Roubinov Danielle S, Turner Aaron P, Williams Rhonda M
Veterans Affairs Puget Sound Healthcare System.
Rehabil Psychol. 2015 May;60(2):162-8. doi: 10.1037/rep0000032. Epub 2015 Mar 30.
Multiple sclerosis (MS) is a chronic illness involving both controllable and uncontrollable stressors. The goodness-of-fit hypothesis posits that managing stressors effectively requires the use of different coping approaches in the face of controllable and uncontrollable stressors. To test the applicability of the goodness-of-fit model in a sample of adults with MS, we evaluated the ratio of 2 types of coping (an active problem-solving approach and an emotion-based meaning-focused approach) as a moderator of the relations between stress uncontrollability and mental health outcomes.
Participants were veterans with MS (N = 90) receiving medical services through the Veterans Health Administration who completed telephone-based interviews. Regression analyses tested the interaction of stress uncontrollability and the problem- and meaning-focused coping ratio on anxious and depressive symptoms. Significant interactions were probed at 1 SD above the mean of coping (use of predominantly problem-focused coping) and 1 SD below the mean of coping (use of predominantly meaning-focused coping).
Findings largely supported the goodness-of-fit hypothesis. Anxiety and depressive symptoms were elevated when participants used more problem-focused strategies relative to meaning-focused strategies in the face of perceived uncontrollable stress. Conversely, symptoms of anxiety and depression were lower when uncontrollable stress was met with predominantly meaning-focused coping; however, the relations did not reach statistical significance.
The impact of uncontrollable stressors on mental health outcomes for individuals with MS may vary depending on the degree to which problem-focused versus meaning-focused coping strategies are employed, lending support to the goodness-of-fit model.
多发性硬化症（MS）是一种涉及可控和不可控应激源的慢性疾病。适配度假说认为，有效应对应激源需要在面对可控和不可控应激源时采用不同的应对方法。为了检验适配度模型在成年MS患者样本中的适用性，我们评估了两种应对方式（积极解决问题的方法和基于情绪的意义聚焦方法）的比例，作为应激不可控性与心理健康结果之间关系的调节因素。
参与者是通过退伍军人健康管理局接受医疗服务的患有MS的退伍军人（N = 90），他们完成了基于电话的访谈。回归分析测试了应激不可控性与以问题为中心和以意义为中心的应对比例对焦虑和抑郁症状的交互作用。在应对均值以上1个标准差（主要使用以问题为中心的应对方式）和应对均值以下1个标准差（主要使用以意义为中心的应对方式）处探究显著的交互作用。
研究结果在很大程度上支持了适配度假说。当参与者在面对感知到的不可控应激时，相对于以意义为中心的策略使用更多以问题为中心的策略时，焦虑和抑郁症状会升高。相反，当面对不可控应激时主要采用以意义为中心的应对方式时，焦虑和抑郁症状较低；然而，这些关系未达到统计学显著性。
不可控应激源对MS患者心理健康结果的影响可能因采用以问题为中心与以意义为中心的应对策略的程度而异，这为适配度模型提供了支持。
