Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 6, Number 2, April 2015, pages 239-248

Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured

Figure 1. Modified four-factor model of Brief COPE. Parameter estimates are standardized coefficients. Non-significant correlations between the latent factors are not displayed in the model.

**Table 1.** Demographic and Clinical Data of the Total Sample, n = 183 (Cohort 1, n = 80 and Cohort 2, n = 103)
	Total sample	Cohort 1 (%)	Cohort 2 (%)
^aNYHA class: New York Heart Association class. ^bACEi: Angiotensin Converting Enzyme inhibitor. ^cARB: Angiotensin II Receptor Blocker.
Age (mean ± SD)	71.3 ± 9.7 (range 39 - 94)		72.1 ± 10.5	70.7 ± 9.1
Sex (female)	54	29.5	27.5	31.1
Marital status
Married/cohabitant	117	64.0	60.0	67.0
Single	66	36.0	40.0	33.0
Education
Compulsory school	53	29.0	35.0	24.3
Upper secondary school	69	37.7	38.8	36.9
University	61	33.3	26.2	38.8
Occupation
Working	35	19.1	18.8	18.4
Pensioner	140	76.5	77.5	75.7
Disability pensioner	5	2.7		5.8
Other	3	1.6	3.7
NYHA class^a
Class II	126	68.9	48.75	84.5
Class III	55	30.1	48.75	15.5
Class IV	2	1.1	2.5
Duration of heart failure
Less than 6 months	48	26.2	18.8	32.0
6 months to 1 year	25	13.7	17.5	10.7
1 year to 2 years	30	16.4	11.2	20.4
2 years to 5 years	43	23.5	22.5	24.3
More than 5 years	37	20.2	30.0	12.6
Heart failure medication
ACEi^b	116	63.4	61.3	65.0
ARB^c	61	33.3	35.0	32.0
Beta-blockers	178	97.3	96.3	98.1
Aldosterone receptor antagonist	88	48.1	53.8	43.7
Diuretics	148	80.9	92.5	70.9
Left ventricular ejection fraction (LVEF)
Normal (LVEF > 50%)	27	14.8	16.2	13.6
Mildly reduced (LVEF 40-49%)	43	23.5	15.0	32.0
Moderately reduced (LVEF 30-39%)	68	37.2	35.0	38.8
Severely reduced (LVEF < 30%)	45	24.6	33.8	15.5

Table 1. Demographic and Clinical Data of the Total Sample, n = 183 (Cohort 1, n = 80 and Cohort 2, n = 103)

Total sample

Cohort 1 (%)

Cohort 2 (%)

^aNYHA class: New York Heart Association class. ^bACEi: Angiotensin Converting Enzyme inhibitor. ^cARB: Angiotensin II Receptor Blocker.

Age (mean ± SD)

71.3 ± 9.7 (range 39 - 94)

72.1 ± 10.5

70.7 ± 9.1

Sex (female)

29.5

27.5

31.1

Marital status

Married/cohabitant

117

64.0

60.0

67.0

Single

36.0

40.0

33.0

Education

Compulsory school

29.0

35.0

24.3

Upper secondary school

37.7

38.8

36.9

University

33.3

26.2

38.8

Occupation

Working

19.1

18.8

18.4

Pensioner

140

76.5

77.5

75.7

Disability pensioner

2.7

5.8

Other

1.6

3.7

NYHA class^a

Class II

126

68.9

48.75

84.5

Class III

30.1

48.75

15.5

Class IV

1.1

2.5

Duration of heart failure

Less than 6 months

26.2

18.8

32.0

6 months to 1 year

13.7

17.5

10.7

1 year to 2 years

16.4

11.2

20.4

2 years to 5 years

23.5

22.5

24.3

More than 5 years

20.2

30.0

12.6

Heart failure medication

ACEi^b

116

63.4

61.3

65.0

ARB^c

33.3

35.0

32.0

Beta-blockers

178

97.3

96.3

98.1

Aldosterone receptor antagonist

48.1

53.8

43.7

Diuretics

148

80.9

92.5

70.9

Left ventricular ejection fraction (LVEF)

