The role of coping strategies in the association between illness perception and quality of life in an Italian sample of patients with noncommunicable diseases

Author/s Ersilia Auriemma, Assunta Maiello, Concetta Esposito, Maria Francesca Freda
Publishing Year 2023 Issue 2023/2
Language Italian Pages 19 P. 84-102 File size 295 KB
DOI 10.3280/PDS2023-002006
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Noncommunicable diseases (lung disease, cardiovascular disease, diabetes, cancer) are chronic diseases that require long-term management. Among the psychological variables that mostly contribute to the quality of life in people with these diseases, there are illness percep-tion and coping strategies. This study aims to test, in a sample of 107 Italian patients (53% F; 47% M; age: 59.9 ± 10.57) affected by one or more noncommunicable diseases, two analogous mediation models, one with mental component of quality of life and one with the physical component of quality of life as mediation variables, according to which illness perception affects quality of life both directly and through the mediation of coping strategies. Data were collected through an on-line questionnaire and descriptive statistical analyses, a Student T-test, and mediation analysis with gender and age as covariates were performed. The results show that illness perception affects mental component of quality of life both directly and through the mediation of avoidance coping, while it affects the physical compo-nent only directly; age affects greater use of avoidant strategies and a worse physical quality of life. Interestingly, the positive effect of approach strategies is smaller than the negative effect of avoidant strategies. It would be important to promote psychological interventions that support patients to develop a less threatening illness perception that could be associated with less use of avoidant strategies.

Keywords: noncommunicable disease, illness perception, coping strategies, "quality of life".

  1. Andersson A. F. S. (2000). Coping strategies in patients with acquired brain injury: Relationships between coping, apathy, depression and lesion location. Brain injury, 14(10), 887-905. DOI: 10.1080/02699050044571
  2. Asbring P. (2001). Chronic illness–a disruption in life: identity‐transformation among women with chronic fatigue syndrome and fibromyalgia. Journal of advanced nursing, 34(3), 312-319.
  3. Ashley L., Marti J., Jones H., Velikova G. & Wright P. (2015). Illness perceptions within 6 months of cancer diagnosis are an independent prospective predictor of health‐related quality of life 15 months post‐diagnosis. Psycho‐Oncology, 24(11), 1463-1470.
  4. Aujoulat I., d’Hoore W. & Deccache A. (2007). Patient empowerment in theory and practice: polysemy or cacophony?. Patient education and counseling, 66(1), 13-20.
  5. Aujoulat I., Marcolongo R., Bonadiman L. & Deccache A. (2008). Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control. Social science & medicine, 66(5), 1228-1239.
  6. Bodenheimer T., Wagner E. H. & Grumbach K. (2002). Improving primary care for patients with chronic illness. Jama, 288(14), 1775-1779.
  7. Broadbent E., Petrie K. J., Main J. & Weinman J. (2006). The brief illness perception questionnaire. Journal of psychosomatic research, 60(6), 631-637.
  8. Broadbent E., Wilkes C., Koschwanez H., Weinman J., Norton S. & Petrie K. J. (2015). A systematic review and meta-analysis of the brief Illness Perception Questionnaire. Psychology & health, 30(11), 1361-1385.  DOI: 10.1080/08870446.2015.107085
  9. Brock K., Clemson L., Cant R., Ke L., Cumming R. G., Kendig H. & Mathews M. (2011). Worry in older community-residing adults. The International Journal of Aging and Human Development, 72(4), 289-301. DOI: 10.2190/AG.72.4.
  10. Bury M. (1982). Chronic illness as biographical disruption. Sociology of health & illness, 4(2), 167-182. 
  11. Carver C. S., Scheier M. F. & Weintraub J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of personality and social psychology, 56(2), 267. DOI: 10.1037/0022-3514.56.2.26
  12. Carver C. S. (1997). You want to measure coping but your protocol’ too long: Consider the brief cope. International Journal of Behavioral Medicine, 4(92).
