title: The role of appraisal and coping style in relation with societal participation in fatigued patients with multiple sclerosis: a cross-sectional multiple mediator analysis.
abstract: To determine the relationship between appraisal and societal participation in fatigued patients with Multiple Sclerosis (MS), and whether this relation is mediated by coping styles. 265 severely-fatigued MS patients. Appraisal, a latent construct, was created from the General Self-Efficacy Scale and the helplessness and acceptance subscales of the Illness Cognition Questionnaire. Coping styles were assessed using the Coping Inventory Stressful Situations (CISS21) and societal participation was assessed using the Impact on Participation and Autonomy. A multiple mediator model was developed and tested by structural equation modeling on cross-sectional data. We corrected for confounding by disease-related factors. Mediation was determined using a product-of-coefficients approach. A significant relationship existed between appraisal and participation (β = 0.21, 95 % CI 0.04-0.39). The pathways via coping styles were not significant. In patients with severe MS-related fatigue, appraisal and societal participation show a positive relationship that is not mediated by coping styles.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. l.vandenakker@vumc.nl.|EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. l.vandenakker@vumc.nl.|MS Center Amsterdam, Amsterdam, The Netherlands. l.vandenakker@vumc.nl.
authors.forename: Lizanne Eva
authors.initials: LE
authors.lastname: van den Akker
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|MS Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Beckerman
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Emma Hubertine
authors.initials: EH
authors.lastname: Collette
authors.affiliation: Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|MS Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: de Groot
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D020377:Self Efficacy; D058992:Social Participation / Q000523:psychology*
keywords: Appraisal; Coping; Multiple mediator model; Multiple sclerosis; Participation