The relationships among coping strategies and depression and anxiety in adult bone marrow and peripheral blood stem cell transplantation patients

Abstract

Bone Marrow Transplantation (BMT) and Peripheral Blood Stem Cell Transplantation (PBST) are rapidly becoming standard treatment alternatives for a variety of malignant and hematological diseases. BMT/PBSTs are associated with a multitude of both physical and psychological stresses. As a consequence of these multiple stresses, the coping capabilities of patients become depleted, resulting in a myriad of stress-induced behavioral and psychological responses including depression and anxiety. The purpose of this study was twofold to examine the relationship between coping strategies and depression and anxiety, and to investigate the prevalence and severity of depression and anxiety in BMT/PBST patients. Lazarus and Folkman's (1984) transactional theory of stress and coping provided the conceptual framework for this study. A cross-sectional, descriptive, correlational research design was used. A convenience sample of 50 adult hospitalized BMT/PBST patients was recruited from a cancer center's BMT unit. The measures used in the study were the Ways of Coping-Cancer (WOC-CA) and the Hospital Depression and Anxiety Scale (HADS). Multivariate statistics were used to analyze the data. The results indicated the following: (1) the majority of patients appraised this procedure and its associated hospitalization recovery period as stressful to extremely stressful; (2) a significant number of patients experienced moderate to severe levels of depression and anxiety; (3) more frequent use of distancing coping predicted higher levels of depression; (4) distancing coping, higher levels of stress appraisal, and less than a college education predicted higher levels of anxiety; and (5) various person and situation factors were associated with use of specific coping strategies. Implications for nursing practice included three areas: reduction of stress associated with undergoing a BMT/PBST, evaluation of depression and anxiety, and interventions to decrease depression and anxiety. Recommendations for future research included: further psychometric testing of the WOC-CA, methodological issues, and future advancement of knowledge regarding the relationship between coping and psychological outcomes in hospitalized BMT/PBST patients.