Health Reports
Factor structure of a coping measure in the 2013 Canadian Forces Mental Health Survey

by Jennifer E.C. Lee, Stacey Silins and Christine Frank

Release date: May 15, 2019

DOI: https://www.doi.org/10.25318/82-003-x201900500003-eng

Coping is commonly believed to represent efforts to prevent or lessen threat, harm and loss, or to reduce distress.Note 1 This concept was brought to the forefront of research as part of the body of work on cognitive appraisals that grew in the 1970s.Note 2Note 3 In particular, based on the cognitive appraisal theory of stress, when individuals face a potentially threatening or stressful event, they engage in primary appraisal, where they assess the level of personal threat that they encounter. This is followed by a secondary appraisal, during which individuals assess the extent of resources they have available to help them deal with this threat. In response, individuals may experience a range of emotions that influence the specific coping strategies they use to deal with a threatening or stressful event.Note 4

Coping typologies

Research shows that individuals typically employ multiple strategies to cope with stressful situations.Note 3 Rather than investigating all of these strategies individually in coping research, it can be useful for researchers to examine broader indicators that reflect coping typologies. Carver and Connor-SmithNote 1 outlined some of the previously used coping typologies. The most common of these involves the distinction between problem-focused (i.e., coping efforts aimed at changing the stressor) and emotion-focused coping (i.e., coping efforts aimed at minimizing distress). Similarly, other researchers have made the distinction between coping efforts aimed at addressing the stressor or distress—approach coping—and coping efforts aimed at avoiding the stressor or distress—avoidance coping.Note 1

Population-based coping research

Among the factors that contribute to interest in coping is the longstanding view that coping responses influence health and well-being.Note 5 In fact, research shows that giving individuals coping resources can substantially reduce the well-established negative health impacts of stress.Note 6 This has particular relevance in military and veteran populations, where research reports higher rates of mental health conditions when compared with the general population.Note 7Note 8 Having a better understanding of how military members cope with their unique job demands may provide some explanation of these differences. For example, research links poor coping with negative mental health outcomes among military personnel, both broadly and upon their return from combat missions.Note 9Note 10 These findings support Alarcon and colleagues’Note 11 suggestion that “coping is fundamental in understanding how individuals (including soldiers) negotiate stressful life events” (p. 30).

To develop approaches that could be applied to increase individuals’ use of more adaptive coping strategies, a clear understanding of coping practices is first needed. In the general Canadian population, coping has been assessed using a set of items in Canadian Community Health Survey (CCHS).Note 12 Past analyses of the CCHS show that coping varies by age, sex and health status,Note 13 and that avoidance coping and substance use coping mediate the relationship between stress and general psychological distress.Note 14 Of greater relevance to the issue of coping typologies, analyses have also been conducted to examine the factorial structure of coping items in the CCHS.Note 13Note 15 For instance, Gilmour and PattenNote 15 found that the items were best represented by positive coping and negative coping among currently employed Canadians.

Research has also examined coping practices and typologies among military members. Using data collected in the 2002 CCHS—Canadian Forces Supplement (CCHS-CFS), Mota and colleaguesNote 16 assessed the structure of the same set of coping items in a sample of active-duty Canadian Forces members and found evidence that the items could be represented by three underlying factors in this population: avoidance coping, active coping and self-medication. This structure shares some similarity with other research on coping in military populations. A review of studies on U.S. military aviators found that they are more likely than the general population to use externalizing, avoidant and problem-focused coping when confronting stress.Note 17 Other studies report slightly different typologies in military populations, including factors described as adaptive, maladaptive and religious coping.Note 9 A few studies also report gender differences in coping strategies among military personnel,Note 18Note 19 including the finding that female service members are more likely to use emotion-focused strategies in stressful situations than their male counterparts.Note 19

The research described above reflects a growing interest in delineating and understanding coping strategies and typologies in military members. However, many of the studies to date have focussed on coping strategies within smaller, heterogeneous subsamples of military populations, such as Air Force officers,Note 11 new recruits,Note 20 conscripts, reserve forces,Note 21 and health care practitioners.Note 22 By contrast, population-level research identifying coping typologies in military members is less common, and research on Canadian Armed Forces (CAF) members, specifically, has been limited to the work by Mota and colleagues.Note 16 Given the considerable time lapse since the CCHS-CFS was administered, there is a need to determine the replicability of their findings in a more recent sample of CAF members.

