generalized self-efficacy, coping, and self-esteem as predictors of psychological adjustment among...

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Generalized Self-Efficacy, Coping, and Self-Esteem asPredictors of Psychological Adjustment Among ChildrenWith Disabilities or Chronic IllnessesDavid T. Dahlbeck a & Owen Richard Lightsey Jr. aa Department of Counseling, Educational Psychology & Research , The University ofMemphis , Memphis, TNPublished online: 17 Nov 2008.

To cite this article: David T. Dahlbeck & Owen Richard Lightsey Jr. (2008) Generalized Self-Efficacy, Coping, and Self-Esteemas Predictors of Psychological Adjustment Among Children With Disabilities or Chronic Illnesses, Children's Health Care, 37:4,293-315, DOI: 10.1080/02739610802437509

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Children’s Health Care, 37:293–315, 2008

Copyright © Taylor & Francis Group, LLC

ISSN: 0273-9615 print/1532-6888 online

DOI: 10.1080/02739610802437509

Generalized Self-Efficacy, Coping, andSelf-Esteem as Predictors of

Psychological Adjustment AmongChildren With Disabilities or

Chronic Illnesses

David T. Dahlbeck and Owen Richard Lightsey, Jr.Department of Counseling, Educational Psychology & Research,

The University of Memphis, Memphis, TN

This study tested the hypothesis that more use of acceptance coping and less use of

avoidance, emotional reaction, and wishful thinking coping would predict higher

generalized self-efficacy (GSE) and self-esteem, and that higher GSE and self-

esteem would, in turn, predict better psychological adjustment, operationalized as

lower anxiety and higher life satisfaction. The alternative hypothesis that GSE

and self-esteem would serve as psychological resources that predict coping, and

that coping would, in turn, directly predict psychological adjustment, also was

tested. Children (n D 42) enrolled at a camp for children with disabilities were

administered instruments that assessed coping styles, GSE, self-esteem, anxiety,

and life satisfaction. Hierarchical multiple regression and bootstrapping tested the

mediational hypotheses. Emotion-oriented coping and self-esteem predicted life

satisfaction; distance coping, self-efficacy, and self-esteem predicted anxiety; and

self-esteem mediated the relation between self-efficacy and anxiety.

Children with disabilities or chronic illnesses are exposed not only to daily

stressors, but to illness or disability-related stress (Nelms, 1989), and the chal-

lenges of developing while learning how to manage their disease or disability

(Magrab, 1985). Unless these challenges are managed effectively, they can lead

Correspondence should be addressed to David T. Dahlbeck, Department of Counseling, Educa-

tional Psychology & Research, The University of Memphis, 100 Ball Education Hall, Memphis, TN

38152. E-mail: [email protected]

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294 DAHLBECK AND LIGHTSEY

to low self-concept (Breslau, 1985) as well as depression, anxiety, and other

psychological sequela that result in behavior problems (Hamlett, Pellegrini, &

Katz, 1992). Therefore, it is vital that children acquire coping resources that can

lead to resilience (Reichel & Schanz, 2003).

The risk-resilience literature offers a framework for understanding why illness

and disability result in growth for some children and psychological dysfunction

for others (see Tedeschi & Kilmer, 2005). Masten, Best, and Garmezy (1990,

cited in Alvord & Grados, 2005) defined resilience as “the process of, capacity

for, or outcome of successful adaptation despite challenging or threatening

circumstances” (p. 426). Although many studies of resilience are primarily

descriptive (e.g., Luthar, 1991; Wyman, Cowen, Work, & Parker, 1991), re-

searchers have recently called for more operational definitions of resilience,

unifying theoretical frameworks, and identification of person variables that lead

to positive outcomes among highly stressed children and adolescents (Friedman,

2005; Lightsey, 2006; Naglieri & LeBuffe, 2005; Tedeschi & Kilmer, 2005). Of

the person variables that foster well-being, coping styles, self-efficacy, and self-

esteem are among the most important (see Alvord & Grados, 2005). Conversely,

of person variables that have been linked to reduced well-being, avoidance

coping and emotion-oriented coping are among the most pernicious.

