Exploring Coping Strategies of Culturally

Diverse Family Members of Psychiatric Patients

Phyllis M. Eaton
PhD, RN, PMHCNS-BC

Introduction
Coping strategies can be classified as (Lazarus &
Folkman, 1984):

Emotion-focused: Manage the negative

emotions associated with the stressful
situation
Cognitive distraction
Seeking emotional support
Cognitive restructuring

Problem focused: Efforts used to directly

change the basis of stress
Changing external pressures
Seeking resources
Utilization of social supports

Introduction
These coping strategies can be further
classified as:
Positive Coping strategies:
Utilization of appropriate:
Social supports (family, friends,
church)
Resources (education, finances,
professionals)
Positive thinking
Negative coping strategies:
Avoidance
Substance abuse
Negative thinking
(Letvak, 2002; McCubbin and Comeau, 1991; Perkins, Winn, Murray, Murphy, & Schmidt, 2004)

Statement of the Problem

Family members of hospitalized psychiatric
patients are being given the responsibility of
caring for their relative to help fill the gap in
service that exits between inpatient to
outpatient treatment (Enns,et al., 1999).
Many families do not have the coping
strategies to cope with this situation (Rose, 1997).
The problem of this investigation is to explore
the coping strategies of family members of
hospitalized psychiatric patients.

Background
Families caring for a mentally ill relative
experience economic strain, isolation, stigma,
and burnout [negative coping] (McKenry & Price, 2005).

Little research has been done on how the

specific variables of support systems and
resources impact the familys coping ability
(Enns, et al., McKenry & Price, 2005).

Significance of Problem
With about half of the mentally ill suffering
from more than one mental disorder at the
same time, continuation of care post
hospitalization is essential for positive
treatment outcomes (Enns, et al.,1999; NIMH, 2007).
Identification of family coping strategies may
help support the familys ability to cope with
their situation and improve patient outcomes
(Enns, et al.).

Statement of Purpose
The purposes of this study were to
investigate what coping strategies
families of psychiatric patients use and
to identify their positive and negative
coping strategies.

Conceptual Framework
The Neumans Systems Model was
used to guide this study and test the
middle-range theory of Coping
Strategies of Family Members of
Psychiatric Patients.

Conceptual Framework
Neumans Systems Model
Views client/client systems as dynamic
interrelated variables that interact
continuously with stressors from the
environment.
All client systems have five interrelated
variables, which work together
simultaneously as the client responds to
the internal, external, and created
environment (Neuman, 1995; 2002).

Neuman's Systems Model

Theory of coping strategies of family members of

hospitalized psychiatric patients
Conceptual
Model
Concepts
MiddleRange
Theory
Concepts
Empirical
Research
Methods

External
Environment

Psychological

Sociocultural

Developmental

Spiritual

Stressor

Family
Coping
Strategies

Social Cultural
Supports

Family
Relation

Spirituality
as a Coping
Strategy

Family
member with
diagnosed
psychiatric
disorder

F-COPES
Subscales:
- Acquiring

Social
Support

-Reframing
-Seeking Spiritual
Support
-Mobilizing Family to
Acquire/Accept Help

F-COPES
Subscales:
-Acquiring Social
Support
-Mobilizing Family to
Acquire/Accept Help

BDS

F-COPES
Subscales:
-Seeking
Spiritual
Support

Semistructured
Interview

-Passive Appraisal
BDS- Background Data Survey

Semistructured
Interview

F-COPES- Family Crisis Oriented Personal Evaluation

Scales
10

Research Questions
1. What coping strategies do family members
of psychiatric patients use?
2. What are the common support systems used
by family members of psychiatric patients?
3. What is the relationship between ethnicity,
gender, income, family relation, and coping
of family members of psychiatric patients?

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Research Design
Exploratory, Descriptive Correlation Research
Design with a mixed method approach.
Quantitative & Qualitative
Survey
Semistructured Interview

12

Sample/Setting
Convenient sample
45 participants-chosen so there is at least
90% power to conduct both the descriptive
and regression analyses
All 45 participants completed the survey
and semi-structured interview.
Inclusion criteria:
Adult (18-80 years of age)
Family member of psychiatric patient
Family member is anyone who the
mentally ill individual deems to be family
13

Instrumentation
A participant background data survey (BDS)
consisting of demographic data was
collected.
Gender
Age
Ethnicity
Income
Family relation
Approximately five minutes to complete

14

Instrumentation
The Family Crisis Oriented Personal
Evaluation Scales (F-COPES) (McCubbin, Olson, &
Larsen, 1991):

Permission to use instrument was obtained

30 item instrument
5-point scale
Approximately 10-15 minutes to complete
Identifies problem-solving and behavioral
strategies the family uses during difficult
situations
Identifies coping levels of the family
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Instrumentation
F-COPES examines five areas of family
coping (subscales):
Acquiring social support
Reframing (familys ability to redefine
stress/ situation)
Seeking spiritual support
Mobilizing family to acquire & accept help
Passive appraisal (familys ability to accept
difficult issues minimizing reactivity)

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Semi-Structured Interview
The interview consisted of questions
regarding the familys perception of their:
Coping strategies
Support systems
Family resources
Role of health care professionals in helping
them cope with their mentally ill relative
Developed by the research with the help of
an expert in psychiatric nursing and the IRB
committees.

