

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297334. [ContextLink]

Cyr, J. J., & Atkinson, L. (1986). Selection of appropriate number of factors: A case of questionable dimensions.

Psychological Reports, 58, 251256. Enlaces Bibliograficos [Context Link]

Depue, R. A., & Monroe, S. M. (1986). Conceptualization and measurement of human disorder and life stress research:

The problem of chronic disturbance. Psychological Bulletin, 99, 3651. Texto Completo OVID Enlaces

Bibliograficos [Context Link]

Dohrenwend, B. P. (1979). Stressful life events and psychopathology: Some issues of theory and method. In J. E.

Barrett & R. M. Rose (Eds.), Stress and mental disorders (pp. 115). New York: Raven. [Context Link]

Dohrenwend, B. S., & Dohrenwend, B. P. (Eds.). (1981). Stressful life events and their contexts. New York: Neale

Watson. [Context Link]

Dohrenwend, B. S., Dohrenwend, B. P., Dobson, M., & Shrout, P. E. (1984). Symptoms, hassles, social supports, and

life events: The problem of confounded measures.Journal of Abnormal Psychology, 93, 222230. Texto Completo

OVID [Context Link]

D'Zurilla, T. J., & Nezu, A. (1982). Social problem solving adults. In P. C. Kendall (Ed.),Advances in cognitive-

behavioral research and therapy(Vol. 1, (pp. 202275). Orlando, FL: Academic Press. [Context Link]

Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The schedule for affective disorders and schizophrenia.

Archives of General Psychiatry, 35, 837844. Texto Completo Otros recursos Texto Completo [Context Link]

FACTOR. (1986). In SPSS-X users' guide (2nd ed., (pp. 714730). Chicago: SPSS Inc. [Context Link]

Felton, B. J., & Revenson, T. A. (1984). Coping with chronic illness: A study of illness controllability and the influence

of coping strategies on psychological adjustment.Journal of Consulting and Clinical Psychology, 52, 343353.

[Context Link]

Felton, B. J., & Revenson, T. A. (1987). Age differences in coping with chronic illness. Psychology and Aging, 2,

164170. [Context Link]

Felton, B. J., Revenson, T. A., & Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological

adjustment among chronically ill adults. Social Science and Medicine, 18, 889898. [Context Link]


16 de 21 20/01/2009 23:29


17/21

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample.Journal of Health and

Social Behavior, 21, 219239. [Context Link]

Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: A study of emotion and coping during three

stages of a college examination.Journal of Personality and Social Psychology, 48, 150170. [Context Link]

Folkman, S., & Lazarus, R. S. (1986). Stress processes and depressive symptomatology.Journal of AbnormalPsychology, 95, 107113. Texto Completo OVID [Context Link]

Folkman, S., & Lazarus, R. S. (1988). Coping as a mediator of emotions.Journal of Personality and Social Psychology,

54, 466475. [Context Link]

Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. (1986). The dynamics of a stressful

encounter: Cognitive appraisal, coping, and encounter outcomes.Journal of Personality and Social Psychology, 50,


Frank, R. G., Umlauf, R. L., Wonderlich, S. A., Askanazi, G. S., Buckelew, S. P., & Elliot, T. R. (1987). Differences in

coping styles among persons with spinal cord injury: A cluster-analytic approach.Journal of Counseling and ClinicalPsychology, 55, 727731. [Context Link]

Frankel, M. J., & Merbaum, M. (1982). Effects of therapist contact and a self-control manual on nail-biting reduction.

Behavior Therapy, 13, 125129. [Context Link]

Gibbon, M., McDonald-Scott, P., & Endicott, J. J. (1981). Mastering the art of research interviewing.Archives of

General Psychiatry, 38, 12591262. Texto Completo Otros recursos Texto Completo Enlaces Bibliograficos

[Context Link]

Goldfried, M. R., & D'Zurilla, T. J. (1969). A behavioral-analytic model for assessing competence. In C. D. Speilberger

(Ed.), Current topics in clinical and community psychology(pp. 151196). Orlando, FL: Academic Press. [ContextLink]

Hammen, C., Marks, T., Mayol, A., & deMayo, R. (1985). Depressive self-schemas, life stress, and vulnerability to

depression.Journal of Abnormal Psychology, 94, 308319. Texto Completo OVID [Context Link]

Heppner, P. P., & Peterson, C. H. (1982). The development and implications of a personal problem-solving inventory.