COPING, GENERALIZED SELF-EFFICACY,

SELF-ESTEEM, AND PSYCHOLOGICAL ADJUSTMENT

Acceptance coping (see Table 1 for definitions of coping styles) is negatively

associated with the stress of chronic illness or physical disability among adults

(Roth & Cohen, 1986), accounts (with self-management behavior) for treatment-

related improvements in glycated hemoglobin levels among diabetics (Gregg,

Callaghan, Hayes, & Glenn-Lawson, 2007), predicts fewer next-day physical

symptoms among heart failure patients (Carels et al., 2004) and longer survival

for HIV-infected men without AIDS-related complex or AIDS (Thornton et al.,

2000), and has been linked to more favorable long-term adaptation toward

anxiety (Suls & Fletcher, 1985). Among adult women, greater acceptance or

reframing coping and less avoidance or denial coping have been predicted

by higher coping self-efficacy and have, in turn, predicted better adjustment

(Major, Richards, Cooper, Cozzarelli, & Zubek, 1998). Studies of the benefits

of acceptance coping among children and adolescents, however, are lacking.

In contrast to acceptance coping, avoidance coping can retard treatment and

recovery and has been associated with a variety of negative psychological and

physical consequences among both adolescents and adults (Hudek-Knezevic,

Kardum, & Maglica, 2005; Legault, Anawati, & Flynn, 2006; Roth & Cohen,

1986; Suls & Fletcher, 1985; van der Zaag-Loonen, Grootenhuis, Last, & Derkx,

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SELF-EFFICACY, COPING, AND SELF-ESTEEM 295

TABLE 1

Definitions of Coping Styles

Coping Style Definition

Acceptance coping Active cognitive and behavioral efforts to define and understand

the situation and to resolve or master a stressor by seeking

guidance and engaging in problem-solving activities (Ebata &

Moos, 1991; Rudolph, Dennig, & Weisz, 1995).

Emotion-focused coping Efforts directed toward regulating emotional states that may

accompany a stressor (Ebata & Moos, 1991).

Avoidance coping Using escape behaviors to avoid a stressful event, using

cognitive or behavioral efforts to avoid thinking about a

stressor or its consequences, or resigning oneself to a

situation and seeking alternative rewards (Ebata & Moos,

1991; Rudolph et al., 1995).

Wishful thinking coping An avoidant coping mechanism that is linked to avoidant and

fantasy thinking and that is more developmentally appropriate

for children than for adults (R. Miller et al., 2000).

Cognitive-palliative coping A form of intellectualization or rationalization that involves use

of projective techniques in which one projects similar

experiences or affective states onto others (e.g., telling oneself

that even famous people have illnesses; Stensrud & Stensrud,

1983).

Distance coping Involves distancing oneself from the disease, chronic illness,

problem, or situation to gain understanding, establish

meaning, or decrease emotional distress (Carlick & Biley,

2004).

Approach coping Strategies designed to eliminate, reduce, or manage stressors or

emotions.

2004). For example, denial, an avoidant coping strategy, has been strongly

related to anxiety and somatic complaints (Compas et al., 2006), and avoidant

behaviors have been associated with greater asthma severity among children

diagnosed with chronic asthma conditions (Chen, Hermann, Rodgers, Oliver-

Welker, & Strunk, 2006). In addition, high levels of wishful thinking, a form of

avoidant coping, have been associated with anxiety or sadness among children

with chronic illnesses and children with acute illnesses (Spirito, Stark, & Tyc,

1994).

Similarly, emotion-oriented coping strategies have been associated with many

negative outcomes (Anderson, Marwit, Vandenberg, & Chibnall, 2005; Barrera

et al., 2004; Martin, 2001), including stress reactions to terror attacks among

adolescents (Zeidner, 2005) and lower pain tolerance among 7- to 14-year-old

children (Piira, Taplin, Goodenough, & von Baeyer, 2002). Among persons with

disabilities or illnesses, emotion-oriented and avoidance strategies have been as-

sociated with poorer psychological adjustment or outcomes, whereas approach-

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oriented strategies, including problem-focused coping, have been associated with

positive psychological adjustment (e.g., Gil, Williams, Thompson, & Kinney,

1991; Tyc, Mulhern, Jayawadene, & Fairclough, 1995).

Like adaptive forms of coping, generalized self-efficacy (GSE) has been

positively associated with desirable psychological and behavioral outcomes and

negatively associated with undesirable outcomes among adolescents, and GSE

indexes constructed for use with adults appear reliable and valid among ado-

lescents (e.g., Kumar & Lal, 2006; Passmore, 2004; Török, Kökönyei, Károlyi,

Ittzés, & Tomcsányi, 2006; Wang & He, 2002). Higher GSE has predicted greater

happiness among adolescents in seventh, eighth, and ninth grades, whereas

school-specific self-efficacy did not predict happiness (Natvig, Albrektsen, &

Qvarnstrom, 2003). GSE has also been inversely related to depression among

Latina adolescents (Locke, Newcomb, Duclos, & Goodyear, 2007), and lower

levels of self-efficacy have predicted lower levels of life satisfaction and less

optimism (Pinquart, Silbereisen, & Juang, 2004). A wide range of literature

also indicates that high self-esteem or avoidance of low self-esteem is an im-

portant contributor to health and well-being (DuBois & Flay, 2004), whereas

low self-esteem is associated with depression and other negative affective states

(Hokanson, Rubert, Welker, Hollander, & Hedeen, 1989; Krol et al., 1998).

