Summary
Researchers have shown that coping style is related to pain and adjustment in people with chronic illness. This study was the first to examine how coping style related to pain, pain coping strategies, and depression in lung cancer outpatients. We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4 ± 10.43 years, 88% Caucasian). As in prior studies, we classified patients into four coping style groups based on Marlowe-Crowne Social Desirability Scale and Trait Anxiety scores. The coping style groups were low-anxious (n = 25); high-anxious (n = 31); defensive high-anxious (n = 21); and repressive (n = 30). Compared to other coping style groups, the repressive group reported statistically significant lower mean scores for pain quality, pain catastrophizing, and depression. Assessing coping style by measuring personal characteristics such as social desirability and trait anxiety may help clinicians to identify vulnerable individuals with lung cancer who may be candidates for early and timely intervention efforts to enhance adjustment to pain.
Keywords: Repressive coping style, depression, pain coping strategies, pain, lung cancer
1. Introduction
Pain is a problem for many lung cancer patients [1]. Although cancer pain is usually approached from a biomedical perspective, there is growing recognition that coping plays an important role in the cancer pain experience [2, 3]. Much of the interest in coping stems from the observation that, when faced with persistent cancer pain, patients show quite varied responses. Some patients seem to cope well, report low to moderate pain, and appear to show little psychological distress. In contrast, other patients cope poorly, report high levels of pain and feel depressed.
One approach to studying coping involves a focus on coping strategies, i.e., the specific efforts that individuals engage in to deal with a specific stressful event (e.g., pain.). To date, studies of coping in persons having cancer pain have primarily focused on understanding pain coping strategies. Pain coping strategies identified include cognitive strategies (e.g., distraction, imagery, calming self statements) and behavioral strategies (e.g., pacing activities, setting goals) that patients engage in to tolerate, deal with, and minimize pain[4]. Researchers have shown that cancer patients who rely on maladaptive pain coping strategies, such as pain catastrophizing, report high levels of pain and psychological distress, whereas those who rely on more adaptive strategies report much less pain and psychological distress [5–8].
A second, and more recent, approach to studying coping involves a focus on coping styles. The term coping style refers to a more enduring, trait like predisposition to cope with different stressful events in a similar fashion. A key tenet of coping style theorists is that individuals have certain coping predispositions that they bring into any encounter with a stressor such as pain. According to these theorists coping predispositions not only influence the specific coping strategies that an individual might use to deal with a stressor but also their responses to that stressor (e.g., increased pain or depression).
Although there has been some research on pain coping strategies in lung cancer patients having pain, to our knowledge, no prior studies have focused on coping style in these patients. A repressive coping style, in particular, may be important in this context. A repressive coping style is defined as a person’s tendency to inhibit the experience and the expression of negative feelings or unpleasant cognitions in order to prevent one’s positive self-image from being threatened [9]. A person with a repressive coping style is operationally identified by low scores on a measure of trait anxiety but high scores on a measure of defensiveness such as the Marlowe-Crowne Social Desirability Scale (MCSD) [10].
Research has shown that repressive coping style is linked to the use of specific coping strategies. Specifically there is evidence that individuals with a repressive coping style are particularly prone to rely on two specific strategies to minimize the emotional influence of a threatening stimulus: 1) intentionally not paying attention to it [11, 12], and 2) engaging in active behavioral or cognitive efforts to induce a positive mood or distract themselves from a negative mood [13].
Repressive coping style has been found to relate to the pain experience. For example, studying healthy participants in acute pain, Jamner and Schwartz [14] found that repressive coping style was associated with significantly higher pain tolerance. Moreover, persons with a repressive coping style were found to have less sensitivity to pain than other coping styles [15]. However, researchers studying samples of persons with chronic non-malignant pain have found that a repressive coping style is associated with high pain severity [16]. Repressive coping style also has been found to relate to the psychology distress. Researchers also have found that persons with a repressive coping style report significantly lower levels of depression [16–19]. Taken together, these findings suggest that, when coping with pain, a repressive coping style may be adaptive.
The purpose of our study was to examine how repressive coping style is related to pain, pain coping strategies, and depression in lung cancer patients. Based on prior research, we predicted that persons having a repressive coping style will report lower levels of pain, increased use of adaptive pain coping strategies (e.g., distraction), decreased use of maladaptive pain coping strategies (i.e., pain catastrophizing), and lower levels of depression.
