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Research on distress and coping provides theoretical and practical information on treatment. Cognitive and behavioural coping with illness itself or a specific treatment affect adjustment in the hospital setting.1-4
Assessment of coping in children with serious and chronic illness is useful for a variety of reasons. Most paediatric patients are psychologically healthy and, therefore, traditional measures of psychopathology are inappropriate. In this and the accompanying paper,5 two instruments will be reviewed; both are designed for physically ill, but mentally healthy, children. Assessing distress and coping over time and in different situations will lead to hypotheses about distress and coping—hypotheses that can be tested in treatment or clinical research programmes. Encouraging clinicians to explore children's coping will improve the care of children, especially those with a long term illness.
In the past, many different self report measures were applied (Tobin et al, 1984, unpublished; Patterson and McCubbin, 1983, unpublished).6-8 It is suggested that widespread use of the same instrument would allow distress and coping data to be compared more convincingly. Systematic administration and uncomplicated, yet thorough, analyses would lead to establishing a solid research base from which the effects of coping could be explored. The strengths and weaknesses of different coping strategies could then be demonstrated.
Definition of distress and of coping
Lazarus refers to “distress” as a reaction to stress with emotional overtones.9 Coping is also a reaction to stress. Lazarus and Folkman define “coping” as “constantly changing cognitive and behavioural efforts to manage the specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person”.10 Thus, in Lazarus' view, distress is an emotional reaction whereas coping always involves efforts to deal with the stress. This definition also suggests that coping strategies used by the individual may vary across types of stressor and over …