Strong links have been established, then, between coping, GSE and self-

esteem, on the one hand, and life satisfaction or adjustment on the other (Caprara,

Steca, Gerbino Paciello, & Vecchio, 2006; Pinquart et al., 2004). In addition, both

self-efficacy and self-esteem have been linked to coping. For example, Caprara

et al. found that adolescents’ self-efficacy in managing positive and negative

emotions contributed to positive expectations about the future, maintenance of

high self-esteem, and increased life satisfaction. Similarly, adolescents who use

less emotion-oriented coping and more problem-focused coping have evinced

higher self-esteem (Mullis & Chapman, 2000).These findings suggest that coping

strategies predict adjustment through their effect on GSE and self-esteem or that,

conversely, GSE and self-esteem predict psychological adjustment through their

effects on coping.

SUMMARY AND HYPOTHESES

Lightsey (2006) argued that well-developed theories in the adult literature may

serve as a framework for helping to understand resilience among children and

adolescents. Among such theories, social cognitive theory maintains that mastery

coping experiences lead to higher self-efficacy, which in turn serves as a proximal

mediator of the relation between coping and outcomes (see Bandura, 1997). This

is consistent with a model in which coping predicts psychological adjustment

through the mediation of GSE and self-esteem.

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Alternatively, both Lightsey (1996) and Lent (2004) proposed that GSE can

serve as an antecedent resource that predicts future coping efforts, which in

turn predict psychological and behavioral outcomes. In a similar vein, self-

esteem may act as a resource that inversely predicts negative outcomes (Lightsey,

Burke, Ervin, Henderson, & Yee, 2006) and directly predicts positive outcomes.

Consistent with this thesis, GSE has prospectively predicted use of acceptance,

accommodation, planning, and humor forms of coping (Schwarzer, Boehmer,

Luszczynska, Mohamed, & Knoll, 2005), and has predicted additional forms

of coping (e.g., problem solving, negative interior-appraised, negative exterior-

appraised, and social support) among Chinese middle school students (Yuhui &

Jianxin, 2004). These findings are consistent with the alternative hypothesis that

GSE and self-esteem serve as psychological resources that predict psychological

adjustment through an effect on coping.

The primary purpose of this study, then, was to test two alternative models

of resilience among children and adolescents with disabilities or chronic ill-

nesses. Specifically, we tested the hypothesis that adaptive coping (i.e., more

use of acceptance-oriented coping and less use of avoidance coping, wishful

thinking coping, and emotional reaction coping) would predict higher GSE

and self-esteem, which would in turn predict lower anxiety and higher life

satisfaction. We also tested the alternative hypothesis that higher GSE and self-

esteem would predict more use of acceptance-oriented coping and less use of

avoidance coping, wishful thinking coping, and emotional reaction coping, and

that these forms of coping would, in turn, predict lower anxiety and higher life

satisfaction. Finally, we tested a third model in which coping directly predicts

anxiety and life satisfaction, and GSE predicts anxiety and life satisfaction

both directly and indirectly through self-esteem. This model is consistent with

recent evidence that self-esteem partially mediates the relation between GSE

and negative affect (Lightsey et al., 2006). In addition, in each model, we

tested in an exploratory vein whether two less widely researched forms of

coping—cognitive-palliative coping and distance coping—predicted anxiety and

life satisfaction.

Satisfaction with life, a person’s subjective, global evaluation of the positivity

of her or his life as a whole (Diener, Suh, Lucas, & Smith, 1999), is central to

well-being and is thus vitally important when evaluating models of coping among

children with chronic illnesses or disabilities (Gilman, Easterbrooks, & Frey,

2004). Similarly, trait anxiety, a relatively stable difference in anxiety proneness,

especially in response to stressors (Spielberger, 1972), has been significantly

related to the presence of chronic medical conditions (Holmes, Respess, Greer,

& Frentz, 1998; Silver, Westbrook, & Stein, 1998), and has been higher among

children with chronic illnesses than among their healthy peers (Johnson, Whitt

& Martin, 1987). Thus, anxiety is another important benchmark of children’s

psychological adjustment.

