Coping as a Personality Process: How Elderly Patients Deal with Cataract Surgery

Transcription

1 Coping as a Personality Process: How Elderly Patients Deal with Cataract Surgery Nina Knoll Dissertationsschrift zur Erlangung des Doktorgrades der Philosophie am Fachbereich Erziehungswissenschaft und Psychologie der Freien Universität Berlin Berlin 2002 Gutachter: Prof. Dr. Ralf Schwarzer Priv.-Doz. Dr. Clemens Tesch-Römer Disputation: 8. Mai 2002

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3 To Hildegard Hauck and Charlotte Knoll

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5 Table of Contents I Table of Contents Acknowledgments.. Abstract... Zusammenfassung.. XV XVI XVII 1. Introduction 2. Theoretical Background 2.1 Personality The Integrative Hierarchical Structure of Personality Traits Assessment of the Big Five: The NEO Personality Inventory Limitations of the Five-Factor Solutions Stability of Interindividual Differences over the Life-Span On the Coexistence of Stability and Change 2.2. Coping with Stress The Psychodynamic Perspective on 'Coping' The Stimulus-Based Perspective The Transactional Perspective Personality and Coping Formal Classification of Coping Content-Free Aspects of Coping Coping in Old Age Coping in Old Age - Empirical Results 2.3. Outcomes in Stress and Coping Research Positive and Negative Affect A Word on Interrelatedness: Personality and Affect Health, Affect, and Old Age Anxiety, Fear, Stress Coping Satisfaction Longer-Term Outcomes in Coping Research Emotional Well-Being Functional Adaptation Selection of the Study Setting Perioperative Stress The Cataract Cataract Surgery 3. Central Research Questions and Hypotheses 3.1. A Stressor Indeed?

6 II Table of Contents Expected Changes in State Affect Pre- to Post-Surgery Change in Longer-Term Outcome Measures: Well-Being Change in Longer-Term Outcome Measures: Functional 3.2. Personality: Prediction of Outcomes During the Situation and Beyond? Personality Traits and Situation-Specific Outcomes Personality Predicts Longer-Term Outcomes Age and Situation-Specific Coping versus Dispositional Coping Coping: Prediction of Outcomes During the Situation and Beyond? Situation-Specific Coping Predicts Affect and Coping Satisfaction Dispositional Coping Predicts Long-Term Outcomes Differential Effects Regarding Personality and Coping 3.6. Coping as a Personality Process? 'Content-Free' Aspects of Coping: Selective Coping and Total Range of Coping 4. Method 4.1. Participants Recruitment Procedures Exclusion Criteria Sample Size and Rate of Participation Chronological Age and Gender Sociodemographic Variables General Health Status Ophthalmic Data Major Variables Under Study: Biases Due to Drop Out? Materials and Measures The Study Information Brochure Demographic Variables Control Variables Personality Traits -The German Adaptation of the NEO-FFI The Big Three in the Present Study Coping Two Content-Free Aspects of Coping Situation-Specific Outcomes: Positive and Negative Affect Positive and Negative Affect in the Present Study Situation-Specific Outcomes: Coping Satisfaction Longer-Term Outcomes: Depressive Symptoms Longer-Term Outcomes: Life-Satisfaction Another Long-Term Outcome: Vision-Related Functional Status Data Assessment and Design 4.4. Analyses

7 Table of Contents III Treatment of Missing Values and Outliers General Analytic Procedures 5. Results 5.1. Descriptive Results: Situation-Specific Outcomes Distribution of State Affect Measures Changes in State Affect Around Surgery Unique Time Effects: State Negative Affect Unique Time Effects: State Positive Affect Covariates of State Positive and Negative Affect Satisfaction with Coping Efforts Descriptive Results: Longer-Term Well-Being Outcomes Depressive Symptoms: Distribution and Correlates Life Satisfaction 5.3. Descriptive Results: Longer-Term Vision-Related Functional Outcomes 5.4. Descriptive Results: Major Predictors NEO-Personality Traits: Distribution and Correlates Coping: Distribution and Correlates Two Content-Free Aspects of Coping: Selective Coping versus Total Range of Coping Testing Mediation with Situation-Specific Measures Personality Variables Predict State Affect N, E, and O Predict State Positive Affect Neuroticism and Openness Predict State Negative Affect Situation-Specific Coping Predicts State Affect Situation-Specific Coping Predicts State Positive Affect Situation-Specific Coping Predicts State Negative Affect Personality Predicts Situation-Specific Coping Coping as a 'Personality Process'? Coping Mediates the Relationship Between Personality Traits and Negative Affect? Coping Mediates the Relationship Between Higher-Order Personality Traits and Positive Affect? Summary Thus Far: Coping as a Personality Process? Testing an Alternative Model: "Differential Effectiveness" Another Situation-Specific Outcome: Satisfaction with Coping Predicted by Personality? Situation-Specific Coping Predicts Satisfaction with Coping Efforts? Does Coping Mediate between Personality and Coping Satisfaction?