  13. Chudasama Y. V., Gillies C. L., Zaccardi F., Coles B., Davies M. J., Seidu S. & Khunti K. (2020). Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 14(5), 965-967.
  14. Clavé S., Tsimaratos M., Boucekine M., Ranchin B., Salomon R., Dunand O., Garnier A., Lahoche A., Fila M., Roussey G., Broux F., Harambat J., Cloarec S., Menouer S., Deschenes G., Vrillon I., Auquier P. & Berbis J. (2019). Quality of life in adolescents with chronic kidney disease who initiate haemodialysis treatment. BMC nephrology, 20: 1-10.
  15. Corbin J. & Strauss A. (1985). Managing chronic illness at home: three lines of work. Qualitative sociology, 8(3), 224-247. DOI: 10.1007/BF0098948
  16. De Beni R. e Borella E., a cura di (2015). Psicologia dell’invecchiamento e della longevità [Psychology of ageing and longevity]. Bologna: Il mulino.
  17. Diefenbach M. A., and Leventhal H. (1996). The common-sense model of illness representation: Theoretical and practical considerations. Journal of social distress and the homeless, 5(1), 11-38. DOI: 10.1007/BF0209045
  18. Dwan T. & Ownsworth T. (2019 The Big Five personality factors and psychological well-being following stroke: a systematic review. Disability and rehabilitation, 41(10), 1119-1130. DOI: 10.1080/09638288.2017.141938
  19. Eisenberg S. A., Shen B. J., Schwarz E. R. & Mallon S. (2012). Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients. Journal of behavioral medicine, 35(3), 253-261.
  20. Erp S. V., Brakenhoff L. K. M. P., Vollmann M., Heijde D., Veenendaal R., Fidder H., Hommes D. W., Kaptein A. A., van der Meulen-de Jong A. E. & Scharloo M. (2016). Illness perceptions and outcomes in patients with inflammatory bowel disease: is coping a mediator?. Journal of Crohn’s and Colitis, 10: S156-S157. 10.1007/s12529-016-9599-y
  21. Freda M. F., Savarese L., Dolce P. & Picione, R. D. L. (2019). Caregivers’ sensemaking of children’s Hereditary Angioedema: a semiotic narrative analysis of the Sense of Grip on the Disease. Frontiers in Psychology, 10: 2609.
  22. Gandek B., Ware J. E., Aaronson N. K., Apolone G., Bjorner J. B., Brazier J. E., Bullinger M., Kaasa S., Leplege A., Prieto L. & Sullivan M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Journal of clinical epidemiology, 51(11), 1171-1178.
  23. Hayes A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford publications.
  24. Holman H. & Lorig K. (2004). Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public health reports, 119(3), 239-243.
  25. Kantidakis J. D., Moulding R. & Knowles S. R. (2021). Psychological mediators of psychological distress and quality of life in inflammatory bowel disease. Journal of Psychosomatic Research, 149: 110596.
  26. Knowles S. R., Apputhurai P., O’Brien C. L., Ski C. F., Thompson D. R. & Castle D. J. (2020). Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. Psychology, health & medicine, 25(2), 214-228. DOI: 10.1080/13548506.2019.169586
  27. Kodraliu G., Mosconi P., Groth N., Carmosino G., Perilli A., Gianicolo E. A., Rossi C. & Apolone G. (2001). Subjective health status assessment: evaluation of the Italian version of the SF-12 Health Survey. Results from the MiOS Project. J Epidemiol Biostat, 6(3), 305-316. DOI: 10.1080/135952201317080715
  28. Kristofferzon M. L., Engström M. & Nilsson A. (2018). Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study. Quality of Life Research, 27, 1855-1863.