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Although most of the evidence supporting the previous constructs and models

stems from studies of adults and adolescents, it is important to examine the

relevance of resilience models to younger children as well: Children’s knowledge

of their illness is not necessarily predictable from their cognitive developmental

level (Neul et al., 2003), and cognitive development is not necessarily commen-

surate with age (Bibace & Walsh, 1979). Thus, stage models of development

must be supplemented by models that incorporate the role of experience (Crisp,

Ungerer, & Goodnow, 1996) including experience with coping, cognitive factors,

and self-concept.

Chronic illness is defined in this study as medically diagnosed conditions

(e.g., hemophilia, spina bifida, muscular dystrophy, cystic fibrosis, and cerebral

palsy) that affect children for extended periods of time or over the life span.

Children with a diagnosis or disability of mental retardation or autism based on

parental report were excluded from the study. Physical disability is defined as

any degree of infirmity, malformation, or disfigurement that is caused by bodily

injury, birth defect, or illness including, but not limited to, diabetes mellitus,

epilepsy, any degree of paralysis, amputation, lack of physical coordination,

blindness or visual impediment, deafness or hearing impediment, muteness or

speech impediment, or physical reliance on a guide dog or on a wheelchair or

other remedial appliance or device (Ontario Human Rights Commission, 2000).

METHOD

Procedures

Children who enrolled at a mid-Western summer camp that specializes in pro-

viding a camp experience for children with chronic illnesses or disabilities

received, by mail, a recruitment letter and survey packet. Included in the survey

packet was an informed consent form to be signed by the parent or legal

guardian. In addition, an assent form was included to be signed by the child

or adolescent. Both the informed consent and the assent form indicated that

no personally identifying information would be associated with the responses,

and that participation was voluntary and they could withdraw from the study at

any time without consequence. Each child who volunteered completed a survey

packet consisting of all instruments. The demographic data form was completed

by the parent. All packets were completed prior to participation in camp. An

additional wave of data was collected after camp, but the sample size (N D 20)

did not permit meaningful analyses.

Participants

Of the 195 participants solicited, 53 children or adolescents responded, which

constituted a 27.1% response rate. On seven surveys (3.5% of the 195), parents

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indicated on the demographic form that their children could not complete the

surveys due to an additional diagnosis or disability that they did not list on

the form provided in the initial mailing. In addition, 2% of the surveys (4 par-

ticipants) were excluded due to failure of participants and parents to sign the

informed consent or assent form, the parent rather than the child completing the

survey, or the survey being completed after the child attended the camp. Thus,

42 participants were included in the final sample.

The age range of the final sample was 10 to 18, with a mean age of 13.83

years (SD D 2.36). Participants had attended the 1-week camp for a mean of

4 years. The sample was 50% male (n D 21) and 50% female (n D 21). The

majority of participants were Caucasian (82.5%, n D 33), with 10% (n D 4)

identifying as African American, 2.5% (n D 1) as Asian American, 2.5% (n D

1) as multiracial, and 2.5% (n D 1) as “other.” Parents of 2 participants (4.8%)

did not report race. The largest reported disabilities were cerebral palsy (23.8%,

n D 10) and blind or visually impaired (23.8%, n D 10). Other disabilities or

injuries reported were ataxia (9.5%, n D 4), deafness (7.2%, n D 3), muscular

dystrophy (4.7%, n D 2), burns (4.7%, n D 2), and hemophilia (4.7%, n D

2). The 9 remaining participants each reported a single and distinct disorder.

Thirty-six percent (n D 15) of the parents rated their child’s disability as severe,

36% (n D 15) rated the disability or illness as moderate, 19% (n D 8) reported

the disability as mild, and 9% (n D 4) of the parents did not report the severity

of their child’s disability.

Instruments

Parents of the children with disabilities were instructed to provide demographic

data, which included age, gender, sibling status, race, and number of years the

child has attended camp. The parents provided information about the child’s

type of illness or disability, severity, time of diagnosis, and type of treatments

received.

Coping with a Disease (CODI; Petersen, Schmidt, Bullinger, & the

DISABKIDS Group, 2004). The CODI consists of 28 items, organized into

six scales that measure corresponding coping strategies: Acceptance, Avoidance,

Cognitive-Palliative, Distance, Emotional Reaction, and Wishful Thinking. Ex-

amples of the scale items are as follows: Acceptance, “I accept my illness”;

Avoidance, “I try to ignore my illness”; Cognitive-Palliative, “I think of worse

situations”; Distance, “I think my illness is no big deal”; Emotional Reaction, “I

am angry”; and Wishful Thinking, “I hope my illness disappears.” Participants

are asked how often they apply a certain strategy on a scale ranging from 1

(never) to 5 (always). Items are linearly transformed to a 0 to 100 scale. A higher

score represents more frequent use of a particular coping strategy. Coefficient

alphas range from .72 to .88 (Petersen et al., 2006). The CODI was normed on

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children and adolescents between the ages of 8 and 18 years, who had received

a diagnosis of asthma, arthritis, epilepsy, cerebral palsy, diabetes mellitus, atopic

dermatitis, or cystic fibrosis (Petersen, Schmidt, Bullinger, & the DISABKIDS

Group, 2004).

