The Moderating Effects of Coping Strategies on Major Depression in the General Population

JianLi Wang, MMSc, PhD1, Scott B Patten, MD, PhD, FRCPC2

Objectives: To evaluate the moderating effects of various coping strategies on the association between stressors and the prevalence of major depression in the general population.

Methods: Subjects from the Alberta buy-in component of the 1994 –1995 National Population Health Survey (NPHS) were included in the analysis (n = 1039). Each subject was asked 8 questions about coping strategies that dealt with unexpected stress from family problems and personal crises. Major depression was measured using the World Health Organization’s (WHO) Composite International Diagnostic Interview-Short Form (CIDI-SF) for major depression. The impacts of coping strategies in relation to psychological stressors on the prevalence of major depression were determined by examining interactions between coping and life stress on major depression using logistic regression modelling.

Results: No robust impact of coping strategies in relation to various categories of stress evaluated in the NPHS was observed. There was evidence that the use of “pray and seek religious help” and “talks to others about the situations” as coping strategies by women moderated the risk of major depression in the presence of financial stress and relationship stress (with a partner). Using emotional expression as a coping strategy by women might decrease the risk of major depression in the presence of 1 or more recent life events, personal stress, relationship stress (with a partner), and environmental stress.

Conclusion: Different coping strategies may have a differential impact on the prevalence of major depression in specific circumstances. These findings may be important both to prevent and to treat depressive disorders.

(Can J Psychiatry 2002;47:167–173)

Clinical Implications

Coping strategies in relation to life stressors may be determinants of mood disturbance in the general population.
The moderating effects of coping strategies on the prevalence of major depression are sex-specific and conditional on the specific stress exposures.
The National Population Health Survey (NPHS) was a representative survey; these findings can apply to the Canadian community populations.

Limitations

This analysis was cross-sectional; therefore, a causal inference could not be drawn.
The NPHS relied on self-reported information and a rudimentary method of evaluating coping strategies.
The Composite International Diagnostic Interview-Short Form (CIDI-SF) is a brief indicator for major depression.

Key Words: major depression, coping, stressors, women, life events, chronic stress

Résumé : Les effets modérateurs des stratégies d’adaptation sur la dépression majeure dans la population générale

Coping is a response aimed at diminishing the physical, emotional, and psychologic burden linked to stressful life events and daily hassles (1,2). Coping responses are believed to play an important role in depression (3,4). Further, stressful life events have been found to have a causal relation with the onset of major depression (5). However, the relations among stressful life events, coping, and major depression at the population level remain unclear.

One possible way in which coping can affect well-being is by moderating the effects of stress on depressive symptoms (6,7) where individuals with effective coping strategies may have a lower risk of depressive disorders. However, there has been a paucity of epidemiological research on the moderating effects of coping strategies on major depression. Evidence from an existing literature with respect to the moderating effect of coping on depressive symptom levels has been inconsistent. In a study using 60 patients with major depression according to the DSM-IV criteria, Bouhuys and others (8) failed to find that coping moderated the effects of negative emotions on the levels of depressive symptoms measured 6 weeks later. Similarly, using a sample comprising 424 depression patients, Billings and Moos (9) reported that coping responses did not moderate the effects of life stressors on depressive symptom levels measured by the Research Diagnostic Criteria for Depression (10). However, in a longitudinal community study, problem-focused coping was found to have a moderating effect on depressive symptoms among those who were exposed to a self-named stress episode (11).

Appropriate coping also reduced depressive symptom levels among parents of children with autism and among caregivers working in nursing homes and long-term care facilities (12,13).

The objective of this analysis was to examine the moderating effects of various coping strategies on the associations between stressful life events, chronic stresses, and major depression in the general population. To fulfill this objective, data from the Alberta buy-in component of the Canadian National Population Health Survey (NPHS) were used. In 1994–1995, Statistics Canada initiated the NPHS using a multistaged, stratified, random sampling procedure. The NPHS was conducted every 2 years. The target population of the NPHS included household residents in all provinces, with the exclusion of residents of Indian reserves, Canadian Forces bases, and some remote areas in Ontario and Quebec (14). Under agreements between Statistics Canada and provincial governments, the sample size in a province could be increased, and additional information could be collected in return for extra funds. As part of a buy-in agreement between Statistics Canada and the Alberta Ministry of Health, respondents who were age 18 years or over in Alberta in the 1994–1995 NPHS were asked questions about how they coped with unexpected stress from family problems and personal crises. These subjects formed the basis of this analysis.