A STRUCTURAL MODEL OF THE RELATIONSHIPS AMONG STAGE OF DISEASE, AGE, COPING, AND PSYCHOLOGICAL ADJUSTMENT IN WOMEN WITH BREAST-CANCER

The present study used structural equation modeling to examine the rel ationships among disease stage (i.e. Stage II versus Stage IV), age, c oping style, and psychological adjustment in 100 women diagnosed with breast cancer. Five separate models were examined: a full model, a med iational model, a demographic-disease model, a coping style model, and a regression model The analyses revealed that the present data best f it the mediational model in which age and stage of disease were not di rectly associated with psychological adjustment but, instead, were med iated by coping style (chi(2)(25) = 45.776, AASR = 0.05, CFI = 0.94). The mediational model accounted for 56% of the variance in psychologic al adjustment. In particular, the model showed that younger women and women with an earlier disease stage used greater levels of the coping strategy characterized as a fighting spirit and lower levels of the co ping strategies characterized as hopelessness/helplessness, anxious pr eoccupation, and fatalism which, in turn, were related to better psych ological adjustment. Overall, these findings may offer an explanation for the conflicting findings regarding the relationship between age, s tage of disease, and psychological adjustment to breast cancer by illu strating that coping strategies may be an essential mediating factor; in turn, a mediating model of psychological adaptation may offer usefu l information for clinicians as they implement interventions designed to improve patients coping efforts. (C) 1998 John Wiley & Sons, Ltd.