Person. indiuid. D@ Vol. 13, No. IO, pp. 1145-1147, 1992 Printed in Great Britain. All rights reserved

0191-8869/92 $5.00 + 0.00 Copyright 0 1992 Pergamon Press Ltd

NOTES AND SHORTER COMMUNICATIONS

Coping styles and depression among psychiatric outpatients*

RUTH A. TURNER,’ PAUL R. KINGLY and PAUL F. TREMBLAY’

’ Nipissing Universily-College, Norrh Bay, Ontario and ‘North Bay Psychiatric Hospital, P.O. Box 3010, North Bay, Ontario, PlB 8L1, Canada

(Received 4 January 1992)

Summary-The present investigation examined the relationships among coping styles and depressive symptomatology in a sample of adult psychiatric outpatients. The Beck Depression Inventory was used to assess depressive symptomatology. The Multidimensional Coping Inventory, a preliminary version of the Coping Inventory for Stressful Situations, was employed to assess coping styles. Twenty-six individuals completed the above inventories immediately prior to attending their first appointments at a community mental health clinic. Results revealed significant negative correlations between level of depressive symptomatology and both task and avoidance oriented coping styles, and a significant positive correlation between the former variable and emotion oriented coping style. These results were consistent with previous research findings with respect to task and emotion oriented coping styles.

Exploring the connections between life events and psychopathology has emerged as a significant research focus in recent years (Rosenberg, Peterson & Hayes, 1987). In this regard, the manner in which individuals cope with stressful life circumstances and the experience of depressive symptomatology have come to be seen as variables that are significantly intertwined (Abramson. Selipman & Teasdale. 1978: Beck. 1976: Fondacaro & Moos. 1987). More soecificallv. the canine styles that individuals adopt-have been described as mediating between precedent stressful situations and such anteceheny psychological consequences as depression (Billings & Moos, 1981, 1984; Endler, 1988; Endler & Parker, 1988a, 1988b; Pearlin & Schooler, 1978; Rohde, Lewinson, Tilson & Seeley, 1990).

With respect to coping, current conceptions of this variable are grounded in a “fundamental assumption that people are actively responsive to forces that impinge on them” (Pearlin & Schooler, 1978, p. 2). Coping refers to efforts to master, reduce or tolerate a troubled personenvironment relationship (Folkman, 1984; Folkman & Lazarus, 1980). and the coping process has been seen as a response or reaction to a stressful life event (Endler & Parker, 1988b, 199Oc; Folkman & Lazarus, 1980, 1985; McCrae. 1984; Wong & Reker. 1984). Endler and Parker (1990a) have considered the cooing resoonse from . , a multidimensional perspective, and have, through empirical methods, identified three coping styles: task oXented, emotion oriented and avoidance oriented.

Task oriented coping emphasizes the achievement of problem resolution through purposeful efforts to solve or cognitively restructure the problem, or alter the situation (Endler & Parker, 1990a). Emotion oriented coping delineates a set of reactions (e.g. tension, anger) of a self-oriented nature which occur in response to a problematic event (Endler & Parker, 1990a). Avoidance oriented coping involves reactions or responses which have the effect of distracting or diverting the individual’s attention from the stressful situation (Endler & Parker, 1990a). The Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990a) is a recently introduced psychometric method of assessing individuals’ inclinations towards task, emotion and avoidance oriented coping styles.

With respect to the interface between depression and coping, it has been noted that depressed and non-depressed individuals differ with regard to the coping strategies they employ (Barnett & Gotlib, 1988; Coyne, Aldwin & Lazarus, 1981; Endler & Parker, 1990~). Compared to non-depressed persons, depressed individuals are more inclined to display emotion oriented coping responses (Billings & Moos, 1984, 1985; Endler & Parker, 199Oc; Mitchell, Cronkite & Moos, 1983), and less likely to engage in task oriented coping responses (Billings & Moos, 1981, 1984, 1985; Billings, Cronkite & Moos, 1983; Endler & Parker, 1988a, 1990~; Mitchell et al., 1983). Further, Endler and Parker (1988b) have discussed research indicating that individuals experiencing depressive symptoms are more likely to manifest avoidance oriented coping responses than their non-depressed counterparts.

The present study sought to offer additional clarification of the relationship between coping style and depression by examining these variables in a sample of psychiatric outpatients. The present context represents perhaps the first attempt to generate data of this nature from a psychiatric sample in a largely rural Canadian setting. The following hypotheses, which are consistent with the research results described above, were developed for this study:

(1) A significant positive (correlational) relationship between emotion oriented coping style and level of depression will be observed.

(2) A significant negative (correlational) relationship between task oriented coping style and level of depression will be observed.