Normal (LVEF > 50%)

14.8

16.2

13.6

Mildly reduced (LVEF 40-49%)

23.5

15.0

32.0

Moderately reduced (LVEF 30-39%)

37.2

35.0

38.8

Severely reduced (LVEF < 30%)

24.6

33.8

15.5

**Table 2.** Pearson Correlation Coefficient and Mean Inter-Correlation Coefficient of Subscales in Brief COPE
	1	2	3	4	5	6	7	8	9	10	11	12	13	14
1. Active coping
2. Planning	0.58
3. Positive reframing	0.43	0.48
4. Acceptance	0.37	0.45	0.50
5. Humor	0.28	0.32	0.38	0.28
6. Religion	0.09	0.13	0.25	0.09	-0.01
7. Emotional support	0.32	0.17	0.27	0.24	0.21	0.16
8. Instrumental support	0.39	0.51	0.35	0.19	0.30	0.26	0.56
9. Self-distraction	0.33	0.25	0.30	0.11	0.18	0.18	0.19	0.19
10. Denial	-0.02	0.01	0.11	-0.08	0.01	0.05	0.06	0.10	0.38
11. Venting	0.23	0.21	0.17	0.07	0.11	0.27	0.31	0.41	0.33	0.27
12. Substance use	0.01	0.00	-0.04	-0.08	0.09	-0.07	0.00	0.08	0.11	0.07	0.09
13. Behavioral diseng.	-0.15	-0.09	-0.01	-0.10	-0.07	0.05	-0.05	0.01	0.28	0.48	0.18	0.30
14. Selfblame	0.26	0.40	0.39	0.18	0.16	0.25	0.16	0.35	0.36	0.18	0.48	0.04	0.26
Mean inter-correlation coefficient	0.27	0.28	0.28	0.21	0.18	0.14	0.21	0.28	0.25	0.14	0.24	0.07	0.16	0.27

Table 2. Pearson Correlation Coefficient and Mean Inter-Correlation Coefficient of Subscales in Brief COPE

