title: Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured.
abstract: BACKGROUND
  Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.
  
  
  METHODS
  One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.
  
  
  RESULTS
  A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.
  
  
  CONCLUSIONS
  This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.
authors.affiliation: The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden.
authors.forename: Catarina
authors.initials: C
authors.lastname: Nahlen Bose
authors.affiliation: The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Bjorling
authors.affiliation: Malardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Vasteras, Sweden.
authors.forename: Magnus L
authors.initials: ML
authors.lastname: Elfstrom
authors.affiliation: Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.affiliation: The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Saboonchi
keywords: Adaption; Factor analysis; Heart failure; Psychological; Quality of life; Self-report; Statistical