Coping Strategies Are More Nuanced Than Just ‘Active’ or ‘Passive,’ Study Suggests

People with Parkinson’s disease who use passive coping strategies, rather than active ones, are more likely to experience worse depression, motor impairment, and quality of life, a new study indicates.

However, the study’s findings suggest that not all individuals can be accurately classified as using either only active or only passive coping strategies, suggesting a need for greater nuance in this type of research.

The study, “Association between different coping styles and health-related quality of life in people with Parkinson’s disease: a cross-sectional study,” was published in BMJ Open.

A person’s coping strategy refers to the actions and thought processes they use in order to maintain a state of normalcy in response to stress. Broadly, coping mechanisms can be classified as active or passive. Active mechanisms focus on changing a person’s environment; passive mechanisms usually are more emotional (e.g., feelings of depression or engaging in wishful thinking).

People with health conditions such as Parkinson’s require coping strategies in order to manage their disease and how it affects their life. Understanding the interplay between coping strategies, quality of life, and clinical outcomes is an ongoing area of research. More passive coping strategies have been linked to worse outcomes, in Parkinson’s and in other conditions.

In the new study, researchers in Germany surveyed 162 people with Parkinson’s (35.8% female, 64.2% male, average age 70) who were being treated at their hospital.

In addition to collecting demographic, clinical, and quality of life data, researchers used the Essen Coping Questionnaire (ECQ) to assess coping strategies. The ECQ measured coping strategies across nine specific strategies, some more active (e.g., acting and problem-oriented coping), others more passive (e.g., trivialization, wishful thinking, and defense).

Researchers divided the surveyed Parkinson’s patients into two groups: those who used an active coping strategy (77 people, 47.5%); and those who used a passive coping strategy (85 people, 52.5%).

Relative to those who used passive coping, people with Parkinson’s who used active coping had significantly shorter disease duration, fewer motor and non-motor symptoms, better cognitive abilities, and fewer depressive symptoms. Relative to those who used active coping, people with Parkinson’s employing passive coping were significantly more likely to be female and to have less formal education.

These and other factors were imputed into statistical models in order to account for the differences simultaneously. In these models, depression and longer disease duration were associated significantly with passive coping.

In separate analyses, passive strategies were associated significantly with worse mental health-related quality of life. However, there was no significant association between coping strategies and physical health-related quality of life.

“Our results confirmed that a longer disease duration, more severe limitations by motor and non-motor symptoms, and greater impairment by depressive symptoms promote passive and maladaptive coping strategies,” the researchers wrote.

They noted that, because of the way this study was designed, it is impossible to conclude there is a cause-and-effect relationship between coping strategies and the various other factors. Rather, the results show only that they are statistically associated with each other.

Although the researchers used a simplistic division of active or passive for the analyses, they found that a substantial portion of the patients surveyed didn’t really fit into only one category or the other. Indeed, 39 (24%) of the participants fit into an “overlap” between the two extremes.

The overlap group had significantly less depressive symptoms and significantly shorter disease duration than the passive group, but poorer cognitive function than the active group.

“In addition to the traditional division into active and passive coping, there is an overlapping group in terms of coping with PD [Parkinson’s disease],” the researchers wrote. “Patients who employ mixed coping strategies are in the transition zone between active and passive coping and differ from those who use a single coping strategy in terms of cognitive impairment, depressive symptoms and duration of disease.”

The researchers proposed that further characterization of coping strategies in Parkinson’s disease as a spectrum — rather than based on the active/passive binary — could be useful in designing supportive strategies to aid patients.

“Further exploration of mixed coping styles can aid in the implementation of resource-oriented medical and psychological care to maintain well-being in patients with PD in the clinical routine,” the researchers concluded.