Methods
Patients and study design
We conducted secondary analysis of existing data from a National Institutes of Health [20] sponsored study of effects of a nurse coaching protocol on cancer pain. All data in this study were collected at the pre-treatment baseline evaluation. The study received approval from the Institutional Review Boards (IRBs) at the University of Washington, all referral institutions, and the University of Illinois at Chicago and adhered to all human subject regulations. The primary study was a randomized controlled study of patients recruited from 11 clinical oncology sites. Participants gave written consent for their data to be used for educational purposes and for future research. For the primary study, the eligible patients were adults 18 years or older who spoke English, had a diagnosis of lung cancer, and experienced at least one pain episode within the week prior to data collection. Patients who scored 20 or less on a Mini-Mental State Examination (MMSE) [21] were excluded. The final total sample for our study was 107 lung cancer patients who had completed the study instruments. The demographic characteristics of our sample appear in Table 1.
Table 1.
Demographics of the total sample (n = 107)
| Characteristics | Frequency (%) | Mean | SD | Min-Max |
|---|---|---|---|---|
| Age in years | 61.4 | 10.7 | 39–82 | |
| Months since pain first noticed | 6.4 | 2.7 | ||
| Gender | ||||
| Male | 76 (71) | |||
| Female | 31 (29) | |||
| Ethnicity | ||||
| Caucasian | 94 (87.9) | |||
| African-American | 8 (7.4) | |||
| Asian | 3 (2.8) | |||
| Other | 2 (1.9) | |||
| Marital | ||||
| Single | 35 (32.7) | |||
| Married | 61 (57) | |||
| Widowed | 11 (10.3) | |||
| Histology of Tumor | ||||
| Squamous cell | 21 (20.2) | |||
| Adenocarcinoma | 35 (33.7) | |||
| Large cell | 10 (8.8) | |||
| Small cell | 8 (7.1) | |||
| Non-small cell | 30 (26.5) | |||
| Location of Primary Tumor | ||||
| Right upper lobe | 26 (24.3) | |||
| Right lung –U, M, L | 20 (18.7) | |||
| Left upper lobe | 22 (20.6) | |||
| Left lung –U, M, L | 18 (18.6) | |||
| Mediastinal | 1 (0.9) | |||
| Other | 20 (18.7) | |||
| TNM Classification at Time of Enrollment | ||||
| Stage I | 9 (8.3) | |||
| Stage II | 4 (5.5) | |||
| Stage III | 46 (46.8) | |||
| Stage IV | 48 (39.4) | |||
| Treatment | ||||
| Surgery | 35 (32.7) | |||
| Chemotherapy | 59 (55.1) | |||
| Radiation | 103 (96.3) | |||
| Cause of pain | ||||
| Tumor-related | 52 (50) | |||
| Treatment-related | 31 (29.8) | |||
| Both | 21 (20.2) | |||
2.2. Measures
Repressive coping style: We identified repressive coping style using the standard approach described in prior research [10]. This approach is based on patients’ scores on the Marlowe-Crowne Social Desirability Scale (MCSD) and the trait anxiety score of the Spielberger State -Trait Anxiety Inventory (STAI) scores. The Marlowe-Crowne Social Desirability Scale (MCSD) is a 33–item, self-report, true–false questionnaire. The MCSD was originally designed to assess the tendency of an individual to respond in a culturally sanctioned and desirable manner to gain approval from others. However, the MCSD is now considered to represent a substantive and stable dimension that differ by individual and more reflective of defensiveness [22]. The MCSD has appropriate internal consistency reliability (K-R 20 = 0.88) and test-retest stability (r = 0.88) [23], and in our study internal consistency was (K-R 20 = 0.86).
The trait scale of State-Trait Anxiety Inventory (STAI) measures the personality trait of anxiety. It consists of 20 statements that subjects rate on a scale of 1 to 4, and the total score for the trait scale has a range from 20 to 80 [24]. Internal consistency for the STAI ranges from .86 to .92 [25]. In our sample, the internal consistency for the STAI-trait scale was .92.
In accord with the standard approach to determining coping style [10] patients’ scores on the MCSD and STAI-Trait Anxiety Inventory scores were dichotomized into high and low groups based on the median values of the MCSD (median = 19) and STAI trait anxiety scale (median = 35) scores. Participants were then divided into the four groups based on Weinberger et al.’s coping style typology [10]: low-anxious (LA, n = 25); high-anxious (HA, n = 31); defensive high-anxious (DHA) (n = 21); and repressive (n = 30).