Study objectives

Administered in 2013, the Canadian Forces Mental Health Survey (CFMHS) included the same set of items to assess coping as the CCHS and CCHS-CFS. The present study’s objectives were to (1) provide a descriptive analysis of the extent to which members of the CAF Regular Force use these various coping strategies, (2) examine the factorial structure of these items, and (3) assess the resulting coping factors by examining their concurrent validity with theoretically related indicators and examining differences along key demographic and military characteristics. Ultimately, the study aimed to shed light onto a coping typology that could guide the development of indicators for use in future coping research based on the CFMHS.

Method

Participants

Participants included 6,996 CAF Regular Force members (86.2% men) who completed in the CFMHS. Table 1 provides information on key demographic and military characteristics of participants. Many of these details are provided elsewhere along with additional information.Note 7Note 23

Procedure

Statistics Canada administered the CFMHS using computer-assisted interviews to a stratified sample of CAF Regular Force members and Reservists. The Regular Force sample was stratified by rank (junior non-commissioned member [NCM], senior NCM, officer) and deployment status (no past deployment in support of the Afghanistan mission, past deployment in support of the Afghanistan mission) to ensure its representativeness of these characteristics.

Measures

Coping. Fourteen items were used to assess coping in the CFMHS. The items’ origin has been described in detail elsewhere.Note 24 Each item represents a particular type of strategy (e.g., “talk to others,” “blame yourself”) that people might use to handle stress, prefaced by the statement “People have different ways of dealing with stress. Thinking about the ways you deal with stress, please tell me how often you do each of the following.”Participants indicated how often they use each strategy on a four-point scale (often, sometimes, rarely or never). It should be noted that many non-smoking participants did not respond to the item “try to feel better by smoking more cigarettes than usual.” For the purposes of this analysis (to avoid issues with missing data), these non-smokers were assigned a rating of “never” on this item.

Self-rated ability to handle stress. Two items were used to assess participants’ perceived ability to handle unexpected and difficult problems and their perceived ability to handle the day-to-day demands of life. Both were rated on a five-point scale (poor, fair, good, very good or excellent).

Demographic and military characteristics. Information was recorded on participants’ sex, age group, rank (junior NCM, senior NCM, officer), element (Army, Navy, Air Force), Afghanistan deployment history (i.e., whether they had been deployed in support of the mission in Afghanistan) and exposure to mental health training. The latter was measured by calculating the total number of hours that participants reported having received mental health or resilience training over the past five years.Note 25 Participants were then grouped according to whether or not they received any mental health training (i.e., no mental health training versus at least one hour of mental health training).

Analyses

Descriptive analyses. Means, proportions and corresponding 95% confidence intervals (CIs) for the individual coping items were examined in Stata using the survey command. Specifically, the population weights, strata and population finite correction were specified and a Taylor linearized variance estimation approach was applied.

Factor analyses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted in Mplus to assess the underlying factor structure of the coping items. The complex analysis type was used, with population weights, strata and the population finite correction specified. Mplus uses a sandwich estimator to estimate standard errors.

In preparation for these analyses, the sample was subjected to a stratified random split so as to produce two subsamples containing a similar sex, rank and deployment profile. Using data from the first subsample (n=3,349), an EFA was conducted with Geomin oblique rotation (which accounts for the fact that resulting factors may be correlated). The resulting factor structure was further assessed by conducting a CFA on data from the second subsample (n=3,347). In both analyses, coping items were treated as categorical ordinal variables, and the weighted least square mean and variance adjusted estimation was used.

