THE INTERRELATIONSHIP BETWEEN COPING STYLES, COGNITIVE APPRAISAL, POST-TRAUMATIC STRESS DISORDER SYMPTOMS AND PSYCHOLOGICAL REACTIONS IN INDIVIDUALS WITH HAND INJURIES

Abstract

The following study examined the psychological reactions following hand injuries and the interrelationship of coping styles (in particular, emotion-versus problem-focused coping), post-traumatic stress disorder reactions and psychological distress in this client group, compared to a comparison group of individuals with non-traumatically induced hand deformities (primarily Dupuytren's contractures). The hypothesized positive impact of problem-focused coping and negative impact of emotion-focused coping on psychological outcome was also investigated. A total of 25 individuals with hand injuries and 20 individuals with a hand deformity were interviewed. This involved completion of a semi-structured interview plus a range of standardized assessment scales including the COPE (coping inventory), the Post-traumatic Stress Disorder Inventory, the Impact of Event Scale and the Hospital Anxiety and Depression Scale (HAD). The majority of hand injury sufferers were seen six days to four weeks after their injury and three participants were seen at a longer duration of injury between 10 months to three years. Individuals were followed up at an average of approximately four months. The results showed significantly higher levels of PTSD symptomatology, anxiety and negative affect (at time 1) and emotional distress (at time 2) in the hand injury group compared to the comparison group. Increased use of emotion-focused coping in the hand injury group at time 2 coincided with differences in appraisal. The hand injury group appraised their injury as more threatening than the comparison group and loss appraisals were their predominant form of appraisal at time 2, whereas challenge appraisals were predominant in the comparison group. Positive associations emerged between both problem- and emotion-focused coping, PTSD symptoms and HAD anxiety and depression scores, although the correlations with emotion-focused coping tended to account for more common variance compared to those with problem-focused coping. Cross-lagged panel correlations indicated a possible causal influence of emotion-focused coping on total PTSD-I scores, intrusion on the Impact of Event Scale and anxiety (providing some support for the negative impact of emotion-focused coping). Analysis also suggested a possible role of problem-focused coping in the onset of anxiety symptoms, in addition to a bi-directional relationship between problem-focused coping and total PTSD-I scores. However, the failure of these results to reach statistical significance cannot provide conclusive evidence for these effects. The findings are discussed in relation to previous research and suggestions are made for future studies.