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Data Analysis
Quantitative:
Descriptive statistics described demographic
data.
F-COPES item analysis determined the use
of coping strategies.
Univariate linear regression analysis
examined the relationship between
independent variables and the total F-COPES
Ethnicity, Age, Gender, Income, Family
Relation

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Data Analysis
Quantitative:
Chi-Square analysis compared the lowest
and highest coping scores with the
demographic data.

Spearman Rank Correlation examined the

relationship between coping ability and
spirituality of family members.
The significance level was set at 0.05.

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Data Analysis
Qualitative:
Semi-structured interviews data
Content analysis was performed
Themes identified
Data categorized
Patterns and trends identified
Expert reviewing data
Both research methods were used to
measure family coping, use of support
systems, resources, and spirituality.

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Sample Characteristics
N= 45 Family members
51.1% were women
48-57 years old (37.8%) most common age
range
Children was the prevalent family relation
(35.6%)
Annual income $100,000 or more per year
most common (29.7%)
Ethnicity of Participants:
Caucasians (55.6%)
African Americans (42.22%)
Hispanic/Latino (2.22%)
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Research Question #1
What coping strategies do family
members of psychiatric patients use?
F-COPES subscales:
Seeking spiritual support
(most common: median = 4)

Reframing
Mobilizing family to acquire/accept
help
Passive Appraisal
Acquiring social support
(least common: median = 3.11)
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Research Question #1
The most common coping strategy
F-COPES item used was Having faith in God
(median = 5)

Common coping strategies:

Doing things with relatives
Acceptance of difficulties and defining the
problem in a positive way
Seeking information and advice from the
family doctor
Feeling no mater what we do to prepare,
we will have difficulty handling problems
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Research Question #1
The least common coping strategy F-COPES
item used was Sharing problems with
neighbors (median = 2)
Least common coping strategies:
Believing we can handle our own problems
Participating in church activities
Seeking assistance from community
agencies and programs designed to help
families in our situation
Believing if we wait long enough, the
problem will go away
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Research Question #1
Semi-structured interview:
What coping strategies do you use when
caring for your loved one?
Prayer and having faith in God (most
common theme)
PrayPray a lot!
I do spiritual thingslike pray, read
the bible.

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Research Question #1
Common themes:
Acceptance
I just accept her behavior
I just face it head on

Support of immediate family

My family is my lifeline
I only talk to my family about the situation.
I dont share it with anyone elsethey just
wouldnt understand.

Passive activities
When I need a break I just watch TV
Reading is my escape
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Research Question #2
What are the common support systems used
by family members of psychiatric patients?
F-COPES subscale:
Seeking spiritual support
(most common: median = 4)

Church involvement
Seeking ministers advice
Mobilizing family to acquire and accept
help (median = 3.75)
Acquiring social support from friends,
neighbors, and relatives (Least common:
median = 3.11)
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Research Question #2
Semi-structured interview:
What support systems do you use to help
you cope with your loved one?
The most common theme was
immediate family.
My family membersimmediate
family
My family, my husband
Other common themes:
Church; Good friends
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Research Question #3
What is the relationship between ethnicity,
gender, income, family relation, and coping of
family members of psychiatric patients?
F-COPES:
Demographic variables did not have a
significant impact on coping ability.
Age (R = 0.08)
Ethnicity (R = 0.04)
Gender (R = 0.01)
Annual income (R = 0.33)
Relation (R = 0.09)
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Research Question #3
Demographic data was compared to the
lowest number of total coping scores (10%)
and the highest number of total coping scores
(10%).
Lowest total coping score:
Individuals aged 48-57 years old
Males
African Americans
Spouse/significant others
Incomes under $50,000/year
Demographic profile was not statistically
significant when compared to the lowest total
coping scores.
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Research Question #3
Highest total coping score:
Individuals aged 48-57 years old
Females
White
Children
Incomes under $70,000/year
Only gender (female) was statistically
significant (p = 0.04) when compared to the
highest total coping scores.

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Major Findings
Family members of psychiatric patients use
more emotion-focused coping strategies than
problem-focused coping strategies.
Talking with immediate family
Acceptance of situation

Passive activities is a significant coping

strategy used by family members.
Watching television
Reading

Negative, maladaptive coping strategies do

not significantly impact the results of the is
study.
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Major Findings
Family members of psychiatric patients
use a variety of support systems.
Quantitative analysis reveals families use
spiritual supports, such as attending
church and seeking advice from a minister.
Qualitative analysis reveals families state
their immediate family as the most
common support system they use.

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Major Findings
No significant relationship between
coping and socioeconomic factors
Examining the demographic factors of
the highest coping scores, only gender
(female) was found to be statistically
significant.
May suggest that female relatives of
psychiatric patients may be able to cope
better than male relatives

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Conclusions
Family members of psychiatric patients use
more emotion-focused coping strategies than
problem-focused coping strategies.
Communication with family members
Cognitive distraction (watching TV)
Cognitive restructuring (acceptance)

There is no significant relationship between

coping strategies and culturally diverse family
members.

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Conclusions
Information is a vital resource for families:
Illness education
Support groups
Condition of relative
Spirituality is found to be central in the
familys ability to cope with their mentally ill
loved one.
Spirituality as a coping strategy is a positive
influence on the familys overall coping ability.
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Hampton University
Dissertation Committee Members:
Bertha L. Davis, PhD, RN, FAAN, ANEF
Chair of Committee

Pamela V. Hammond, PhD, RN, FAAN, ANEF

Esther H. Condon, PhD, RN
Zina T. McGee, PhD

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