1. Active coping

2. Planning

0.58

3. Positive reframing

0.43

0.48

4. Acceptance

0.37

0.45

0.50

5. Humor

0.28

0.32

0.38

0.28

6. Religion

0.09

0.13

0.25

0.09

-0.01

7. Emotional support

0.32

0.17

0.27

0.24

0.21

0.16

8. Instrumental support

0.39

0.51

0.35

0.19

0.30

0.26

0.56

9. Self-distraction

0.33

0.25

0.30

0.11

0.18

0.19

10. Denial

-0.02

0.01

0.11

-0.08

0.01

0.05

0.06

0.10

0.38

11. Venting

0.23

0.21

0.17

0.07

0.11

0.27

0.31

0.41

0.33

0.27

12. Substance use

0.01

0.00

-0.04

-0.08

0.09

-0.07

0.00

0.08

0.11

0.07

0.09

13. Behavioral diseng.

-0.15

-0.09

-0.01

-0.10

-0.07

0.05

-0.05

0.01

0.28

0.48

0.18

0.30

14. Selfblame

0.26

0.40

0.39

0.18

0.16

0.25

0.16

0.35

0.36

0.18

0.48

0.04

0.26

Mean inter-correlation coefficient

0.27

0.28

0.21

0.18

0.14

0.21

0.28

0.25

0.14

0.24

0.07

0.16

0.27

**Table 3.** Model Fit Values on Confirmatory Factor Analysis (CFA) for Different Models of Brief COPE in Heart Failure Population. Calculated With M-plus
	χ²	df	CFI^b	RMSEA^c	90% CI^d	SRMR^e	Omitted subscales
^aError variance for planning is correlated with the error variance for instrumental support and emotional support. *P < 0.001. ^bCFI: Comparative Fit Index. ^cRMSEA: Root Mean Squared Error of Approximation. ^dCI: Confidence Interval. ^eSRMR: Standardized Root Mean square Residual.
Two-factor model, Bean et al [32]	279.78*	76	0.676	0.121	0.106 - 0.136	0.103	None
Two-factor model, Eisenberg et al [33]	224.59*	53	0.703	0.133	0.115 - 0.151	0.099	Humor, Religion
Three-factor model Paukert et al [34]	275.49*	63	0.643	0.136	0.120 - 0.152	0.114	Humor
Four-factor model, Perez-Garcia et al [35]	64.02*	17	0.878	0.123	0.092 - 0.156	0.070	Denial, humor, religion, self-distraction, substance use, venting
Four-factor model Carver et al (from COPE) [25]	53.18*	21	0.922	0.092	0.061 - 0.122	0.058	Humor, religion, self-blame, self-distraction, substance use
Four-factor model Nahlen and Saboonchi [21]	91.67*	49	0.911	0.069	0.049 - 0.091	0.063	Self-blame, self-distraction
Modified four-factor model Nahlen and Saboonchi^a [21]	70.43*	47	0.951	0.052	0.024 - 0.076	0.060	Self-blame, self-distraction

Table 3. Model Fit Values on Confirmatory Factor Analysis (CFA) for Different Models of Brief COPE in Heart Failure Population. Calculated With M-plus

χ²

CFI^b

RMSEA^c

90% CI^d

SRMR^e

Omitted subscales

^aError variance for planning is correlated with the error variance for instrumental support and emotional support. *P < 0.001. ^bCFI: Comparative Fit Index. ^cRMSEA: Root Mean Squared Error of Approximation. ^dCI: Confidence Interval. ^eSRMR: Standardized Root Mean square Residual.

Two-factor model, Bean et al [32]

279.78*

0.676

0.121

0.106 - 0.136

0.103

None

Two-factor model, Eisenberg et al [33]

224.59*

0.703

0.133

0.115 - 0.151

0.099

Humor, Religion

Three-factor model Paukert et al [34]

275.49*

0.643

0.136

0.120 - 0.152

0.114

Humor

Four-factor model, Perez-Garcia et al [35]

64.02*

0.878

0.123

0.092 - 0.156

0.070

Denial, humor, religion, self-distraction, substance use, venting

Four-factor model Carver et al (from COPE) [25]

53.18*

0.922

0.092

0.061 - 0.122

0.058

Humor, religion, self-blame, self-distraction, substance use

Four-factor model Nahlen and Saboonchi [21]

91.67*

0.911

0.069

0.049 - 0.091

0.063

Self-blame, self-distraction

Modified four-factor model Nahlen and Saboonchi^a [21]

70.43*

0.951

0.052

0.024 - 0.076

0.060

Self-blame, self-distraction

**Table 4.** Mean and Standard Deviation of the Four Factors of Coping Strategies in Brief COPE for the Total Sample, Men, Women, Below and Over Median Age of 71 Years
	Problem focused coping (two subscales)	Avoidant coping (three subscales)	Socially supported coping (three subscales)	Emotion focused coping (four subscales)
Theoretical range	4 - 16	6 - 24	6 - 24	8 - 32
Man	10.7 ± 2.8	8.6 ± 2.5	12.9 ± 3.6	17.7 ± 4.4
Woman	9.8 ± 3.2	9.6 ± 3.1	12.5 ± 3.9	15.4 ± 3.5
Age < 71	10.9 ± 2.9	9.4 ± 2.8	13.4 ± 3.8	17.3 ± 4.2
Age ≥ 71	9.4 ± 3.0	8.2 ± 2.4	12.1 ± 3.5	16.7 ± 4.3
Total sample	10.5 ± 2.9	8.9 ± 2.7	12.8 ± 3.7	17.1 ± 4.3

Table 4. Mean and Standard Deviation of the Four Factors of Coping Strategies in Brief COPE for the Total Sample, Men, Women, Below and Over Median Age of 71 Years

Problem focused coping (two subscales)

Avoidant coping (three subscales)

Socially supported coping (three subscales)

