Sick and Tired: Understanding and Managing Sleep Difficulties in ...

Coping
The Coping Orientation of Problem Experience Inventory (The COPE Scale, Carver et
al., 1989) is a theoretically guided multi-dimensional coping measure that has been
widely used in the health field. The COPE has 15 component scales, each containing
four items. Participants were asked to indicate how often they use different types of
coping on a scale, ranging from 1 (I usually don‟t do this at all) to 4 (I usually do this a
lot). The items for each scale are summed to give the score for each of the 15 scales.
The 15 subscales include: Positive reinterpretation and growth, Mental disengagement,
Focus on and venting of emotions, Use of instrumental social support, Active coping,
Denial, Religious coping, Humour, Behavioural disengagement, Restraint, Use of
emotional social support, Substance use, Acceptance, Suppression of competing
activities and Planning. Higher scores are indicative of higher use of the coping
strategy. The COPE scale has been widely used to explore coping behaviour, and the
planning, restraint coping, seeking instrumental support, seeking emotional support,
turning to religion, focus on venting emotion and denial sub-scales have revealed
Cronbach‟s alphas between 0.71-0.92, although the mental disengagement, active
coping, positive reinterpretation and behavioural disengagement scales revealed internal
consistency co-efficients (Cronbach‟s alphas) below 0.7 (0.45, 0.62, 0.68 and 0.63
respectively). Test-retest reliability over an 8 week period was found to be between
0.46-0.86 which was considered to be poor, however this may reflect the transient
nature of the use of coping strategies over time (Carver et al., 1989).
Quality of Life
Health related quality of life was assessed using the RAND 36-item Health Survey (SF -
36) (Hays, Sherbourne, & Mazel, 1993a; Ware & Sherbourne, 1992). For this
questionnaire participants were asked to describe how they felt and how able they were
to carry out their usual activities over the past month. Scores for the individual items
were recoded and summed to create eight component scales. Scores ranged from 0-100,
a higher score indicating higher health related quality of life. The RAND SF-36 has
been extensively used in the general population and patients with chronic illness to
describe health related quality of life and as an outcome measures in clinical trials (Hays
& Morales, 2001). The wide utility of the measure offers the benefit that scores can be
compared between different populations. Indeed, several studies have revealed that
people with FMS have poorer health related quality of life outcomes across the eight
outcome domains than healthy controls (Martinez et al., 2001), those with arthritis and
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