Schnoll R, Harlow L L, Brandt U, Stolbach L L
Department of Psychology, University of Rhode Island, Kingston 02881, USA.
Psychooncology. 1998 Sep-Oct;7(5):424-35. doi: 10.1002/(SICI)1099-1611(1998090)7:5<424::AID-PON322>3.0.CO;2-2.
The validity and reliability of two factor structures of the Mental Adjustment to Cancer (MAC) scale for assessing coping style was assessed by examining the relationship between the subscales, psychological distress, and quality of life (QOL) among Stage II and Stage IV breast cancer patients in four phases. First, MANOVAs assessed differences in coping, distress, and QOL across disease stages. Second, for each MAC factor structure, canonical correlation analyses assessed the relationship between coping styles, distress, and QOL, for each disease-stage group separately. Third, structural equation modeling (SEM) assessed the relationship among coping styles, distress, and QOL for all participants. Finally, the internal consistency of both MAC factor structures was assessed using Chronbach's alpha. The results were as follows: (1) significant differences across disease stages were found for coping styles using either the Watson or the Schwartz MAC subscales, but there were no differences in levels of distress or QOL; (2) for both MAC factor structures, coping style was found to be highly related to emotional distress and QOL, however, the strengths of the correlations between individual coping styles and distress/QOL indicators varied across disease stages; (3) SEM indicated that coping style was significantly related to distress and QOL when stage of disease was not considered, and that coping style and indicators of distress/QOL are separate, but highly correlated factors, as opposed to a single latent construct; and, (4) the Watson MAC subscales showed slightly better internal consistency than the Schwartz MAC subscales. Taken together, these findings highlight: (i) the validity of both MAC factor structures for clinical and research use with American breast cancer patients; (ii) the role of coping style as a mediator between disease stage and psychological distress and QOL; and, (iii) the need for refinement of certain Watson and Schwartz subscales.
通过分四个阶段检查Ⅱ期和Ⅳ期乳腺癌患者分量表、心理困扰和生活质量（QOL）之间的关系，评估了用于评估应对方式的癌症心理调适（MAC）量表的两种因子结构的有效性和可靠性。首先，多变量方差分析评估了不同疾病阶段应对方式、困扰和生活质量的差异。其次，对于每种MAC因子结构，典型相关分析分别评估了每个疾病阶段组应对方式、困扰和生活质量之间的关系。第三，结构方程模型（SEM）评估了所有参与者应对方式、困扰和生活质量之间的关系。最后，使用克朗巴赫α系数评估了两种MAC因子结构的内部一致性。结果如下：（1）使用沃森或施瓦茨MAC分量表时，发现不同疾病阶段的应对方式存在显著差异，但困扰程度或生活质量没有差异；（2）对于两种MAC因子结构，应对方式与情绪困扰和生活质量高度相关，然而，个体应对方式与困扰/生活质量指标之间的相关强度在不同疾病阶段有所不同；（3）结构方程模型表明，不考虑疾病阶段时，应对方式与困扰和生活质量显著相关，并且应对方式和困扰/生活质量指标是独立但高度相关的因素，而不是单一的潜在结构；（4）沃森MAC分量表的内部一致性略优于施瓦茨MAC分量表。综上所述，这些发现突出了：（i）两种MAC因子结构在美国乳腺癌患者临床和研究中的有效性；（ii）应对方式在疾病阶段与心理困扰和生活质量之间的中介作用；以及（iii）对某些沃森和施瓦茨分量表进行完善的必要性。