8 IV Table of Contents Testing Coping as a Moderator between Personality and Coping Satisfaction 5.6. Testing the Mediator Hypothesis with Long-Term Measures Personality Predicts Depression and Life Satisfaction Dispositional Coping Predicts Depressive Symptoms and Life Satisfaction Personality Predicts Dispositional Coping? Evidence for Mediation between Neuroticism and Depressive Symptoms? Differential Effectiveness: Testing Possible Moderation Visual Acuity Post-Surgery and Long-Term Well-Being: Personality and Coping as Moderators? Better Vision - More Action for Some? Neuroticism and Openness Predict Aspects of Functional Status Six Weeks Post-Surgery Openness: See Better, Complain Less? Habitual Coping Predicts Vision-Related Functional Status Post-Surgery Adjusting to Better Vision on a Functional Level: Partly a Matter of Openness, Dispositional Coping, or Both? Would Dispositional Coping Moderate the Relationship Between Visual Acuity and Functional Status? Better Vision, More Action for Some: Summary So Far Selective Coping Versus Total Range of Coping More Content-Free Aspects of Coping Predict Sit.-Spec. Outcomes More Content-Free Measures Predict Affect Above and Beyond Content of Coping Efforts? Distal Well-Being Predicted by Dispositional Content-Free Coping Measures? More Content-Free Aspects of Dispositional Coping Predict Functional Status? Associations Between Higher-Order Personality Traits and More Content-Free Coping Measures Evidence for Content-Free Aspects as Mediators? General Summary. 6. Discussion 6.1. A Stressor Indeed? 6.2. Satisfaction with Coping Efforts as Another Situation-Specific Outcome Depressive Symptoms and Life Satisfaction

9 Table of Contents V 6.4. Long-Term Functional Outcomes Coping and Age 6.6. Gender and Coping 6.7. Unique Effects of Coping Predicting Situation-Specific Outcomes Unique Relations of Dispositional Coping with Long-Term Outcomes Dispositional Coping and Functional Limitations Unique Predictions of Coping Generally Mediation and Unique Effects of Personality: Coping as a Personality Process? Personality Predicts Coping Predicts Outcome? Emotionally Labile Versus Emotionally Stable Patients Extraverts Versus Introverts High versus Low Openness to Experience Neuroticism and Extraversion Lacking Explicit Affectivity Items Two Approaches to More Content-Free Aspects of Coping Selective Coping: The Better Way to Cope? Total Range of Coping: Troubled Souls Overreact and Make it Worse Instead of Better? Indirect Effects of NEO-Personality Traits on Outcomes via 'Content-Free' Coping Limitations of the Present Study and Perspectives for Future Research Conclusions References 8. Appendices 8.1. Appendix A: Comparison of Berlin and Mainz Patients Appendix B: Central Constructs 8.3. Appendix C: Documentation of Analyses The Brief COPE: Inter-Item and Inter-Scale Correlations of the Original Two-Item Subscales The Brief COPE: Documentation on the Final CFA Models of the Situation-Specific and Dispositional Versions The PANAS: Additional Analyses on PA and NA Subfacets Additional Control Analyses for the Prediction of State Positive Affect Additional Control Analyses for the Prediction of Coping by Higher- Order Personality Traits Additional Documentation of Analyses Concerning Coping Satisfaction Content-Free Aspects of Coping Predict Affect Balance Content-Free Aspects of Coping Predicting Affect Above and Beyond Content Scales?

10 VI Table of Contents Content-Free Aspects of Coping Predicting Long-Term Outcomes Above and Beyond Content Scales? Age and Multimorbidity Appendix D: Net of Affectivity Versions Neuroticism/S and Extraversion/S Additional Analyses Neuroticism/S and Extraversion/S Predict Positive Affect Neuroticism/S Predicts Negative Affect Neuroticism/S and Extraversion/S Predict Long-Term Outcomes Neuroticism/S and Extraversion/S Predict Coping Neuroticism/S and Extraversion/S Predict the Affects: Directly and Indirectly Neuroticism/S Predicts Longer-Term Outcomes: Directly and Indirectly Neuroticism/S Predicts Positive Affect: Directly and Indirectly via Selective Coping Neuroticism/S Predicts Intensity of Limitations at t1: Directly and Indirectly via Total Range of Coping/D Appendix E: Additional Information on Materials and Tests Consent Form: Participation (German) Consent Form: Participation (English) Consent Form: Patient Confidentiality (German) Consent Form: Patient Confidentiality (English) The Brief COPE: German and English Versions (Carver, 1997) The PANAS: German and English Versions (Watson, Clark, & Tellegen, 1988) Assessment of Vision-Related Functional Status (after Javitt, et al., 1997)