The State–Trait Anxiety Inventory for Children (STAIC). The STAIC is

a downward extension of the State–Trait Anxiety Inventory. The STAIC was

initially developed in 1969 for elementary school students between Grades 4

through 6. However, multiple studies have utilized the STAIC for ages ranging

from 7 to 19 years of age (Araujo, Medic, Yasnovsky, & Steiner, 2006; Baki

et al., 2004; Piekarska, 2000; Vila et al., 1999). Muris, Merckelbach, Ollendick,

King, and Bogie (2002) found that STAIC scores evinced a Cronbach’s alpha

of .91 among 521 adolescents (age range 12–18 years, M D 15.1 years). In a

study of 541 seventh and eighth graders, Cross and Huberty (1993) found that

STAIC scores exhibited a stable trait factor structure for this age group.

The 40-item STAIC includes two separate self-report scales for measuring

state anxiety (A-state) and trait anxiety (A-trait), and has no time limits. For this

study, only the A-trait scale was administered. The STAIC A-trait is a 20-item

instrument designed to assess general anxiety proneness among children. Items

are answered on a 3-point scale ranging from 1 (hardly ever), 2 (sometimes),

to 3 (often). The coefficient alpha for the STAIC A-trait was .78 for males

and .81 for females. Test–retest reliability coefficients were .65 for males and

.71 for females over 6 weeks. Evidence of concurrent validity of the STAIC

A-trait is shown by its correlation with the Children’s Manifest Anxiety Scale

(CMAS) and the General Anxiety Scale for Children (GASC). In a sample of

75 children, the STAIC A-trait correlated .75 with the CMAS and .63 with the

GASC (Spielberger, 1973).

The GSE Scale (Tipton & Worthington, 1984). The GSE Scale measures

“one’s willingness and determination to initiate and tenaciously stay with an

undertaking in the face of physical and/or emotional adversity” (p. 546). Items

are rated on a 7-point Likert scale that ranges from 1 (completely disagree) to

7 (completely agree). Sample items include, “Once I set my mind to a task

almost nothing can stop me,” and “I can succeed in most any endeavor to which

I set my mind.” Compared to undergraduates low in GSE as measured by the

27-item scale, undergraduates high in GSE demonstrated greater endurance and

higher goal-attainment scale scores in efforts to reduce smoking or lose weight

(Tipton & Worthington, 1984). The 10-item version of the GSE Scale consists

of items with the highest discrimination (R. M. Tipton & E. L. Worthington,

personal communication, April 26, 1989), and was used in this study. Coefficient

alpha was reported to be .87 and .89 in two samples from one study (Lightsey

et al., 2006). Coefficient alpha in this study was .77. GSE score has predicted

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depression and self-esteem and has evinced expected and moderate correlations

with related constructs (Lightsey, 1997; Lightsey & Christopher, 1997; Lightsey

et al., 2006). Because of the young age of some of this sample, we modified

and simplified several items. For example, Item 6, “I can succeed in most any

endeavor to which I set my mind,” was changed to, “I can do well if I set

my mind to it.” Similarly, Item 10 was modified: “I would endure physical

discomfort to complete a task because I just don’t like to give up” was replaced

with, “I can take aches and pains to finish something because I do not like to give

up.” The GSE Scale has been utilized with adolescents between the ages of 13

and 17, and evinces convergent validity among this population (e.g., expected

correlations with a measure of program completion self-efficacy; Vincent &

Houlihan, 1991). As noted, other GSE scales constructed with and initially

normed on adults appear reliable and valid for use among adolescents (e.g.,

Kumar & Lal, 2006; Passmore, 2004; Török et al., 2006; Wang & He, 2002).

Students’ Life Satisfaction Scale (SLSS; Huebner, 1991). The SLSS

is a seven-item self-report measure that has been used with children ages 8 to

18 to measure life satisfaction—“one of the most well-established indicators of

general wellness and : : : positive functioning” (Suldo, Riley, & Shaffer, 2006,

p. 567). The items require respondents to rate their life satisfaction based on a

general evaluation of the quality of their lives, rather than making judgments of

satisfaction based on evaluation of specific domains, such as family or friends.