2.2.1. Pain
Pain was assessed using the visual analogue scale (VAS) as a measure of current pain intensity and the McGill Pain Questionnaire (MPQ) as a measure of current pain quality. The VAS was a horizontal, 10-cm line anchored on the left with “no pain” and on the right with “pain as bad as it could be.” The patient was asked to place a mark to indicate the intensity of present pain, and we obtained a score using a digitizer tablet to measure from the left side of the scale to the mark that the patient placed [26]. The VAS has been shown to be a valid and reliable for acute pain and cancer pain, and for detecting clinically important changes in pain [27–29].
The MPQ is a self-report instrument and one of its four parts consists of 78 pain descriptors classified into 20 groups that provides scores on six pain measures including four measures of pain quality (1) Pain Rating Index sensory (PRI-S); (2) affective (PRI-A); (3) evaluative (PRI-E); and (4) miscellaneous (PRI-M); and two composite measures of pain quality: (1) total (PRI-T); and (2) number of words selected (NWC). The MPQ is a well-validated pain measurement tool. Concurrent (r = .31 to .41) [30], predictive (67% to 77%) [31], and construct validity [32], as well as test-retest reliability (.70 to .90) and sensitivity of the MPQ have been reported [33].
2.2.2. Pain coping strategies
The Coping Strategies Questionnaire (CSQ) is a 50-item self-report, seven-point Likert scaled (0 = never; 6 = always) measure that assesses five cognitive and two behavioral strategies for coping with pain [34]. The cognitive strategies include Coping Self–Statement, Catastrophizing, Diverting Attention, Reinterpreting Pain Sensation, and Ignoring Pain Sensation. The behavioral strategies include Praying/Hoping and Increasing Behavioral Activities. The CSQ has been widely used for measuring coping strategies in chronic pain patient populations. In patients with cancer pain, the internal consistency has been reported to be .79 for the entire instrument [8]. In our sample, the internal consistency was .77.
2.2.3. Depression
The Center for Epidemiological Studies Depression Scale (CES-D) is a 20-item self-report tool that measures symptoms of depression including depressed mood, guilt/worthlessness, helplessness/hopelessness, psychomotor retardation, loss of appetite and sleep disturbance [35]. Its use in people with cancer is advocated instead of other depression scales that include items focused on effects of cancer, such as weight loss, rather than depression. Items are rated on a scale from 0 to 3; 0 = rarely or none of the time (less than 1 day), 1 = some or a little of the time (1–2 days), 2 = occasionally or a moderate amount of time (3–4 days), 3 = most or all of the time (5–7 days). The total score ranges from 0 to 60, and this single total score is used as an estimate of the degree of depressive symptomatology [36, 37]. The internal consistency reliability of the CES-D in the general population has been reported to be .80 [38], and in cancer patients, the internal consistency was .85 [36]. In our sample, the internal consistency was .89.
2.3. Statistics
We performed all statistical analyses with the SPSS 17.0 statistical package with two-tailed significance set at p < 0.05). We used descriptive statistics to summarize the frequencies and means for variables and analyses of variance (ANOVA) to compare means between groups, and conducted the post- hoc Dunnett’s test to compare the four groups on the dependent variables. We used the Kruska-Wallis non-parametric ANOVA to compare the mean rank of pain intensity between coping style groups.
3. Results
3.1. Univariate analyses
Descriptive statistics for the social desirability and anxiety measures that we used to determine coping style are listed in Table 2. On average, patients reported moderate social desirability and mild anxiety. There was substantial variability in these measures with some patients scoring much higher than others. Also shown in Table 2 are descriptive statistics for the measures of pain, pain coping strategies, and depression. On average, patients reported moderate use of a wide range of behavioral and cognitive pain coping strategies, pain intensity ratings that were in the mild to moderate range, and mild depression. Once again, there was substantial variability in these measures with some patients reporting much higher scores than others.
Table 2.
Descriptive results for social desirability, anxiety, pain coping strategies, depression, and pain intensity (N = 107)
| Variables | Min | Max | Mean (SD) |
|---|---|---|---|
| MCSD | 4 | 32 | 18.70 (5.90) |
| STAI-Trait | 20 | 67 | 36.68 (11.23) |
| CSQ (Total) | 9 | 216 | 120.94 (47.33) |
| Catastrophizing | 0 | 31 | 7.97 (7.32) |
| CES-D | 0 | 45 | 16.30 (9.98) |
| Present pain (0–10 VAS) | 0 | 6.9 | 1.82 (1.84) |
| Pain intensity –MPQ (0–5) | |||
| Present pain | 0 | 5 | 1.91 (1.74) |
| Worst pain | 0 | 5 | 3.42(1.1) |
| Least pain | 0 | 2 | 0.62 (0.62) |
Marlowe-Crowne Social Desirability Scale (MCSD); State Anxiety Inventory (STAI-State); Trait Anxiety Inventory (STAI-State); Coping Strategies Questionnaire (CSQ); Center for Epidemiological Studies Depression Scale (CES-D); Visual Analogue Scale (VAS
3.2. Bivariate analyses
We compared mean scores for depression, pain coping strategy subscales, and pain quality in the four coping style groups. The means and standard deviations for the four groups along with the results of the ANOVAs are summarized in Tables 3 and 5.