(3) A significant positive (correlational) relationship between avoidance oriented coping style and level of depression will be observed.

*This paper is based on an honours thesis completed by the first author, under the second author’s supervision. tTo whom correspondence should be addressed.

1146 NOTES AND SHORTER COMMUNICATIONS

METHOD

Subjects

Ss in this investigation were 26 adults (18 females and 8 males) who were referred to the Dr Claude J. Ranger Mental Health Clinic, a community mental health service administered by North Bay Psychiatric Hospital, North Bay, Canada. Ss mean age was 39.29 years (SD = 9.43). Fourteen Ss were married, while 12 were either single, separated or divorced. With respect to level of education, 9 Ss had at least some exposure to post-secondary studies, while 17 had terminated their studies prior to, or upon completion of, secondary school. Sixteen Ss were employed, while IO were not in the workforce.

Test instruments Coping styles. The Multidimensional Coping Inventory (MCI; Endler & Parker, 1988b), an early version of the CISS

(Endler & Parker, 1990a), was employed to assess coping styles. The MCI is a 66-item, self-report multidimensional assessment instrument which measures task oriented (19 items), emotion oriented (12 items) and avoidance oriented (13 items) coping styles. The composition of the MCI also includes 22 buffer items. Examples of task oriented items are “work to understand the situation” and “learn from my mistakes”. Two of the 12 emotion oriented items are “blame myself for procrastinating” and “get angry”, while examples of avoidance oriented items are “take a warm bath” and “treat myself to a favourite food or snack”. Ss indicate on a five point scale ranging from “not at all” (1) to “very much” (5) the extent to which each item describes “how much you engage in these types of activities when you encounter a difficult, stressful or upsetting situation”.

Depression. The Beck Depression Inventory (BDI; Beck, 1978) was used to assess Ss depressive symptomatology. Each BDI item introduces a particular emotional (e.g. “sadness”, “crying”) or cognitive (e.g. “pessimism”, “indecisiveness”) theme associated with depression. Ss are provided with several statements pertaining to each item, and are asked to select that statement which is most closely aligned with their own experience. Scores on each item range from zero to three, with higher values being associated with more significant depressive content.

Procedure

Ss were contacted by telephone by the first author 1 day prior to their initial intake appointments at the above-mentioned facility, and were invited to participate in this investigation. Ss were clearly informed that involvement in this investigation was on a voluntary basis, and that declining to participate would have no implications for their treatment at the mental health facility. Those individuals who agreed to participate signed a consent form and completed the MCI and BDI immediately prior to attending their intake appointments.

RESULTS*

Pearson product-moment correlation coefficients were computed between BDI scores, and each of the above-mentioned MCI subscale scores (task, emotion and avoidance oriented coping style). The results of this analysis produced a significant positive correlation between BDI scores and the emotion oriented subscale of the MCI, r (24) = 0.55, P i 0.01. Significant negative correlations between BDI scores and each of the task and avoidance oriented MCI subscales were obtained, r (24) = -0.43, P < 0.05 and r (24) = -0.44, P < 0.05, respectively.

DISCUSSION

With respect to the first hypothesis, as predicted, the emotion oriented subscale of the MCI was found to be positively and significantly correlated with BDI scores. As noted by Endler and Parker (1988a). this result is both consistent with the findings of other investigations (e.g. Billings & Moos, 1984, 1985), and also understandable in the context of depressive symptomatology. In the latter regard, as Endler and Parker (1988a) have indicated, “Depression is primarily an emotional disorder, therefore it would be predicted that depressives would engage in more emotion related coping behaviours than non-depressives” (p 4).

With respect to the second hypothesis, which predicted that BDI and task oriented MCI scores would be negatively related, results were also in accordance with expectations, as a significant negative correlation coefficient was observed in the case of the latter two variables. As other writers (Billings & Moos, 1984, 1985; Endler & Parker, 1988a) have indicated, individuals who experience depressive symptoms are inclined to be self-preoccupied, and are perhaps less likely to engage in task oriented coping behaviours, in that the latter generally requires a more external focus.

The third hypothesis predicted a positive relationship between BDI and MCI avoidance oriented scores. Obtained results were opposite to those expected, in that the latter two variables were significantly correlated in a negative direction. The present result can be interpreted to mean that increases in depressive symptomatology are associated with fewer avoidance oriented coping behaviours. Other writers (Endler & Parker, 1988a) have suggested that depressives may be more inclined to engage in avoidance oriented coping behaviours by virtue of their tendency towards self-preoccupation. However, it could also be argued that the influence of self-preoccupation may discourage or prevent depressives from engaging in avoidance oriented coping behaviours, in that the latter will likely be unsuccessful with respect to the goal of obtaining psychological relief.

