title: Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model.
abstract: OBJECTIVE
  To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI).
  
  
  METHODS
  A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI.
  
  
  RESULTS
  Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles.
  
  
  CONCLUSIONS
  The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.
authors.affiliation: School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.|School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Dongjuan
authors.initials: D
authors.lastname: Xu
authors.affiliation: School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.
authors.forename: Nana
authors.initials: N
authors.lastname: Liu
authors.affiliation: Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Haili
authors.initials: H
authors.lastname: Qu
authors.affiliation: School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.
authors.forename: Liqin
authors.initials: L
authors.lastname: Chen
authors.affiliation: School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China. wangkf@sdu.edu.cn.
authors.forename: Kefang
authors.identifier: http://orcid.org/0000-0003-2985-6593
authors.initials: K
authors.lastname: Wang
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012111:Residence Characteristics; D014549:Urinary Incontinence / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy
keywords: Coping style; Quality of life; Symptom severity; Urinary incontinence; Women