Huebner reported an alpha of .82 in a sample of students in grades 4 through 8

in a Midwestern state. Test–retest reliability over 1 to 2 weeks was .74. A factor

analyses on each SLSS item supported a 1-factor solution accounting for 47%

of the variance, providing support for the construct validity of the scale. Strong

correlations were found between the SLSS and other well-being measures, such

as the Piers–Harris Self Concept scale and the Andrews–Withey Life Satisfaction

Scale. Satisfaction scores did not differ as a function of age, grade, or gender;

and the analyses of individual items, as well as total scale scores, indicated a

high degree of overall life satisfaction, which is consistent with findings reported

for adults (Huebner, 1991). The SLSS has been, and continues to be, widely

used (e.g., Schiff, Nebe, & Gilman, 2006; Valois, Paxton, Zullig, & Huebner,

2006).

The Rosenberg Self-Esteem Scale (RSE; M. Rosenberg, 1965). For

children 12 and older, the 10-item RSE was used. The self-report RSE measures

global or unidimensional self-esteem (Fleming & Courtney, 1984), defined as

the feeling that one is “good enough : : : a person of worth” (M. Rosenberg,

1965, p. 31). Respondents rate items such as, “I feel that I’m a person of worth

at least on an equal plane with others,” on a 5-point Likert scale that ranges from

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1 (strongly disagree) to 5 (strongly agree). Higher scores indicate higher self-

esteem. Test–retest reliability was .85 over 2 weeks, and correlations with related

measures and clinical assessment range from .56 to .83 (Silber & Tippett, 1965).

Average test–retest reliability ranges from .73 to .80 (Hagborg, 1993; Kaplan

& Pokormy, 1969), and coefficient alpha has been found to be .80 (Walters &

Simoni, 1993) and to range from .72 to .87 (Wylie, 1989).

Over the past 4 decades, construct validity and convergent validity of RSE

scores have been consistently demonstrated (Gray-Little, Williams, & Hancock,

1997; Hagborg, 1993). The RSE has been found to be especially reliable when

used with high school and college students (Bagley, Bolitho, & Bertrand, 1997;

Goldsmith, 1986), and has often been used to assess the self-esteem of children

and adolescents with diagnoses such as asthma, attention deficit hyperactivity

disorder, and eating disorders (Binford & le Grange, 2005; Grave, De Luca,

& Campello, 2001; Healey, & Rucklidge, 2006; Preechawong et al., 2007),

as well as problems with parents, coping difficulties, and cross-cultural issues

(Farruggia, Chen, Greenberger, Dmitrieva, & Macek, 2004; Haberstroh, Hayslip,

Essandoh, 1998; Mi Sung, Puskar, & Sereika, 2006).

Children’s Self-Image Scale (CSIS; M. Rosenberg & Simmons, 1972).

Participants who were 10 and 11 years of age were administered the CSIS, a

self-report measure of self-esteem for younger children. Rosenberg and Simmons

used the RSE as the basis for developing the six-item CSIS by reducing the num-

ber of questions and rephrasing the wording of the RSE items. The coefficient

of reproducibility for the CSIS is 90.2%, and the coefficient of scalability is

67.6%, which meet the standards for the Guttman scales and indicate that the

CSIS possesses reasonable internal consistency. A Pearson correlation of .91

between the RSE and CSIS was obtained (Packman et al., 1997).

RESULTS

Preliminary Analyses

A one-way analysis of variance was utilized to test for age differences between

camp attendees who participated in the study and camp attendees who were

solicited but did not participate. The result was non-signficant, F(2, 192) D

0.758, p D .47. The range of disabilities of participants and non-participants

was also examined. Non-participants (n D 142) consisted of persons with the

following diagnoses, disabilities, or injuries: 33.1% (n D 47) with cerebral palsy;

19.7% (n D 28) who were blind or visually impaired; 9.9% (n D 14) with spina

bifida; 4.2%, (n D 6) who were deaf; 8.4%, (n D 12) with ataxia, developmental

delays, or diabetes; and 4.2% (n D 6) with brain injuries or static encephalopathy.

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In addition, the non-participants represented a wider range of disabilities or

illnesses reported by 1 or 2 children, with 20.5% (n D 29) having disabilities

ranging from osteogenesis imperfecta to Angelman syndrome. This range of

disabilities appears to be meaningfully different from, and perhaps more severe

than, the children who completed the surveys, which may have contributed to

the low response rate.