In general, the results reported above provide some support for the findings of previous research. There would appear to be value in further research directed at examining the above variables in psychiatric populations, as present results are based on a relatively small sample. Such future research might also include psychiatric inpatients, in an effort to address coping styles among individuals who perhaps manifest more depressive symptomatology.

*Preliminary analyses indicated that BDI and MCI subscale scores were unrelated to age, gender, employment status, marital status and educational level. While the above variables could have provided competing explanations for the observed relationships between coping and depression, statistical enquiry revealed that this did not occur in any case.

NOTES AND SHORTER COMMUNICATIONS 1147

Acknowledgements-The authors wish to thank the staff of the Dr Claude J. Ranger Mental Health Clinic, North Bay, Canada for their assistance with data collection. Thanks are also extended to the 26 individuals who generously agreed to serve as subjects.

REFERENCES

Abramson, L. Y., Seligman, M. E. & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74.

Barnett, P. A. & Gotlib, I. H. (1988). Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences. Psychological Bulletin, 104, 97-126.

Beck, A. T. (1976). Cognitive therapy and the emofional disorders. New York: International Universities Press. Beck, A. T. (1978). Depression Inventory. Philadelphia: Centre for Cognitive Therapy. Billings, A. G. & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the impact of stressful

life events. Journal of Behavioral Medicine, 4, 139-157. Billings, A. G. & Moos, R. H. (1984). Coping, stress and social resources among adults with unipolar depression. Journal

of Personality and Social Psychology, 46, 877-89 1. Billings, A. G. & Moos, R.H. (1985). Psychosocial processes of remission in unipolar depression: Comparing depressed

patients with matched community controls. Journal of Consulting and Clinical Psychology, 53, 314-325. Billings, A. G., Cronkite, R. C. & Moos, R. H. (1983). Social-environmental factors in unipolar depression: Comparisons

of depressed patients and non-depressed controls. Journal of Abnormal Psychology, 9.2, 119-133. Coyne, J. C., Aldwin, C. & Lazarus, R. S. (1981). Depression and coping in stressful episodes. Journal of Abnormal

Psychology, 90, 43947. Endler, N. S. (1988). Hassles, health and happiness. In Janisse, M. P. (Ed.), Individual d$erences, stress and health

psychology (pp. 2456). New York: Springer. Endler, N. S. & Parker, J. D. A. (1988a). Coping styles, anxiety and depression. Departmenf of Psychology Reports, York

University, Toronto, Canada, No. 175. Endler, N. S. & Parker, J. D. A. (1988b). The assessment of coping: The Multidimensional Coping Inventory. Department

of Psychology Reports, York University, Toronto, Canada, No. 174. Endler, N. S. & Parker, J. D. A. (1990a). Coping inventory for stressful situations: Manual. Toronto: Multi Health Systems. Endier, N. S. & Parker, J. D. A. (1990b). Multidimensional assessment of coping: A critical evaluation. Journal of

Personality and Social Psychology, 58, 844-854. Endler, N. S. & Parker, J. D. A. (199Oc). State and trait anxiety, depression and coping styles. Ausfralian Journal of

Psychology, 42, 2077220. Folkman, S. (1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and

Social Psychology, 46, 839-852. Folkman, S. & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and

Social Behavior, 21, 219-239. Folkman, S. & Lazarus, R. S. (1985). If it changes it must be a process: A study of emotion and coping in three stages

of a college examination. Journal of Personality and Social Psychology, 48, 150-170. Fondacaro, M. R. & Moos, R. H. (1987). Social support and coping: A longitudinal analysis. American Journal of

Community Psychology, IS, 653673. McCrae, R. R. (1984). Situational determinants of coping responses: Loss, threat and challenge. Journal of Personality and

Social Psychology, 46, 919-928. Mitchell, R. E., Cronkite, R. C. & Moos, R. H. (1983). Stress, coping and depression among married couples. Journal of

Abnormal Psychology, 92, 4333448. Pearhn, L. J. & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21. Rohde, P., Lewinson, P. M., Tilson, M. & Seeley, J. R. (1990). Dimensionality of coping and its relation to depression.

Journal of Personality and Social Psychology, 58, 499-511. Rosenberg, S. J., Peterson, R. A. & Hayes, J. R. (1987). Coping behaviors among depressed and nondepressed medical

inpatients. Journal of Psychosomatic Research, 31, 653-658. Wong, P. T. P. & Reker, G. T. (1984). Coping behaviors of successful agers. Paper presented at the 30th Annual Meeting

of the Canadian Psychological Associafion, Ottawa, Canada.