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The measurement and meaning of coping in psychiatric patients

Ryan, Jacqueline (2014) The measurement and meaning of coping in psychiatric patients. PhD thesis, Murdoch University.

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In psychology and psychiatry there is a fundamental presumption that a categorical difference between “normal” and mentally ill people exists. The primary research goal of this thesis was to explore the measurement and meaning of coping in a psychiatric population. The major research questions were: 1) Does the underlying assumption about “not coping” in those diagnosed with a mental illness do justice to the complexity of what coping might be for these people? and 2) Does it make sense to measure coping in a psychiatric population? Quantitative and qualitative approaches were employed to answer these questions.

Study A examined the psychometric adequacy of an existing coping scale, the Coping Scale for Adults Questionnaire (CSA; Frydenberg & Lewis, 1997) and its ability to discriminate between the coping strategies of a “normal” (n=369) and a psychiatric sample (n=110). Comparisons were made between the two groups across the 19 coping strategies, in terms of factor structure, gender and age. An additional comparison of coping strategies was made between a sub-sample of those diagnosed with schizophrenia and the “normative” sample.

Study B was a separate study between an age-and gender-matched subsample from a separate community sample in Western Australia matched to members of the psychiatric population.

Study C extended the examination of the CSA, with the inclusion of a sample of undergraduate university students (n=110). The CSA was found to have adequate psychometric properties and the ability to discriminate between the coping strategies of the psychiatric, community and university samples. However, it was identified that built into quantitative measurement of coping is a set of problematic assumptions about the coping strategies of those diagnosed with a mental illness that raised concerns about both the validity and sole reliance on quantitative measures in this area, prompting further qualitative studies.

The first part of the qualitative analyses comprised 25 male and 13 female inpatients of a psychiatric hospital who were interviewed about how they coped. The thematic analyses of psychiatric patients’ descriptions of their coping revealed five key themes: patients reported that professional intervention reduced their ability to cope; they distrusted the mental health system and its professionals; coping mechanisms were misinterpreted; situational crises modulated coping; and, that sometimes coping was just “not coping.”

The second qualitative part of the thesis comprised case studies from interviews, medical file information and patient demographics of 10 psychiatric inpatients. Psychiatric patients’ narratives contained in the case files revealed commonalities in coping strategies and much more detailed descriptions of how they coped. Employing both the methodology of quantitative and qualitative approaches to coping offers an opportunity to construct a powerful and plausible argument about how people diagnosed with a mental illness cope. Overall, the findings from the studies revealed that the bedrock assumptions underpinning the current mental health system to understanding the meaning of coping in those diagnosed with a mental illness did not reflect or do justice to their actual accounts of coping. A more respectful, nuanced understanding of the notion of coping by mental health professionals is suggested.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): School of Psychology and Exercise Science
Supervisor(s): Dziurawiec, Suzanne, Rapley, Mark and Walker, Iain
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