11 Table of Contents VII List of Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figures 6/7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Mediator model Mean Negative Affect (+/- one standard error, range 1 to 4) at all measurement points in time Means of Negative Affect subfacets at all measurement points in time Mean Positive Affect (+/- one standard error, range 1 to 4) at all measurement points in time Means of Positive Affect subfacets over all measurement points in time. Separate affect means for 1 st Eye versus 2 nd Eye patients over all assessments Mean depressive symptom sumscores for men and women. Overall means (+/- one standard error) of intensity of limitations upon admission and six weeks post-surgery. Means of situation-specific and dispositional coping subscales. Means for situation-specific active coping in patients receiving invasive versus non-invasive forms of local anesthesia Patients low (a) and high (b) in selective coping, situation-specific coping profiles... Mean Negative Affect pre-surgery for patients high versus low in Openness to Experience.. Simple Positive Affect means across the two pre-surgical time points for different age-groups with different levels of Support Seeking (situationspecific).. Mean Negative Affect upon admission for men and women high and low in levels of Support Seeking (situation-specific)... Relationship among Neuroticism, situation-specific coping, and Negative Affect at t1. Relationship among Neuroticism, situation-specific coping, and Negative Affect at t2. Relationship among Openness, situation-specific coping, and change from Negative Affect at t1 to Negative Affect at t2... Relationship among Openness, situation-specific coping, and Positive Affect at t1. Relationship among Extraversion, situation-specific coping, and Positive Affect at t2. Relationship among Extraversion, situation-specific coping, and change of Positive Affect at t1 to Positive Affect at t

12 VIII Table of Contents Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Figure 28 Figure 29 Figure 30 Figure 31 Figure 32 Figure 33 Figure 34 Relationship among Neuroticism, situation-specific coping, and Positive Affect at t3. Relationship among Neuroticism, situation-specific coping, and change of Positive Affect at t2 to Positive Affect at t3. Mean Positve Affect pre-surgery for groups high versus low in Extraversion and Focus on Positive coping (situation-specific)... Relationship among Neuroticism, situation-specific coping, and coping satisfaction. Relationship among Neuroticism, dispositional coping, and depressive symptoms six weeks post-surgery. Mean sumscores of depressive symptoms six weeks post-surgery by levels of Neuroticism and post-surgical visual acuity in the eye operated on... Simple means for participants high in change in visual acuity,comparing open individuals and their counterparts. Relationship among Openness, dispositional coping, and change in number of activities from t1 to t4. Simple means of number of activities (with glasses on) for low dispositional active copers with high and low levels of Openness over time. Relationship among Openness, selective coping (situation-specific), and Positive Affect at t1. Relationship among Neuroticism, selective coping (situation-specific), and Positive Affect at t3.. Relationship among Neuroticism, selective coping (situation-specific), and change in Positive Affect from t2 to t3. Relationship among Neuroticism, total range of coping/d (dispositional), and vision-related intensity of limitation at t List of Tables Table 1 Table 2 Table 3 Hierarchical Structure of Personality Traits. Information on Number of Participants Throughout the Study.. Age and Gender Distributions for the Full Sample, Contiuers, and Non- Continuers

13 Table of Contents IX Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 Table 11 Table 12 Table 13 Table 14 Table 15 Table 16 Table 17 Table 18 Table 19 Table20 Table 21 Table 22 Table 23 Table 24 Table 25 Table 26 Socio-Demographic Characteristics for the Full Sample, Continuers, and Non-Continuers.. Information on General Health for the Full Sample, Continuers, and Non-Continuers Information about Subjective and Objective Visual Impairment for the Full Sample, Continuer, and Non-Continuer Sample... Information about Ophthalmic History for the Full Sample, Continuer, and Non-Continuer Sample The Brief COPE: Subscales... Internal Consistencies for Situation-Specific and Dispositional Coping Scales Situation-Specific and Dispositional Coping: Scale-Intercorrelations. The PANAS: Positive and Negative Affect, Subfacettes Internal Consistencies (Cronbach's α) of PANAS Subscales and Facets. Intercorrelations Between State PANAS-Scales Items After the Cataract TyPE Specification by Javitt and Colleagues (1997) Design of the Present Study... Means and Standard Deviations of Positive Affect at t1 and t2. Pearson Correlations Between General Coping Satisfaction and Positive and Negative Affect.. Pearson Correlations of Depressive Symptoms and Life Satisfaction with the Affects. Pearson Correlations Between Personality Traits and Outcome Variables Positive and Negative Affect.. Summary of Hierarchical Regression Analyses Predicting Positive Affect at Different Points in Time. Summary of Hierarchical Regression Analyses Predicting Positive Affect at Different Points in Time. Pearson Correlations Between Situation-Specific Coping and Outcome Variables State Positive and Negative Affect. Summary of Hierarchical Regression Analyses Predicting State Positive Affect at Different Points in Time. Summary of Hierarchical Regression Analyses Predicting State Negative Affect... Pearson Correlations Between Personality Traits and Situation-Specific Coping Summary of Hierarchical Regression Analyses Predicting Situation- Specific Coping Responses

