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Definitions, New Treament Directions
Disease" and Beyond: Misdiagnosis, Antidepressant Use, and a Proposed
Definition for Bipolar Spectrum Disorder
S Nassir Ghaemi,
James Y Ko, Frederick K Goodwin
of Bipolar Disorder: Focus on Signal Transduction Pathways and the
Regulation of Gene Expression
Yarema Bezchlibnyk, L Trevor Young
and Its Association With Long-Term Medical Conditions
Lisa M Gagnon, Scott B Patten
Disorders: Relevance of Icelandic and Icelandic-Canadian Evidence
to Etiologic Hypotheses
Jóhann Axelsson, Jón G Stefànsson,
Andrés Magnússon, Helgi Sigvaldason, Mikael M Karlsson
Inpatient Religious Commitment: An Association With Mental Health
Marilyn Baetz, David B Larson, Gene Marcoux, Rudy
Bowen, Ron Griffin
Moderating Effects of Coping Strategies on Major Depression in the
JianLi Wang, Scott B Patten
Side Effects in Depression Patients Treated in A Naturalistic Setting:
A Study of Bupropion, Moclobemide, Paroxetine, Sertraline, and Venlafaxine
JD Vanderkooy, Sidney H Kennedy, R Michael Bagby
Delays for Involuntary Psychiatric Patients Associated With Reviews
of Treatment Capacity
Michelle Kelly, Sandra Dunbar, John E Gray, Richard
Letters to the Editor
The Moderating Effects of Coping Strategies on Major Depression in the
JianLi Wang, MMSc, PhD Scott B Patten,
MD, PhD, FRCPC
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 Organizations (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
(Can J Psychiatry 2002;47:167173)
- 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
- 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
: Les effets modérateurs des stratégies dadaptation
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 19941995, 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 19941995 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.