Journal of Counseling Psychology, 29, 6675. [Context Link]

Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Psychosomatic Medicine, 11, 213218.

Otros recursos Texto Completo [Context Link]

Johnson, J. H., & Sarason, I. G. (1978). Life stress, depression and anxiety: Internalexternal control as a moderator

variable.Journal of Psychosomatic Research, 23, 205208. [Context Link]

Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Comparisons of two models of stress measurement:

Daily hassles and uplifts versus major life events.Journal of Behavioral Medicine, 4, 139. [Context Link]

Kaplan, G. A., Roberts, R. E., Camacho, T. C., & Coyne, J. C. (1987). Psychosocial predictors of depression:

Prospective evidence from the Human Population Laboratory studies.American Journal of Epidemiology, 125,

206220. Texto Completo Enlaces Bibliograficos [Context Link]

Keller, M. B., Shapiro, R. W., Lavori, P. W., & Wolfe, N. (1982). Recovery in major depressive disorder.Archives ofGeneral Psychiatry, 39, 905910. [Context Link]

Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness.Journal of Personality


17 de 21 20/01/2009 23:29


18/21

and Social Psychology, 37, 111. [Context Link]

Lazarus, R. S. (1981). The stress and coping paradigm. In C. Eisdorfer, D. Cohen, A. Kleinman, & P. Maxim (Eds.),

Models in clinical psychopathology(pp. 117214). New York: Spectrum. [Context Link]

Lazarus, R. S., DeLongis, A., Folkman, S., & Gruen, R. (1985). Stress and adaptational outcomes: The problem of

confounded measures.American Psychologist, 40, 770779. Texto Completo OVID [Context Link]

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. [Context Link]

Lewinsohn, P. M., & Alexander, C. (1983). Learned resourcefulness and depression.Unpublished manuscript,

University of Oregon, Eugene. [Context Link]

Lewinsohn, P. M., Hoberman, H. M., & Rosenbaum, M. (1988). A prospective study of risk factors for unipolar

depression.Journal of Abnormal Psychology, 97, 251264. Texto Completo OVID [Context Link]

Lewinsohn, P. M., Mermelstein, R. M., Alexander, C., & MacPhillamy, D. J. (1983). The Unpleasant Events Schedule: A

scale for the measurement of aversive events.Journal of Clinical Psychology, 41, 483498. [Context Link]

Lewinsohn, P. M., Tilson, M., Rohde, P., & Seeley, J. (1988). Risk factors for the occurrence of nonbipolar

depression in the elderly.Unpublished manuscript, University of Oregon, Eugene. [Context Link]

Lloyd, G. G., & Lishman, W. A. (1975). Effect of depression on the speed of recall of pleasant and unpleasant

experiences. Psychological Medicine, 5, 173180. [Context Link]

Martin, R. A., & Lefcourt, H. M. (1983). Sense of humor as a moderator of the relation between stressors and mood.

Journal of Personality and Social Psychology, 45, 13131324. [Context Link]

Mazure, C., & Gershon, E. S. (1979). Blindness and reliability in lifetime psychiatric diagnosis.Archives of GeneralPsychiatry, 36, 521525. Texto Completo Otros recursos Texto Completo [Context Link]

McLean, P. (1976). Depression as a specific response to stress. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and

anxiety(Vol. 3, (pp. 297323). Washington, DC: Hemisphere. [Context Link]

Meichenbaum, D. (1977). Cognitive-behavior modification: An integrative approach. New York: Plenum Press.

[Context Link]

Mitchell, R. E., Billings, A. G., & Moos, R. H. (1982). Social support and wellbeing: Implications for prevention

programs.Journal of Primary Prevention, 3, 7798. Texto Completo [Context Link]

Mitchell, R. E., Cronkite, R. C., & Moos, R. H. (1983). Stress, coping, and depression among married couples.Journal

of Abnormal Psychology, 92, 433448. Texto Completo OVID [Context Link]

Mitchell, R. E., & Hodson, C. A. (1983). Coping with domestic violence: Social support and psychological health among

battered women.American Journal of Community Psychology, 11, 629654. Texto Completo [Context Link]

Monroe, S. M. (1983). Major and minor life events as predictors of psychological distress: Further issues and findings.

