The role of appraisal and coping style in relation with societal participation in fatigued patients with multiple sclerosis: a cross-sectional multiple mediator analysis
OBJECTIVE To test the Spinal Cord Injury Adjustment Model and gain a better understanding about whether and how the psychological resources general self-efficacy (SE), purpose in life (PIL), appraisals, and coping influence participation in persons with spinal cord injury (SCI). DESIGN Cross-sectional data collection within the Swiss Spinal Cord Injury Cohort. SETTING Community setting. PARTICIPANTS Persons with SCI (N=516) who are ≥ 16 years old and living in the community in Switzerland. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation was measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation, General SE with the General Self-Efficacy Scale, PIL with the Purpose in Life Test-Short Form, appraisals with the Appraisal of Life Events Scale, and coping with the Brief COPE. RESULTS General SE (r=.32) and PIL (r=.23) were associated with less participation restrictions. The initial model yielded a poor model fit. The modified final model had an acceptable fit (χ(2)11=36.2; P<.01; root mean square error of approximation=.067 [90% confidence interval: .045-.09]; comparative fit index=.98). A total of 15% of the variance of participation was explained. In the final model, general SE had a moderate direct effect (β=.24) and mediated effects via threat appraisal and challenge appraisal and humor on participation, indicating a partial mediation effect. The association between PIL and participation was indirect: challenge appraisal and humor acted as mediators. CONCLUSIONS The results only partly support the double-mediating effect as suggested in the SCI adjustment model because both direct and indirect effects on participation were observed. Individuals with higher general SE and PIL perceive less participation restrictions. General SE seems an appropriate target to enhance participation. Longitudinal studies are needed to support our findings.