To assess model fit, a consideration of a combination of indices is recommended.Note 26Note 27 Ideally, the chi-square test should not be significant. However, it is generally suggested that researchers assign greater weight to other indices when evaluating model fit, given that this test is highly inflated with large sample sizes.Note 26 These indices include the Comparative Fit Index (CFI), with values of 0.95 or greater believed to indicate good fit, and the Root Mean Square Error of Approximation (RMSEA), with values of 0.05 to 0.08 indicating fair fit and values of 0.08 to 0.10 indicating mediocre fit.Note 28 In the case of categorical data, YuNote 29 also suggested examining the Weighted Root Mean Square Residual (WRMR), with values around 1.0 indicating acceptable fit.Note 29Note 30

Assessment of concurrent validity and group differences. To assess the properties of resulting factors, overall factor scores were computed. A series of linear regression analyses were conducted to examine the associations of factor scores with self-rated ability to handle stress and assess their concurrent validity. Furthermore, mean differences in factor scores according to key demographic and military characteristics were explored. These analyses were conducted in Stata using the survey command.

Results

Descriptive statistics

Table 2 presents the mean rating and proportion of participants who endorsed each coping item “often,” along with their corresponding 95% CIs. As shown in the table, CAF Regular Force members reported trying to solve the problem most frequently and using drugs least frequently to deal with stress.

Factor analyses

Several factor models were examined, including one-, two- and three-factor models. The one-factor model demonstrated a poor fit, with a CFI of 0.719, RMSEA of 0.077 and WRMR of 3.277. In contrast, the two-factor model demonstrated a good fit based on the RMSEA, yielding a CFI of 0.934, RMSEA of 0.041 and WRMR of 1.547. The three-factor model also demonstrated a good fit, with a CFI of 0.952, RMSEA of 0.038 and WRMR of 1.282. However, no clear conceptual pattern emerged in the solution, rendering the results difficult to interpret. Based on a consideration of fit indices and the interpretability of results, it was decided to retain the two-factor model.

As shown in Table 3, the vast majority of the items in the two-factor model loaded comparatively more strongly onto one factor (i.e., with a loading of 0.30 or more). One exception was “smoke more,” which had low factor loadings of roughly equal magnitude on both factors. Items that loaded onto the first factor represented coping strategies that are generally regarded as less favourable, while items that loaded onto the second factor represented coping strategies that are often considered favourable. The factors were therefore named negative and positive coping, respectively. The factors were found to be negatively correlated, with r = -0.30, p < 0.001.

The two-factor model was tested with a CFA using data from the second subsample. Given that “smoke more” was found to load relatively equally—albeit weakly—onto both factors in the EFA, this item was allowed to load onto both the positive and the negative coping factors in this model. Results of the analysis provided additional support for a two-factor model. Table 4 presents a summary of factor loadings. As shown, the item “smoke more” clearly demonstrated a stronger loading onto negative coping in this model. However, the model did not appear to fit the data as well in this subsample, yielding a CFI of 0.785 and WRMR of 2.881. It nevertheless demonstrated a reasonably good fit based on an RMSEA of 0.067. Again, the factors were significantly negatively correlated, with r = -0.34, p < 0.001.

Concurrent validity

Positive and negative coping factor scores were computed by calculating the sum of ratings for items that loaded onto each factor. Specifically, the items “see the bright side,” “try to solve the problem,” “talk to others,” “do something enjoyable,” “jog or exercise,” and “pray or seek spiritual help” were used to calculate a total score for positive coping, while the remaining items were used to calculate a total score for negative coping. This yielded a possible score range of 6 to 24 for positive coping and 8 to 32 for negative coping. As might be expected, positive coping scores increased as one’s perceived ability to handle unexpected and difficult problems and one’s perceived ability to handle the day-to-day demands of life increased, with an R2 of 0.04, F(4, 6,662) = 51.01, p < 0.001, and an R2 of 0.05, F(4, 6,662) = 76.46, p < 0.001, respectively. Conversely, negative coping scores decreased as one’s perceived ability to handle unexpected and difficult problems and one’s perceived ability to handle the day-to-day demands of life increased, with an R2 of 0.14, F(4, 6,645) = 225.71, p < 0.001, and R2 of 0.16, F(4, 6,645) = 284.03, p < 0.001, respectively. Table 5 presents detailed results.

Group differences

Overall mean estimates for CAF Regular Force members and various demographic and military subgroups are summarized in Table 6. Of note, women obtained significantly higher scores on both positive and negative coping, compared with men. Junior NCMs obtained generally less favourable scores than senior NCMs and officers (that is, lower scores on positive coping and higher scores on negative coping). Finally, Army personnel obtained lower scores on positive coping relative to both Navy and Air Force personnel, as did members with a history of deployment to Afghanistan and those who did not receive mental health training relative to their respective counterparts.