Table 3.
Means (SD) and One-Way ANOVA statistics for pain, and depression scores by coping styles
| Variables | Coping Style | |||||||
|---|---|---|---|---|---|---|---|---|
| Repressive Coping (a) (n = 30) | Defensive high-anxious (b) (n = 21) | Low-anxious (c) (n = 25) | High-anxious (d) (n = 31) | F | df | p | Dunnett’s test | |
| Pain Quality | ||||||||
| PRI-S | 6.8(5.7) | 11.6(8.5) | 10.1(6.5) | 12(8.1) | 3.0 | 3,107 | 0.03* | a<d |
| PRI-A | 0.6 (1.2) | 1.3 (1.8) | 1.3 (1.8) | 2.6(3.1) | 4.0 | 3,107 | 0.01* | a<d |
| PRI-E | 1.3 (1.4) | 1.9 (1.6) | 1.9 (1.6) | 2.0 (1.6) | 1.2 | 3,107 | ns | - |
| PRI-M | 1.4 (1.5) | 2.1 (2.6) | 3.2 (3.0) | 3.3 (3.0) | 3.5 | 3,107 | 0.02* | a<d |
| PRI-T | 10 (8.5) | 17 (11) | 16.4 (12) | 17.7 (12.6) | 2.9 | 3,107 | 0.03* | a<d |
| NWC | 4.5(3.3) | 7.1(3.9) | 6.8 (4.5) | 7.4(4.9) | 2.9 | 3,107 | 0.03* | a<d |
| CES-D | 10.2 (5.7) | 16.8 (7.6) | 13.8 (8.7) | 23.3 (9.8) | 13.8 | 3,107 | 0.00* | a<b<d |
p < 0.05
PRI-S, PRI-A, PRI-E, PRI-M, and PRI-T are rank sensory, affective, evaluative, miscellaneous and total scores respectively, on the McGill Pain Question and NWC is the number of words chosen; Center for Epidemiological Studies Depression Scale (CES-D)
Table 5.
Mean (SD) and One- Way ANOVA statistics for pain coping strategy scores by coping styles
| CSQ subscale | Coping Style | |||||||
|---|---|---|---|---|---|---|---|---|
| Repressive Coping (a) (n = 30) | Defensive high-anxious (b) (n = 21) | Low-anxious (c) (n = 25) | High-anxious (d) (n = 31) | F | df | p | Dunnett’s test | |
| Diverting Attention | 17.6 (8.6) | 17.0 (8.1) | 17.3 (9.9) | 18.3 (7.3) | 0.11 | 3,107 | ns | - |
| Reinterpreting | 7.6 (8.4) | 9.5 (9.3) | 8.9 (9.3) | 8.6 (7.9) | 0.26 | 3,107 | ns | - |
| Sensation | ||||||||
| Coping | 20.6 (11.2) | 20.2 (8.1) | 22.6 (8.3) | 20.1 (7.1) | 0.16 | 3,107 | ns | - |
| Self-Statement | ||||||||
| Catatrophizing | 4.0 (6.5) | 9.7(7.4) | 5.1 (4.7) | 12.6 (7.8) | 9.3 | 3,107 | .00* | a<b<d |
| Ignoring Pain | 14.8 (11.0) | 13.2 (9.7) | 14.0 (8.6) | 10.9 (7.6) | 0.9 | 3,107 | ns | - |
| Praying/Hoping | 17.0 (11.2) | 19.8 (10.5) | 14.9 (10.4) | 20.8 (8.2) | 1.9 | 3,107 | ns | - |
| Behavioral Activity | 17.3 (8.6) | 16.2 (8.2) | 16.2 (7.3) | 16.6 (6.1) | 0.12 | 3,107 | ns | - |
| Pain Behavior | 17.7 (6.1) | 16.7 (7.0) | 20.0 (5.6) | 16.8 (6.3) | 1.4 | 3,107 | ns | - |
| Total | 116 (53) | 121 (53) | 118 (50) | 124 (35) | 0.1 | 3,107 | ns | - |
p < 0.05
Coping style and pain
As presented in Table 3, most pain quality scores differed by coping style groups. The post-hoc test controlling for multiple comparisons revealed several significant findings. First, patients in the repressive coping style group reported significantly lower levels of current pain quality on the sensory subscale, affective subscale, miscellaneous subscale, NWC, and total MPQ scores of the MPQ than patients in the high anxious coping style group. There were no statistically significant differences among the four coping style groups in current pain intensity as measured by the VAS or in the current, least, and most pain intensity scores as measure by the MPQ (Table 4).