  29. Lazarus R. S. & Folkman S. (1984). Stress, appraisal and coping. New York: Springer.
  30. Louvardi M., Pelekasis P., Chrousos G. P. & Darviri C. (2020). Mental health in chronic disease patients during the COVID-19 quarantine in Greece. Palliative & Supportive Care, 18(4), 394-399.  DOI: 10.1017/S1478951520000528
  31. Maiello A., Savarese L., De Luca Picione R., Auriemma E. e Pacella, D. (2022). Il Senso di Padronanza della Malattia Cronica: una ricerca mixed Method con adulti affetti da Angioedema Ereditario [The Sense of Grip on Chronic Disease: a mixed method research with adults suffering from Hereditary Angioedema]. Psicologia della salute, 2, 55-79. DOI: 10.3280/PDS2022-00200
  32. Maresova P., Javanmardi E., Barakovic S., Barakovic Husic J., Tomsone S., Krejcar O. & Kuca K. (2019). Consequences of chronic diseases and other limitations associated with old age–a scoping review. BMC public health, 19, 1-17.
  33. Martino M. L., Lemmo D., Gargiulo A., Barberio D., Abate V., Avino F. & Tortoriello R. (2019). Underfifty women and breast cancer: Narrative markers of meaning-making in traumatic experience. Frontiers in psychology, 10: 618.
  34. Mc Grady A., and Moss D. (2018). Integrative Pathways: Navigating Chronic Illness with a Mind-Body-Spirit Approach. New York: Springer.
  35. McGrady M. E., Peugh J. L. & Hood K. K. (2014). Illness representations predict adherence in adolescents and young adults with type 1 diabetes. Psychology & Health, 29(9), 985-998.  DOI: 10.1080/08870446.2014.89936
  36. Pain D., Angelino E. & Miglioretti M. (2006). Sviluppo della versione italiana del Brief-IPQ (Illness Perception Questionnaire, short version), strumento psicometrico per lo studio delle Rappresentazioni di Malattia. Rivista di Psicologia della Salute, 1, 91-90. DOI: 10.1400/9114
  37. Park C. L. (2010). Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological bulletin, 136(2), 257.
  38. Park C. L. & Kennedy M. C. (2017). Meaning violation and restoration following trauma: Conceptual overview and clinical implications. In Altmaier E. M., ed., Reconstructing meaning after trauma: Theory, research and practice (pp. 17-27). London: Academic Press.
  39. Pedersen A. F., Olesen F., Hansen R. P., Zachariae R. & Vedsted P. (2013). Coping strategies and patient delay in patients with cancer. Journal of psychosocial oncology, 31(2), 204-218. DOI: 10.1080/07347332.2012.76131
  40. Rapelli G., Lopez G., Donato S., Pagani A. F., Parise M., Bertoni A. & Iafrate R. (2020). A Postcard from Italy: Challenges and Psychosocial Resources of Partners Living with and without a Chronic Disease During COVID-19 Epidemic. Frontiers in psychology, 11, 567522.
  41. Richardson E. M., Schuez N., Sanderson K., Scott J. L. & Schüz B. (2017). Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta‐analysis. Psycho‐oncology, 26(6), 724-737.
  42. Salari M., Zali A., Ashrafi F., Etemadifar M., Sharma S., Hajizadeh N. & Ashourizadeh H. (2020). Incidence of Anxiety in Parkinson’s Disease During the Coronavirus Disease (COVID-19) Pandemic. Movement disorders: official journal of the Movement Disorder Society, 35(7), 1095-1096.
  43. Sampaio R., Pereira M. G. & Winck J. C. (2012). Psychological morbidity, illness representations, and quality of life in female and male patients with obstructive sleep apnea syndrome. Psychology, health & medicine, 17(2), 136-149. DOI: 10.1080/13548506.2011.57998
  44. Savarese L., Bova M., De Falco R., Guarino M. D., De Luca Picione R., Petraroli A., Senter R., Traverso C., Zabotto M., Zanichelli A., Zito E., Alessio M., Cancian M., Cicardi M., Franzese A., Perricone R., Marone G., Valerio P. & Freda M. F. (2018). Emotional processes and stress in children affected by hereditary angioedema with C1-inhibitor deficiency: a multicenter, prospective study. Orphanet Journal of Rare Diseases, 13, 1-8.