14 X Table of Contents Table 27 Table 28 Table 29 Table 30 Table 31 Table 32 Table 33 Table 34 Table 35 Table 36 Table 37 Table 38 Table 39 Table 40 Table 41 Table 42 Table 43 Table 44 Pearson Correlations Between Personality Traits and Coping Satisfaction Pearson Correlations Between Situation-Specific Coping and Coping Satisfaction Pearson Correlations of Depressive Symptoms and Life Satisfaction with NEO-Personality Traits.. Results of Hierarchical Regression Analyses Predicting Depressive Symptoms and Life Satisfaction. Pearson Correlations of Depressive Symptoms and Life Satisfaction with Dispositional Coping.. Regression Analyses: Dispositional Coping Predicting Depressive Symptoms and Life Satisfaction. Pearson Correlations Between NEO-Personality Traits and Coping/D... Results of Hierarchichal Regression Analyses Predicting Dispositional Coping Results of Hierarchical Regression Analyses Predicting Depressive Symptoms (t4) by Introducing Two-Way Interaction Terms Results of Follow-Up Analyses Predicting Depressive Symptoms in Lower and Higher Visual Acuity Groups. Results of Follow-Up Analyses Predicting Depressive Symptoms in Lower and Higher Visual Acuity Groups. Correlations Between Higher-OrderPersonality Traits and Vision- Dependent Functional Status. Summary of Hierarchical Regression Analyses Predicting Number of Vision-Dependent Activities and Intensity of Limitation.. Results of Hierarchical Regression Analysis Predicting Change in Vision- Related Intensity of Limitation.. Pearson Correlations Between Dispositional Coping and Outcome Variables Number of Activities and Intensity of Limitation at Different Points in Time... Results of Hierarchical Regression Analyses Predicting Number of Vision-Dependent Activities at Different Points in Time and Vision- Related Intensity of Limitations. Testing Moderation: Results of Hierarchical Regression Analsysis Predicting Change in Number of Activities from t1 to t4. Pearson Correlations of Situation-Specific Total Range of Coping and Selective Coping with Positive and Negative Affect, and Coping Satisfaction

15 Table of Contents XI Table 45 Table 46 Table 47 Table 48 Table 49 Table 50 Table 51 Table 52 Summary of Hierarchical Regression Analyses: Situation-Specific Selective Coping and Total Range of Coping Predicting Positive Affect at Different Points in Time.. Summary of Hierarchical Regression Analyses: Situation-Specific Selective Coping and Total Range of Coping Predicting Negative Affect at Different Points in Time.. Pearson Correlations of Dispositional Total Range of Coping and Selective Coping with Life Satisfaction and Depressive Symptoms.. Correlations Between Dispositional "Content-Free" Aspects of Coping and Vision-Related Functional Status.. Total Range of Coping/D Predicts Vision-Related Intensity of Limitation at t1 Without and With Control for Dispositional Coping Scales.. Pearson Correlations of Situation-Specific and Dispositional Total Range of Coping and Selective Coping with Neuroticism, Extraversion, and Openness to Experience.. Summary of Hierarchical Reggression Analyses Predicting Positive Affect at Admission, Discharge and Change in Positive Affect from Day of Surgery to Discharge.. Summary of Hypotheses and Results List of Tables and Figures in Appendices Appendix A: Comparison of Berlin and Mainz Patients Table A1 Comparison of Socio-Demographic Characteristics Berlin Versus Mainz.. Table A2 General Health Indicators: Berlin versus Mainz.. Table A3 Comparison of Visual Impairment in Berlin and Mainz Patients Appendix B: Central Constructs Table B1 Major Variables Under Study: Descriptive Statistics Appendix C: Documentation of Analyses Table C1 Inter-Item and Inter-Scale Correlations of the Brief COPE (Situation- Specific). Table C2 Inter-Item/Inter-Scale Correlations of the Brief COPE (Dispositional)