Table 4.
Means ranks and Kruskal Wallis test for pain intensity by coping styles
| Variables | Coping Style | ||||||
|---|---|---|---|---|---|---|---|
| Repressive Coping (a) (n = 30) | Defensive high-anxious (b) (n = 21) | Low-anxious (c) (n = 25) | High-anxious (d) (n = 31) | H | df | p | |
| Pain intensity | |||||||
| VAS (0–10) | 39.0 | 49.3 | 47.3 | 49.0 | 1.4 | 3 | ns |
| Pain intensity-MPQ | |||||||
| Present pain | 47.3 | 59.9 | 55.2 | 55.8 | 2.5 | 3 | ns |
| Least pain | 49.0 | 58.4 | 53.4 | 56.3 | 1.6 | 3 | ns |
| Worst pain | 47.1 | 61.6 | 51.0 | 57.8 | 3.7 | 3 | ns |
Coping style and pain coping strategies
Of the CSQ subscale scores, only the catastrophizing subscale score showed a statistically significant difference as a function of coping style group. The post-hoc pairwise comparison controlling for multiple comparisons revealed that patients in the repressive coping style group reported statistically significant lower catastrophizing scores than patients in the defensive–high anxious style group and the high anxious coping style group.
Coping style and depression
As presented in Table 3, the CES-D scores differed by coping style group. The post-hoc pairwise comparisons controlling for multiple comparisons revealed statistically significant lower CES-D scores in the repressive coping style group than in the defensive–high anxious style group and the high anxious coping style group.
4. Discussion
Our results revealed a consistent pattern of group differences in pain quality, coping strategies, and depression by coping styles. Compared to patients in the high anxious coping style group, patients in the repressive coping style group reported significantly less pain on multiple indices of pain quality, lower pain catastrophizing, and fewer symptoms of depression.
One of the most interesting findings of this study was that patients in the repressive coping style group tended to report levels of depressive symptoms that were low and similar to those in the low-anxious coping style group. We measured depressive symptoms with the CES-D, a tool that has been used in many studies of cancer patients because it focuses primarily on cognitive and affective components of depression rather than the physical manifestations of depression. Those physical manifestations of depression in cancer patients may reflect an effect of the cancer or its treatment with chemotherapy or radiation rather than depression.
These findings are consistent with a previous study in cancer patients in which investigators found that individuals who used a repressive coping style were less likely to report negative emotions [39, 40]. Those with a repressive coping style may utilize a range of cognitive strategies to conceal awareness of threatening affective information [41, 42]. Investigators [43, 44] for example have found that patients with a repressive coping style were better able to intentionally forget more negative emotional material and inhibit perception of potentially threatening stimuli [43, 44].
Another important finding of this study was that patients in the repressive coping style group reported engaging in significantly less pain catastrophzing than patients in the defensive high-anxious and the high-anxious group. Catastrophizing generally is a maladaptive cognitive coping strategy [4] and has been broadly conceived as an exaggerated negative mental set brought to bear during actual or anticipated pain experience. Catastrophizing has been consistently associated with heightened experiences of pain across a variety of samples [45–48]. The findings of this study indicate that clinicians should recognize that repressive copers may be less susceptible to pain catastrophizing and thus more resilient emotionally to pain.
Patients in the repressive coping group reported pain that not only was less severe on the MPQ (i.e., NWC, and PRI) but also pain that was of a different quality than patients in the high anxious coping group. Specifically, they reported less pain on the sensory, affective, and miscellaneous dimensions of the MPQ. This finding suggests that the pain experience of cancer patients who score high on social desirability and low on anxiety (repressive copers) differs markedly from that patient who scores low on social desirability and high on anxiety. These findings are inconsistent with those of a previous study in chronic non-malignant pain patients [16]. A possible reason for the inconsistent results may be that pain experienced by lung cancer patients is associated by poor survival outcomes which may lead them to a more adaptive repressive coping style.