Hypothesis Tests

According to Heppner, Kivlighan, and Wampold (1999), variables that account

for 2% or less of the variance in outcomes are unlikely to contribute meaningfully

to knowledge of psychological processes. Therefore, to increase power in light

of the low final sample size, variables that were not significant in prediction

of outcomes or that accounted for 2% or less of the variance in outcomes in

initial regressions were removed. The final model in prediction of life satisfaction

included emotional reaction coping, acceptance coping, and self-esteem; and the

final model in prediction of anxiety included emotional reaction coping, distance

coping, GSE, and self-esteem. A priori power analysis indicated that to achieve

a power of .80 with p < .05 and a medium effect size of .30 and three predictors,

a sample size of 41 would be required. With four predictors, a sample size of

45 would be required. The 2 children with burns were, therefore, retained in

analyses to increase power. Post-hoc power analyses indicated a power of .90

for the equation in prediction of life satisfaction and a power of .99 for the

equation in prediction of anxiety.

Table 2 presents Pearson correlations and instrument means; Tables 3 and 4

present results of regression analyses. In prediction of life satisfaction, emotion-

oriented coping was significant at Step 1, ˇ D �.38, t(1, 39) D �2.53, p <

.02; and self-esteem was significant at Step 3, ˇ D .38, t(1, 37) D 2.47, p <

.02. At the final step, only self-esteem was significant. In prediction of anxiety,

emotion-oriented coping was significant at Step 1, ˇ D .48, t(1, 38) D 3.39, p <

.002; distance coping was significant at Step 2, ˇ D �.34, t(1, 37) D �2.10,

p < .05; self-efficacy was significant at Step 3, ˇ D �.39 t(1, 36) D �2.94,

p < .01; and self-esteem was significant in Step 4, ˇ D �.39, t(1, 35) D �2.68,

p < .02. In the final step, distance coping and self-esteem remained significant.

In prediction of life satisfaction, neither emotion-oriented coping nor accep-

tance coping were significant at Step 2, and self-efficacy was non-significant as

a predictor in preliminary regressions. Therefore, self-efficacy could not mediate

the effects of coping, and mediation was not tested. In the regression in prediction

of anxiety, with both coping styles entered at Step 2, only distance coping

remained significant; therefore, self-efficacy and self-esteem could only mediate

the effects of distance coping on anxiety. However, distance coping remained

highly significant after entry of self-efficacy at Step 3 and self-esteem at Step 4,

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TABLE 2

Pearson Product–Moment Correlation Coefficients, Means, and Standard Deviations

Variable 1 2 3 4 5 6 7 8 9 10 M SD

1. Life satisfaction — �.367* �.097 .089 �.382** .449** �.418** .371* .391** .465** 4.578 0.837

2. Anxiety — .138 .018 .461** �.423** .254 �.467** �.545** �.626** 1.696 0.399

3. Avoidance coping — .336* .292* �.121 .474** �.312* .037 �.101 2.641 1.122

4. Cognitive-palliative coping — �.255 .277* .006 .192 .216 .002 3.164 0.890

5. Emotional reaction coping — �.679** .526** �.521** �.352* �.429** 1.846 0.581

6. Acceptance coping — �.462** .594** .398** .466** 4.076 0.717

7. Wishful thinking coping — �.524** �.306* �.345* 3.384 1.283

8. Distance coping — .241 .285* 3.032 0.961

9. Generalized self-efficacy — .551** 3.801 0.820

10. Self-esteem — �0.008 0.982

Note. N D 39.

*p < .05 (one-tailed). **p < .01 (one-tailed).

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TABLE 3

Summary of Hierarchical Regression Analysis for Prediction of Life Satisfaction

Step Predictor B SE ˇ t p

Lower

CI

(95%)

Upper

CI

(95%)

�R2

(Step) R2

1 Emotional reaction

coping

�.539 .213 �.375 �2.526 .016 �.971 �.107 .141 .141


coping

�.336 .291 �.234 �1.156 .255 �.925 .253 .023 .164

Acceptance coping .227 .222 .207 1.025 .312 �.222 .676


coping

�.182 .280 �.126 �0.648 .521 �.750 .386 .118 .282

Acceptance coping .155 .210 .142 0.737 .466 �.271 .581

Self-esteem .326 .132 .379 2.467 .018 .058 .594

Note. N D 41. CI D confidence interval.

and the beta associated with distance coping was reduced only from �.34 to �.32

with entry of efficacy and from �.32 to �.30 with entry of self-esteem, which did

not constitute significant mediation. The pattern of results in these regressions

also indicates that coping did not mediate the effects of GSE and self-esteem

on outcomes. For example, self-esteem was significant, and coping was non-

significant in the final step of the model for prediction of life satisfaction; GSE

was significant at Step 3, and self-esteem was significant at Step 4 of the model

for prediction of anxiety (after entry of coping); and regression coefficients for

