Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study

Marja-Leena Kristofferzon, Maria Engström, Annika Nilsson, Marja-Leena Kristofferzon, Maria Engström, Annika Nilsson

Abstract

Purpose: The aim of the present study was to investigate relationships between sense of coherence, emotion-focused coping, problem-focused coping, coping efficiency, and mental quality of life (QoL) in patients with chronic illness. A model based on Lazarus' and Folkman's stress and coping theory tested the specific hypothesis: Sense of coherence has a direct and indirect effect on mental QoL mediated by emotion-focused coping, problem-focused coping, and coping efficiency in serial adjusted for age, gender, educational level, comorbidity, and economic status.

Methods: The study used a cross-sectional and correlational design. Patients (n = 292) with chronic diseases (chronic heart failure, end-stage renal disease, multiple sclerosis, stroke, and Parkinson) completed three questionnaires and provided background data. Data were collected in 2012, and a serial multiple mediator model was tested using PROCESS macro for SPSS.

Results: The test of the conceptual model confirmed the hypothesis. There was a significant direct and indirect effect of sense of coherence on mental QoL through the three mediators. The model explained 39% of the variance in mental QoL.

Conclusions: Self-perceived effective coping strategies are the most important mediating factors between sense of coherence and QoL in patients with chronic illness, which supports Lazarus' and Folkman's stress and coping theory.

Keywords: Chronic illness; Coping; Coping effectiveness; Quality of life; Sense of coherence.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
An overview of the conceptual model in the present study based on Lazarus’ and Folkman’s stress and coping theory [19]. The arrows in the figure show the flow of the hypothesized influence of the variables tested in the present study. Sense of coherence is hypothesized to influence both directly and indirectly (through coping) on the outcome. Person factors (age, gender, educational level, comorbidity, economic status) are treated as covariates in the conceptual model
Fig. 2
Fig. 2
A schematic illustration of the effect of sense of coherence (SOC) through the mediators: Emotion-focused coping (EFC), problem-focused coping (PFC), and coping efficiency (CE), in serial, on mental quality of life [Mental Component Score (MCS)]. The coefficient c is the total effect between X and Y and c′ is the direct effect of X on Y while controlling for the three M. Values in the model are unstandardized regression coefficients and (standard errors). The variables are adjusted for age, gender, educational level, comorbidity, and economic status, n = 291. *p < 0.05 The serial multiple mediator model was tested using PROCESS procedure for SPSS [47]. Dotted lines represent non-significant paths

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