Repressive coping, which involves inhibiting negative feelings in order to prevent a threat to one’s self image, is sometimes thought to be maladaptive [9]. However, taken as a whole, the findings of this study suggest that a repressive coping style is associated with indices of positive adjustment (i.e., less depression, pain catastrophizing, and lower pain), particularly when compared to a coping style characterized by lack of inhibition and high anxiety. The current study is correlational in nature. Thus, it is not clear if repressive coping leads to positive adjustment or whether a positive adjustment to cancer promotes repressive coping. However, the finding presented here may have significance for clinicians who evaluate and treat pain in lung cancer patients. Assessing coping style by measuring personal characteristics such as social desirability and trait anxiety may help clinicians to identify vulnerable individuals with lung cancer who may be candidates for early and timely intervention efforts to enhance adjustment to pain.
Clinicians also are encouraged to include the MPQ as the pain measure because it provides valuable information on the sensory, affective and evaluative dimensions of pain experience. It also provides information about both the nociceptive and neuropathic types of pain that are common in lung cancer [49]. A computerized version of the MPQ, PAINReportIt® [50], is now commercially available for use in clinic waiting rooms with touch screen computers or kiosks and summary reports that showcase the components associated with nociceptive and neuropathic pain as well as emotional and evaluative dimensions of the pain experience (Nursing Consult LLC, 801-441-0627). By adding the MCSD and STAI-Trait to the kiosk, clinicians could obtain repressive coping style scores similar to those in our study.
An important direction for future research is to conduct longitudinal studies to determine the temporal relationships between coping style and adjustment. If coping style is found to predict poor adjustment, research could be conducted to test the efficacy of early and timely interventions tailored to the unique needs and problems of vulnerable coping style groups (e.g., those in the high anxiety group). Alternatively if certain coping styles (e.g., repressive coping) are found to predict positive adjustment, then studies could test the utility of interventions designed to support and maintain this coping style. Finally, it is possible that patients who are vulnerable to problems with pain because of their coping style can learn new coping styles.
Although we found in the current study that differences in pain quality based on coping style groups, we did not find statistically significant differences in pain intensity on either the VAS or MPQ. The generally low levels of pain intensity in our sample may have influenced this finding. Prior researchers studying chronic non-malignant pain patients found that repressors report high pain severity subscale [16].
A limitation of our study is that it is a cross-sectional secondary analysis of an existing data set. The generalizability of the study findings is limited by the sample demographics. The data were obtained primarily from Caucasian subjects. Our dataset had only 8% of participants who were African American, a group in which lung cancer rates are high and escalating [51]. Even fewer participants were members of other minorities, in whom lung cancer also develops, although at somewhat lower rates than African Americans or Caucasians[51]. The original study was completed in years 1994–1999, and there may have been changes in the treatment of lung cancer that possibly could affect the pain, depression, anxiety, and coping strategies reporting of patients with lung cancer.
5. Conclusion
In this study we found that outpatients with lung cancer having a repressive coping style reported lower levels of pain quality, decreased use of pain catastrophizing, and lower levels of depression than patients in an high anxiety coping style group. Contrary to our prediction, the repressive coping style group did not report decreased pain intensity or increased use of cognitive or behavioral coping strategies compared to the other coping style groups. Our findings have an important clinical implication in that measuring the influence of personality characteristics as reflected by social desirability and trait anxiety scores may help clinicians to identify resilient individuals (e.g., repressive copers) and vulnerable individuals (e.g., those in a high anxiety group) for further evaluation and possible intervention.
Acknowledgments
This research was made possible by Grant Number R29 CA62477 from the National Institutes of Health, National Cancer Institute, awarded to the last author. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. The authors thank Kevin Grandfield for editorial assistance.
Footnotes
Conflict of interest statement
All authors have no financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work. This includes employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.
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Contributor Information
Nusara Prasertsri, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612.
Janean Holden, College of Nursing, University of Michigan, Ann Arbor, MI 48109.
Francis J. Keefe, Department of Psychiatry and Behavioral Sciences/Medical Psychology, Duke University, Durham, NC 27710.
Diana J. Wilkie, Email: diwilkie@uic.edu, Center for End-of-Life Transition Research, Department Biobehavioral Health Science (MC 802), College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Room 660, Chicago, IL 60612, Voicemail: 312-413-5469, Fax: 312-996-1819.
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