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Exploring Coping Strategies of Culturally

Diverse Family Members of Psychiatric Patients

Phyllis M. Eaton

PhD, RN, PMHCNS-BC

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Introduction Coping strategies can be classified as (Lazarus &

Folkman, 1984):

Emotion-focused: Manage the negative emotions associated with the stressful situation

Cognitive distraction

Seeking emotional support

Cognitive restructuring

Problem focused: Efforts used to directly change the basis of stress

Changing external pressures

Seeking resources

Utilization of social supports

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Introduction These coping strategies can be further

classified as:

Positive Coping strategies:

Utilization of appropriate:

Social supports (family, friends, church)

Resources (education, finances, professionals)

Positive thinking

Negative coping strategies:

Avoidance

Substance abuse

Negative thinking(Letvak, 2002; McCubbin and Comeau, 1991; Perkins, Winn, Murray, Murphy, & Schmidt, 2004)

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Statement of the Problem

Family members of hospitalized psychiatric

patients are being given the responsibility of

caring for their relative to help fill the gap in

service that exits between inpatient to

outpatient treatment (Enns,et al., 1999).

Many families do not have the coping

strategies to cope with this situation (Rose, 1997).

The problem of this investigation is to explore

the coping strategies of family members of

hospitalized psychiatric patients.

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Background

Families caring for a mentally ill relative

experience economic strain, isolation, stigma,

and burnout [negative coping] (McKenry & Price, 2005).

Little research has been done on how the

specific variables of support systems and

resources impact the familys coping ability (Enns, et al., McKenry & Price, 2005).

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Significance of Problem

With about half of the mentally ill suffering

from more than one mental disorder at the

same time, continuation of care post

hospitalization is essential for positive

treatment outcomes (Enns, et al.,1999; NIMH, 2007).

Identification of family coping strategies may

help support the familys ability to cope with

their situation and improve patient outcomes

(Enns, et al.).

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Statement of Purpose

The purposes of this study were to

investigate what coping strategies

families of psychiatric patients use and

to identify their positive and negative

coping strategies.

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Conceptual Framework

The Neumans Systems Model was

used to guide this study and test the

middle-range theory of Coping

Strategies of Family Members of

Psychiatric Patients.

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Conceptual Framework

Neumans Systems Model

Views client/client systems as dynamic

interrelated variables that interact

continuously with stressors from the

environment.

All client systems have five interrelated

variables, which work together

simultaneously as the client responds to

the internal, external, and created

environment (Neuman, 1995; 2002).

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Conceptual

Model

Concepts

Middle-

Range

Theory

Concepts

Empirical

Research

Methods

Neuman's Systems Model

Theory of coping strategies of family members of

hospitalized psychiatric patients

Stressor Family

Coping

Strategies

Social Cultural

Supports

Family

Relation

F-COPES

Subscales:

- Acquiring Social

Support

-Reframing

-Seeking Spiritual

Support

-Mobilizing Family to

Acquire/Accept Help

-Passive Appraisal

Semistructured

Interview

F-COPES

Subscales:

-Acquiring Social

Support

-Mobilizing Family to

Acquire/Accept Help

Semistructured

Interview

BDS

Psychological Sociocultural Developmental

External

Environment Spiritual

Spirituality

as a Coping

Strategy

BDS- Background Data Survey

F-COPES- Family Crisis Oriented Personal Evaluation

Scales

F-COPES

Subscales:

-Seeking

Spiritual

Support

Family

member with

diagnosed

psychiatric

disorder

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Research Questions

1. What coping strategies do family members

of psychiatric patients use?

2. What are the common support systems used

by family members of psychiatric patients?

3. What is the relationship between ethnicity,

gender, income, family relation, and coping

of family members of psychiatric patients?

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Research Design

Exploratory, Descriptive Correlation Research

Design with a mixed method approach.

Quantitative & Qualitative

Survey

Semistructured Interview

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Sample/Setting

Convenient sample

45 participants-chosen so there is at least

90% power to conduct both the descriptive

and regression analyses

All 45 participants completed the survey

and semi-structured interview.

Inclusion criteria:

Adult (18-80 years of age)

Family member of psychiatric patient

Family member is anyone who the

mentally ill individual deems to be family

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Instrumentation

A participant background data survey (BDS)

consisting of demographic data was

collected.

Gender

Age

Ethnicity

Income

Family relation

Approximately five minutes to complete

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Instrumentation

The Family Crisis Oriented Personal

Evaluation Scales (F-COPES) (McCubbin, Olson, & Larsen, 1991):

Permission to use instrument was obtained

30 item instrument

5-point scale

Approximately 10-15 minutes to complete

Identifies problem-solving and behavioral

strategies the family uses during difficult

situations

Identifies coping levels of the family

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Instrumentation

F-COPES examines five areas of family

coping (subscales):

Acquiring social support

Reframing (familys ability to redefine

stress/ situation)

Seeking spiritual support

Mobilizing family to acquire & accept help

Passive appraisal (familys ability to accept

difficult issues minimizing reactivity)

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Semi-Structured Interview

The interview consisted of questions

regarding the familys perception of their:

Coping strategies

Support systems

Family resources

Role of health care professionals in helping

them cope with their mentally ill relative

Developed by the research with the help of

an expert in psychiatric nursing and the IRB

committees.

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Data Analysis

Quantitative:

Descriptive statistics described demographic

data.