  45. Savarese L., Freda M. F., De Luca Picione R., Dolce P., De Falco R., Alessio M., Cancian M., Franzese A., Guarino M. D., Perricone R., Petraroli A., Senter R., Traverso C., Zanichelli A., Zito E. & Bova M. (2020). The experience of living with a chronic disease in pediatrics from the mothers’ narratives: The clinical interview on parental sense of grip on the disease. Health Psychology Open, 7(2), 2055102920971496. DOI: 10.1177/2055102920971496
  46. Sherwin L. B., Leary E. & Henderson W. A. (2016). Effect of illness representations and catastrophizing on quality of life in adults with irritable bowel syndrome. Journal of Psychosocial Nursing and Mental Health Services, 54(9), 44-53. DOI: 10.3928/02793695-20160803-0
  47. Sonney J., Insel K. C., Segrin C., Gerald L. B. & Moore I. M. K. (2017). Association of asthma illness representations and reported controller medication adherence among school-aged children and their parents. Journal of Pediatric Health Care, 31(6), 703-712.
  48. Tiemensma J., Gaab E., Voorhaar M., Asijee G. & Kaptein A. A. (2016). Illness perceptions and coping determine quality of life in COPD patients. International journal of chronic obstructive pulmonary disease, 11, 2001-2007. DOI: 10.2147/COPD.S10922
  49. Tu H., Gong G., Zhang S., Fu Y., Wang T., Chu Q., Hu S., Wang K., Zhu C. & Fan Y. (2022). The association between illness perception and quality of life among Chinese adults with epilepsy: The mediating role of coping style. Epilepsy & Behavior, 130, 108677.
  50. van Dooren F. E., Verhey F. R., Pouwer F., Schalkwijk C. G., Sep S. J., Stehouwer C. D., Henry R. M. A., Dagnelie P. C., Schaper N. C., van der Kallen C. J. H., Koster A., Schram M. T. & Denollet J. (2016). Association of Type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? – The Maastricht Study. Journal of affective disorders, 189: 118-125.
  51. Vaske I., Kenn K., Keil D. C., Rief W. & Stenzel N. M. (2017). Illness perceptions and coping with disease in chronic obstructive pulmonary disease: effects on health-related quality of life. Journal of Health Psychology, 22(12), 1570-1581. DOI: 10.1177/135910531663119
  52. WHO (2022). Noncommunicable disease. -- Retrieved from:
  53. Wierenga K. L., Lehto R. H. & Given B. (2017). Emotion regulation in chronic disease populations: An integrative review. Research and theory for nursing practice, 31(3), 247-271. DOI: 10.1891/1541-6577.31.3.24
  54. Wilski M., Gabryelski J., Brola W. & Tomasz T. (2019). Health-related quality of life in multiple sclerosis: Links to acceptance, coping strategies and disease severity. Disability and health journal, 12(4), 608-614.
  55. Woon L. S. C., Sidi H. B., Ravindran A., Gosse P. J., Mainland R. L., Kaunismaa E. S., Hatta N. H., Arnawati P., Zulkifli A. Y., Mustafa N. & Leong Bin Abdullah M. F. I. (2020). Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study. BMC psychiatry, 20(1), 1-14.

Ersilia Auriemma, Assunta Maiello, Concetta Esposito, Maria Francesca Freda, Il ruolo delle strategie di coping nell’associazione tra rappresentazione di malattia e qualità della vita in un campione di pazienti italiani con noncommunicable diseases in "PSICOLOGIA DELLA SALUTE" 2/2023, pp 84-102, DOI: 10.3280/PDS2023-002006