Journal of Behavioral Medicine, 6, 189205. Enlaces Bibliograficos [Context Link]

O'Hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). Prospective study of postpartum depression: Prevalence,

course, and predictive factors.Journal of Abnormal Psychology, 93, 158171. Texto Completo OVID [Context Link]

Parker, G., & Brown, L. B. (1979). Repertoires of responses to potential precipitants of depression.Australian and

New Zealand Journal of Psychiatry, 13, 327333. [Context Link]


18 de 21 20/01/2009 23:29


19/21

Parker, G. B., & Brown, L. B. (1982). Coping behaviors that mediate between life events and depression.Archives of

General Psychiatry, 39, 13861391. Texto Completo Otros recursos Texto Completo Enlaces Bibliograficos

[Context Link]

Paykel, E. S. (1979). Recent life events in the development of depressive disorders. In R. A. Depue (Ed.), The

psychobiology of the depressive disorder: Implications for the effects of stress.Orlando, FL: Academic Press.

[Context Link]

Pearlin, L. I., Lieberman, M. A., Menagham, E. G., & Mullan, J. T. (1981). The stress process.Journal of Health and

Social Behavior, 22, 337356. [Context Link]

Pearlin, L. I., & Schooler, C. (1978). The structure of coping.Journal of Health and Social Behavior, 19, 221.

[Context Link]

Platt, J. J., & Spivack, G. (1975). Manual for the Means-Ends Problem-Solving Procedure (MEPS): A measure of

interpersonal cognitive problem-solving skill. Philadelphia, PA: Hahnemen Community Mental Health/Mental

Retardation Center. [Context Link]

Rabkin, J. G., & Struening, E. L. (1976). Life events, stress, and illness. Science, 194, 10131020. Texto Completo

Enlaces Bibliograficos [Context Link]

Radloff, L. S. (1977). The CESD Scale: A self-report depression scale for research in the general population.Applied

Psychological Measurement, 1, 358401. [Context Link]

Rippere, V. (1976). Antidepressive behaviour: A preliminary report. Behaviour Research and Therapy, 14, 289299.

[Context Link]

Rippere, V. (1977). What's the thing to do when you're feeling depressed?:A pilot study. Behaviour Research and

Therapy, 15, 185191. [Context Link]

Rosenbaum, M. (1980). A schedule for assessing self-control behaviors: Preliminary findings. Behavior Therapy, 11,


Rosenbaum, M., & Rolnick, A. (1983). Self-control behaviors and coping with seasickness. Cognitive Therapy and

Research, 1, 9397. [Context Link]

Roth, S., & Cohen, L. (1986). Approach, avoidance, and coping with stress.American Psychologist, 41, 813819.

Texto Completo OVID [Context Link]

Shapiro, R., & Keller, M. (1979). Longitudinal Interval Follow-Up Evaluation (LIFE). Boston: Massachusetts GeneralHospital. [Context Link]

Spitzer, R., & Endicott, J. (1977). The schedule for affective disorders and schizophrenia-change (SADSC)

interview. New York: New York State Psychiatric Institute. [Context Link]

Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research diagnostic criteria: Rationale and reliability.Archives of

General Psychiatry, 35, 773782. Texto Completo Otros recursos Texto Completo [Context Link]

Suls, J., & Fletcher, B. (1985). The relative efficacy of avoidant and non-avoidant coping strategies: A meta-analysis.

Health Psychology, 4, 249288. [Context Link]

Tan, S. Y. (1982). Cognitive and cognitive-behavioral methods for pain control: A selective review. Pain, 12, 201208.