16 XII Table of Contents Table C3 Final CFA Models of the Brief COPE-Situation-Specific and Dispositional with Significant Coefficients Presented in Completely Standardized Form.. Table C4 Intercorrelations of the Latent Factors of the Final Modified CFA, Brief COPE Situation-Specific (Above Diagonal) and Dispositional (Below Diagonal).. Table C5 Means and Contrasts of PA Facets Pre-Surgery.. Table C6 Means and Contrasts of NA Facets Pre-Surgery.. Table C7 Summary of Regression Analyses: NEO-Personality Traits Predicting State Positive Affect. Table C8 Summary of Regression Analyses Situation-Specific Coping Predicting State Positive Affect. Table C9 Summary of Hierarchical Regression Analyses: NEO-Personality Traits Predicting Situation-Specific Coping.. Table C10 Summary of Hierarchical Regression Analyses: NEO-Personality Traits Predicting Dispositional Coping.. Table C11 Summary of Hierarchical Regression Analysis for Neuroticism Predicting Coping Satisfaction. Table C12 Summary of Hierarchical Regression Analysis for Situation-Specific Coping Predicting Coping Satisfaction. Table C13 Summary of Hierarchical Regression Analysis: Situation-Specific Content- Free Aspects of Coping Predicting Affect Balance.. Table C14 Summary of Hierarchical Regression Analysis: Situation-Specific Content-Free Aspects of Coping and Coping Content Scales Predicting Affect Balance... Table C15 Summary of Hierarchical Regression Analyses: Content and Content- Free Coping Predicting Positive Affect at Different Points in Time.. Table C16 Summary of Hierarchical Regression Analyses: Content and Content- Free Coping Predicting Negative Affect at Different Points in Time Table C17 Summary of Hierarchical Regression Analyses: Dispositional Content and Content-Free Measures of Coping Predicting Life Satisfaction (t1). Table C18 Spearman Correlations of Different Diseases with Age Appendix D: Net of Affectivity Versions Neuroticism/S and Extraversion/S Additional Analyses Table D1 Pearson Correlations between Personality Traits and Outcome Variables State Positive and Negative Affect... Table D2 Hierarchical Regression Analysis: NEO/S Personality Traits Predicting Positive Affect t

17 Table of Contents XIII Table D3 Table D4 Table D5 Table D6 Table D7 Table D8 Table D9 Table D10 Table D11 Table D12 Table D13 Table D14 Table D15 Table D16 Table D17 Table D18 Table D19 Table D20 Table D21 Hierarchical Regression Analysis: NEO/S Personality Traits Predicting Positive Affect t2. Hierarchical Regression Analysis: NEO/S Personality Traits Predicting Positive Affect t3. Hierarchical Regression Analysis: NEO/S Personality Traits Predicting Change in PA t1 to t2.. Hierarchical Regression Analysis: NEO/S Personality Traits Predicting Change in PA t2 to t3 Summary of Hierarchical Regression Analysis: Neuroticism/S Predicting Negative Affect t1 Summary of Hierarchical Regression Analysis: Neuroticism/S Predicting Negative Affect t2 Summary of Hierarchical Regression Analysis: Neuroticism/S Predicting Negative Affect t3 Summary of Hierarchical Regression Analysis: Neuroticism/S and Extraversion/S Predicting Depressive Symptoms and Life Satisfaction Correlations of Neuroticism/S and Extraversion/S with Situation-Specific and Dispositional Coping... Summary of Hierarchical Regression Analyses: Neuroticism/S and Extraversion/S Predicting Situation-Specific Coping Summary of Hierarchical Regression Analyses: Neuroticism/S and Extraversion/S Predicting Dispositional Coping.. Negative Affect t1 Negative Affect t2 Positive Affect t2. Residualized Change of Positive Affect t1 to t2 Positive Affect t3. Residualized Change of Positive Affect t2 to t3... Depressive Symptoms t4 Positive Affect t

18 XIV Table of Contents Table D22 Table D23 Table D24 Positive Affect t3. Intensity of Limitations t1... Intensity of Limitation Predicted by Neuroticism/S, Dispositional Content Scales and Total Range of Coping Appendix E: Additional Information on Materials and Tests Table E1 The PANAS: Positive and Negative Affect, Subfacettes Table E2 Items after the Cataract TyPE Specification by Javitt and Colleagues (1997) Figure C1 Age trajectory: Number of unweighted medical diagnoses, N=