Discussion

In addition to providing a descriptive overview of coping among CAF Regular Force members, results of the present study provide insight into how coping might be operationalized in future multivariable analyses of CFMHS data. In line with past research on U.S. military personnel,Note 31 Regular Force members reported trying to solve the problem most frequently and using drugs least frequently to deal with stress. These findings appear to be promising given that these strategies are widely considered to represent adaptive and maladaptive approaches to handling stress, respectively.

Similar to past work,Note 15 the EFA suggested that items used to assess coping in the CFMHS were best represented simply by two underlying factors—positive and negative coping. Model fit in the CFA was not ideal. However, researchers have cautioned against an overreliance on fit indices when interpreting model fit, emphasizing that these are only guidelines. As such, failure to meet all suggested cutoff criteria does not necessarily indicate poor model fit.Note 32 Additionally, it is important to note that scale items represented discrete behaviours. Thus, while a theoretical overarching theme may group these together (e.g., positive coping), endorsement of one behaviour does not necessarily guarantee endorsement of another behaviour. Findings on the concurrent validity of factors support the two-factor model, where coping factors were associated with perceptions of one’s ability to handle unexpected and difficult problems and the day-to-day demands of life in an expected manner.

It is important to acknowledge that while the labels of positive and negative coping appear adequate for distinguishing coping items, they may be an overly simplistic representation of coping behaviour. Despite the fact that researchers have often expected certain types of coping to be more beneficial than others,Note 3 the bulk of the evidence over the years has emphasized the complexity of coping and its relationship with well-being. Indeed, researchers are increasingly adopting the view of coping as a dynamic process where it is the ability to appropriately adapt coping strategies when stressful events evolve that is considered adaptive.Note 33

Nevertheless, the factor structure of coping observed in the present study offers some advantages. For example, because of the high number of coping items included in the CFMHS, conducting analyses using all of these may lead to an overfitting of analytical models. To reduce complexity and increase parsimony, examining coping at the factor level allows researchers to examine coping trends in population surveys where it is not feasible to consider all coping strategies individually. Additionally, identifying one set of strategies as positive and one set of strategies as negative can help to assess the broader impacts of policies or programs aimed at increasing coping abilities among CAF members (e.g., Road to Mental Readiness [R2MR]), as the types of coping that these programs promote or discourage can be monitored at the population level.

Another goal of this paper was to examine differences in coping strategies across key demographic and military characteristics. In line with past findings, women scored higher on positive coping than men.Note 34Note 35 However, they also unexpectedly obtained higher scores on negative coping. Research has suggested that women use more varied coping strategies than men.Note 36 This finding may partially explain why women generally report higher levels of stress than men.Note 34Note 37

Differences in coping strategies across rank were also observed, with junior NCMs reporting lower positive coping and higher negative coping than senior NCMs and officers. Currently, little research exists examining coping differences across military rank; however, senior military personnel may have been promoted in part because of their ability to manage stress. Indeed, one study found that recruits who used more adaptive coping strategies were more likely to be selected for promotion at the end of basic training.Note 38

Findings also revealed higher positive coping scores among Regular Force members who had mental health training. It is worth noting that the majority of coping strategies that fell under positive coping are promoted in CAF or Department of National Defence mental health and well-being programs, such as R2MR or Stress: Take Charge! (e.g., talk to others, see the bright side).Note 39 Lastly, findings showed that members with a history of deployment to Afghanistan obtained lower positive coping scores than those who were not deployed in support of this mission. It is possible that exposure to extreme stressors inherent to the mission resulted in a depletion of cognitive resources, which are generally needed to engage in positive coping.Note 4

Conclusion

Results of the present study add to the limited body of research on the use of coping strategies in the CAF Regular Force population. Findings also point to one approach that could be useful to operationalize coping in future research using the CFMHS. As a follow up to this study, additional analyses of the CFMHS will be conducted to examine coping in relation to stressful encounters and well-being and in the military workplace.

References
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