Texto Completo Enlaces Bibliograficos [Context Link]


19 de 21 20/01/2009 23:29


20/21

Tobin, D. J., Holroyd, K., & Reynolds, R. (1982). The assessment of coping: Psychometric development of the Coping

Strategies Inventory.Paper presented at the meeting of the Association for the Advancement of Behavior Therapy,

Los Angeles, CA. [Context Link]

Turk, D. L., & Genest, M. (1979). Regulation of pain: The application of cognitive and behavioral techniques for

prevention and remediation. In P. C. Kendall & S. D. Hollon (Eds.), Cognitive-behavioral intervention: Theory,

research, and procedures (pp. 286318). New York: Academic Press. [Context Link]

Weissman, M. M., & Klerman, G. L. (1977). Sex differences and the epidemiology of depression.Archives of General

Psychiatry, 34, 98111. [Context Link]

AppendixIndividual Items (With Factor Loadings) Constituting Each of the Three Coping Factors

Factor 1: Cognitive Self-Control

1. When I am faced with a difficult problem, I try to approach its solution in a systematic way. (.56)

2. I usually plan my work when faced with a number of things to do. (.54)

3. In order to overcome bad feelings that accompany failure, I often tell myself that it is not so catastrophic and that I

can do something about it. (.54)4. If I find it difficult to concentrate on a certain job, I divide the job into smaller segments. (.54)

5. When I am depressed, I try to keep myself busy with things that I like. (.52)

6. When I find it difficult to settle down to do a certain job, I look for ways to help me settle down. (.51)

7. When I have to do something that is anxiety-arousing for me, I try to visualize how I will overcome my anxieties

while doing it. (.51)

8. When I am feeling depressed, I try to think about pleasant things. (.51)

9. When I do a boring job, I think about the less boring parts of the job and the reward that I will receive once I am

finished. (.51)

10. When I try to get rid of a bad habit, I first try to find out all the factors that maintain this habit. (.48)

11. When I feel that I am too impulsive, I tell myself Stop and think before you do anything. (.48)

12. When I find that I have difficulties in concentrating on my reading, I look for ways to increase my concentration.(.48)

13. When an unpleasant thought is bothering me, I try to think about something pleasant. (.48)

14. First of all I prefer to f inish a job that I have to do and then start doing the things I really like. (.48)

15. My self-esteem increases once I am able to overcome a bad habit. (.46)

16. When I plan to work, I remove all the things that are not relevant to my work. (.46)

17. When I am in a low mood, I try to act cheerful so my mood will change. (.45)

18. Often by changing my way of thinking I am able to change my feelings about almost everything. (.43)

19. Even when I am terribly angry at someone, I consider my actions very carefully. (.43)

20. When I am short of money, I decide to record all my expenses in order to plan more carefully for the future. (.41)

21. When I feel pain in my body, I try to divert my thoughts from it. (.40)

Factor 2: Ineffective Escapism1. Keep away from people. (.63)

2. Do something reckless (like driving a car fast). (.62)

3. Do something rather dangerous. (.61)

4. Wait for someone to help. (.58)

5. Stay in bed. (.57)

6. Take tablets or medicine. (.53)

7. Avoid other people. (.50)

8. Quite often I cannot overcome unpleasant thoughts that bother me. (.49)

9. Wish that you were a stronger personmore forceful and optimistic. (.48)

10. Do nothing in particular. (.48)

11. Daydream about a better time or place. (.46)12. I often find it difficult to overcome my feelings of nervousness and tension without any outside help. (.46)

13. When I am faced with a difficult decision, I prefer to postpone making a decision even if all the facts are at my

disposal. (.45)


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14. I cannot avoid thinking about mistakes I have made in the past. (.45)

15. Try to get the attention of others. (.43)

16. Although it makes me feel bad, I cannot avoid thinking about all kinds of possible catastrophes. (.41)

17. If I had the pills with me, I would take a tranquilizer whenever I felt tense and nervous. (.40)

Factor 3: Solace Seeking

1. Plan something pleasant. (.69)

2. Spend time with friends. (.67)3. Do something enjoyable. (.64)

4. Spend time with a relative or a close friend. (.60)

5. Do something to restore your pride. (.59)

6. Do something to distract yourself from the problem. (.54)

7. Do something to get your mind off the situation. (.54)

8. Busy yourself in your usual work. (.48)

9. Talk over your problem with someone you know. (.47)

10. Take on some new and challenging work or activity. (.43)

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5- Dimensionality of Coping and Its Relation to Depression