Role of Coping in the Relationship Between Depression and Illness Severity in Chronic Fatigue Syndrome, The

Journal of Allied Health, Summer 2009 by Walker, Karen, Lindner, Helen, Noonan, Michelle

The self-regulatory model (SRM) proposes that both cognitive and emotional illness representations influence the coping processes adopted in response to an illness. Aim: This study used the SRM to explore the role of coping in the relationship between depression and self-appraisals of illness severity in a population of patients with chronic fatigue syndrome (CFS). Methods: The sample comprised 156 participants, 34 men and 121 women, aged between 18 and 78 yrs, who had been medically diagnosed with CFS. Participants were asked to complete three questionnaires: the Cardiac Depression Scale, Ways of Coping Questionnaire, and Severity Subscale of the Illness Perceptions Questionnaire-Revised. Results: Analyses revealed that almost 70% of the participants were moderately or severely depressed. Additionally, two particular subscales, social support seeking and positive reappraisals, emerged as positively contributing to self-appraisals of illness severity (ß = 0.20 \p

I was diagnosed quite early, but had no advice on coping, so just kept pushing to carry on with my life as usual, and probably hindered my chance of recovery. I have now had to change the way I live my life, including giving up work, to keep within my limitations. - Participant 009

CHRONIC FATIGUE SYNDROME (CFS) is an extremely debilitating chronic illness in which a diagnosis requires the presence of unexplained persistent fatigue for at least 6 mos.1 Globally, CFS is referred to by a multitude of names, including myalgic encephalomyelitis, chronic fatigue and immune deficiency syndrome, and postviral, posttoxic, and postimmunization syndromes; however, for the sake of consistency, the term CFS is used throughout this report. Symptoms of CFS include both cognitive and behavioral symptoms, such as impairments to memory and concentration, sore throat, muscle pain, tiredness, unrefreshing sleep, and headaches.1 Patients with CFS typically present to a variety of health care professionals, including doctors, nutritionists, psychologists, and rehabilitation specialists; therefore, information on factors related to CFS management is relevant to a wide range of clinicians. Additionally, it is noted that there is a substantial concurrence of depression with CFS, with 35% to 80% of patients with CFS reporting depression.2"5 The management of depression typically involves cognitive and behavioral coping strategies. However, the role of these coping strategies in outcomes, such as perceived chronic illness severity, has not been investigated widely. The aim of this study was to explore the role of coping strategies in the relationship between depression and self-appraisals of illness severity in a population of patients with CFS.

The Self-Regulatory Model (SRM) has been widely used to investigate the relationship between cognitive and emotional responses to illness, coping strategies, and appraisals of illness management.6 According to the SRM, illness representations consist of five identifiable dimensions: identity, cause, timeline, consequences, and curability/control.6,7 More recently, Moss-Morris et al.8 have identified several other important components of the model, including illness coherence, emotional representations, personal control, and treatment control.

Specifically, the SRM proposes that both cognitive and emotional responses to illness influence the coping processes adopted in response to an illness.9-11 The SRM is a dynamic model whereby the effectiveness of the adopted coping process is appraised and influences the perceived severity of illness symptomatology (Figure 1).12,13

Coping, within the framework of the SRM, refers to the behavioral and cognitive efforts used by an individual to manage a stressful encounter.14 Coping addresses two major functions: it enables the individual to actively deal with the stressful situation (problem-focused coping) and allows for the adaptation of emotions generated by the stressful situation (emotion-focused coping).15

In the current study, the focus was on the emotional response, depression, and the mediatory role of coping processes on self-appraisals of illness severity, with a view to gaining a clearer understanding of the relationship between coping styles, depression, and appraisals of illness severity.

Depression and fatigue have been found to have a mutually exacerbating impact on one another in a healthy population.16,17 It has been noted that the depression experienced concurrently with CFS typically falls within the mild to moderate range and appears to be more of a reactive nature than clinical depression5,18,19; nevertheless, patients with CFS and concurrent depression experience greater deficits in social functioning than patients with CFS without depression.20 It has been proposed that lack of legitimization of their illness, by both the general and medical community, contributes to the psychological distress experienced by patients with CFS, particularly due to its stigmatization and the isolating factors associated with such.21-23 Morriss et al.20 found that treating depressed patients with CFS would not necessarily reduce the physiological symptoms of the illness but may in fact improve social functioning.