F-COPES item analysis determined the use

of coping strategies.

Univariate linear regression analysis

examined the relationship between

independent variables and the total F-COPES

Ethnicity, Age, Gender, Income, Family

Relation

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Data AnalysisQuantitative:

Chi-Square analysis compared the lowest and highest coping scores with the demographic data.

Spearman Rank Correlation examined the relationship between coping ability and spirituality of family members.

The significance level was set at 0.05.

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Data Analysis

Qualitative:

Semi-structured interviews data

Content analysis was performed

Themes identified

Data categorized

Patterns and trends identified

Expert reviewing data

Both research methods were used to

measure family coping, use of support

systems, resources, and spirituality.

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Sample Characteristics

N= 45 Family members

51.1% were women

48-57 years old (37.8%) most common age

range

Children was the prevalent family relation

(35.6%)

Annual income $100,000 or more per year

most common (29.7%)

Ethnicity of Participants:

Caucasians (55.6%)

African Americans (42.22%)

Hispanic/Latino (2.22%)

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Research Question #1

What coping strategies do family members of psychiatric patients use?

F-COPES subscales:

Seeking spiritual support (most common: median = 4)

Reframing

Mobilizing family to acquire/accept help

Passive Appraisal

Acquiring social support

(least common: median = 3.11)

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The most common coping strategy

F-COPES item used was Having faith in God (median = 5)

Common coping strategies:

Doing things with relatives

Acceptance of difficulties and defining the

problem in a positive way

Seeking information and advice from the

family doctor

Feeling no mater what we do to prepare,

we will have difficulty handling problems

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The least common coping strategy F-COPES

item used was Sharing problems with

neighbors (median = 2)

Least common coping strategies:

Believing we can handle our own problems

Participating in church activities

Seeking assistance from community

agencies and programs designed to help

families in our situation

Believing if we wait long enough, the

problem will go away

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Semi-structured interview:

What coping strategies do you use when

caring for your loved one?

Prayer and having faith in God (most

common theme)

PrayPray a lot!

I do spiritual thingslike pray, read

the bible.

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Common themes:

Acceptance

I just accept her behavior

I just face it head on

Support of immediate family

My family is my lifeline

I only talk to my family about the situation.

I dont share it with anyone elsethey just

wouldnt understand.

Passive activities

When I need a break I just watch TV

Reading is my escape

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What are the common support systems used

by family members of psychiatric patients?

F-COPES subscale:

Seeking spiritual support (most common: median = 4)

Church involvement

Seeking ministers advice

Mobilizing family to acquire and accept

help (median = 3.75)

Acquiring social support from friends,

neighbors, and relatives (Least common: median = 3.11)

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Semi-structured interview:

What support systems do you use to help

you cope with your loved one?

The most common theme was

immediate family.

My family membersimmediate

family

My family, my husband

Other common themes:

Church; Good friends

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What is the relationship between ethnicity,

gender, income, family relation, and coping of

family members of psychiatric patients?

F-COPES:

Demographic variables did not have a

significant impact on coping ability.

Age (R = 0.08)

Ethnicity (R = 0.04)

Gender (R = 0.01)

Annual income (R = 0.33)

Relation (R = 0.09)

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Demographic data was compared to the

lowest number of total coping scores (10%)

and the highest number of total coping scores

(10%).

Lowest total coping score:

Individuals aged 48-57 years old

Males

African Americans

Spouse/significant others

Incomes under $50,000/year

Demographic profile was not statistically

significant when compared to the lowest total

coping scores.

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Highest total coping score:

Individuals aged 48-57 years old

Females

White

Children

Incomes under $70,000/year

Only gender (female) was statistically

significant (p = 0.04) when compared to the

highest total coping scores.

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Major Findings

Family members of psychiatric patients use

more emotion-focused coping strategies than

problem-focused coping strategies.

Talking with immediate family

Acceptance of situation

Passive activities is a significant coping

strategy used by family members.

Watching television

Reading

Negative, maladaptive coping strategies do

not significantly impact the results of the is

study.

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Major Findings

Family members of psychiatric patients

use a variety of support systems.

Quantitative analysis reveals families use

spiritual supports, such as attending

church and seeking advice from a minister.

Qualitative analysis reveals families state

their immediate family as the most

common support system they use.

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Major Findings

No significant relationship between

coping and socioeconomic factors

Examining the demographic factors of

the highest coping scores, only gender

(female) was found to be statistically

significant.

May suggest that female relatives of

psychiatric patients may be able to cope

better than male relatives

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Conclusions

Family members of psychiatric patients use

more emotion-focused coping strategies than

problem-focused coping strategies.

Communication with family members

Cognitive distraction (watching TV)

Cognitive restructuring (acceptance)

There is no significant relationship between

coping strategies and culturally diverse family

members.

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Conclusions

Information is a vital resource for families:

Illness education

Support groups

Condition of relative

Spirituality is found to be central in the

familys ability to cope with their mentally ill

loved one.

Spirituality as a coping strategy is a positive

influence on the familys overall coping ability.

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Hampton University

Dissertation Committee Members:

Bertha L. Davis, PhD, RN, FAAN, ANEF

Chair of Committee

Pamela V. Hammond, PhD, RN, FAAN, ANEF

Esther H. Condon, PhD, RN

Zina T. McGee, PhD

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