Emotion focused coping (four subscales)

Theoretical range

4 - 16

6 - 24

8 - 32

Man

10.7 ± 2.8

8.6 ± 2.5

12.9 ± 3.6

17.7 ± 4.4

Woman

9.8 ± 3.2

9.6 ± 3.1

12.5 ± 3.9

15.4 ± 3.5

Age < 71

10.9 ± 2.9

9.4 ± 2.8

13.4 ± 3.8

17.3 ± 4.2

Age ≥ 71

9.4 ± 3.0

8.2 ± 2.4

12.1 ± 3.5

16.7 ± 4.3

Total sample

10.5 ± 2.9

8.9 ± 2.7

12.8 ± 3.7

17.1 ± 4.3

**Table 5.** Hierarchical Linear Regression Analyses of Physical and Mental Health Composites in RAND 36 as Dependent Variables
	Standardized beta	t	R²
n = 103. P < 0.01, *P < 0.001. ^aNYHA class: New York Heart Association Class. ^bDuration of Chronic Heart Failure.
Dependent variable: physical health composite RAND 36
Model 1			0.18
Age	0.31	3.06*
NYHA class^a (NYHA III vs. NYHA II)	-0.30	-2.87*
Duration of CHF^b (≥ 6 months vs. < 6 months)	0.11	1.10
F(3) = 6.05, P = 0.001
Model 2			0.26
Age	0.19	1.78
NYHA class (NYHA III vs. NYHA II)	-0.31	-3.07*
Problem focused coping	0.01	0.10
Avoidant coping	-0.30	-2.79*
Socially supported coping	-0.10	-0.92
Emotion focused coping	-0.04	-0.31
F(6) = 4.61, P < 0.001
Dependent variable: mental health composite RAND 36
Model 1			0.17
Age	0.33	3.27*
NYHA class (NYHA III vs. NYHA II)	-0.29	-2.83*
Duration of CHF (≥ 6 months vs. < 6 months)	-0.01	-0.12
F(3) = 5.50, P = 0.002
Model 2			0.40
Age	0.13	1.46
NYHA class (NYHA III vs. NYHA II)	-0.26	-3.04*
Problem focused coping	-0.01	-0.14
Avoidant coping	-0.57	-6.31**
Socially supported coping	-0.07	-0.75
Emotion focused coping	-0.02	-0.16
F(6) = 11.36, P < 0.001

Table 5. Hierarchical Linear Regression Analyses of Physical and Mental Health Composites in RAND 36 as Dependent Variables

Standardized beta

R²

n = 103. *P < 0.01, **P < 0.001. ^aNYHA class: New York Heart Association Class. ^bDuration of Chronic Heart Failure.

Dependent variable: physical health composite RAND 36

Model 1

0.18

Age

0.31

3.06*

NYHA class^a (NYHA III vs. NYHA II)

-0.30

-2.87*

Duration of CHF^b (≥ 6 months vs. < 6 months)

0.11

1.10

F(3) = 6.05, P = 0.001

Model 2

0.26

Age

0.19

1.78

NYHA class (NYHA III vs. NYHA II)

-0.31

-3.07*

Problem focused coping

0.01

0.10

Avoidant coping

-0.30

-2.79*

Socially supported coping

-0.10

-0.92

Emotion focused coping

-0.04

-0.31

F(6) = 4.61, P < 0.001

Dependent variable: mental health composite RAND 36

Model 1

0.17

Age

0.33

3.27*

NYHA class (NYHA III vs. NYHA II)

-0.29

-2.83*

Duration of CHF (≥ 6 months vs. < 6 months)

-0.01

-0.12

F(3) = 5.50, P = 0.002

Model 2

0.40

Age

0.13

1.46

NYHA class (NYHA III vs. NYHA II)

-0.26

-3.04*

Problem focused coping

-0.01

-0.14

Avoidant coping

-0.57

-6.31**

Socially supported coping

-0.07

-0.75

Emotion focused coping

-0.02

-0.16

F(6) = 11.36, P < 0.001