GSE and self-esteem (as revealed by statistics for excluded variables) did not

TABLE 4

Summary of Hierarchical Regression Analysis for Prediction of Anxiety

Step Predictor B SE ˇ t p

Lower

CI

(95%)

Upper

CI

(95%)

�R2

(Step) R2


coping

.336 .099 .482 3.391 .002 .135 .536 .232 .232


coping

.208 .113 .298 1.842 .074 �.021 .436 .082 .314

Distance coping �.140 .067 �.340 �2.098 .043 �.274 �.005


coping

.124 .107 .178 1.164 .252 �.092 .340 .133 .446

Distance coping �.132 .061 �.321 �2.178 .036 �.255 �.009

Generalized self-

efficacy

�.194 .066 �.387 �2.936 .006 �.327 �.060


coping

.056 .102 .081 0.553 .583 �.150 .263 .094 .541

Distance coping �.122 .056 �.296 �2.170 .037 �.236 �.008

Generalized self-

efficacy

�.107 .069 �.215 �1.561 .127 �.247 .032

Self-esteem �.161 .060 �.387 �2.681 .011 �.283 �.039

Note. N D 40. CI D confidence interval.

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meaningfully decline after entry of distance coping in the model for prediction

of anxiety. Results of both regressions were functionally equivalent when the 2

cases whose primary disability was reported as burns were removed.

Regarding the third model, mediational analyses using the widely recom-

mended bias-corrected bootstrapping procedure (Mallinckrodt, Abraham, Wei,

& Russell, 2006; Preacher & Hayes, 2004) revealed that, consistent with recent

literature (Lightsey et al., 2006), self-esteem mediated the relation between self-

efficacy and anxiety (bootstrap coefficient D �.08, confidence interval D �.23 to

�.01, p < .05). With entry of self-esteem, the regression coefficient associated

with self-efficacy was reduced from �.19, t D �2.94, p < .01 to �.11, t D

�1.56, p > .12. It should be noted that bias-corrected bootstrapping is useful on

small sample sizes and produces more accurate confidence intervals and a lower

likelihood of Type-2 errors than all competing methods for testing mediation

(Mallinckrodt et al., 2006).

DISCUSSION

The purpose of this study was to test the hypothesis that more use of acceptance

coping and less use of avoidance, emotional reaction, and wishful thinking

coping would predict higher GSE and self-esteem, and that higher GSE and self-

esteem would, in turn, predict better psychological adjustment, operationalized

as lower anxiety and higher life satisfaction. The alternative hypothesis that GSE

and self-esteem would serve as psychological resources that predict coping, and

that coping would in turn directly predict psychological adjustment, also was

tested.

Contrary to the hypotheses, neither GSE nor self-esteem mediated the relation

between coping and outcomes, nor did coping mediate the effects of GSE and

self-esteem on outcomes. Instead, self-esteem and emotional reaction coping

directly predicted life satisfaction, with higher self-esteem and lower emotional

reaction coping related to higher life satisfaction. Only self-esteem remained

significant in the final step. In prediction of anxiety, emotional reaction cop-

ing, distance coping, self-efficacy, and self-esteem were significant at the steps

entered, but only distance coping and self-esteem remained significant in the

final step, with lower distance coping and higher self-esteem predicting higher

anxiety. Mediational analyses indicate that, consistent with previous evidence

(Lightsey et al., 2006), self-esteem mediated the relation between GSE and anx-

iety. The respective models accounted for 28% of the variance in life satisfaction

and 54% of the variance in anxiety.

Contrary to existing literature (S. M. Miller, Brody, & Summerton, 1988; Suls

& Fletcher, 1985), neither acceptance coping nor avoidance coping predicted

psychological adjustment. This may support the argument that the dichotomous

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acceptance–avoidance coping model constructed for adults does not apply suf-

ficiently to children, who may use coping strategies that are quite distinct from

the strategies used by adults (Petersen et al., 2006).

However, consistent with the hypotheses, higher self-esteem and lower levels

of emotional reaction coping predicted both higher life satisfaction and lower

anxiety, whereas higher GSE and higher distance coping predicted lower anxiety.

These results dovetail with several recent findings. For example, adolescents

with higher levels of self-esteem utilized less emotion-focused coping and ex-

perienced better psychological adjustment (Mullis & Chapman, 2000). Less

use of emotion-focused coping among children and adolescents with chronic

illnesses or disabilities has been associated with higher levels of self-worth and

happiness, whereas more use of emotion-focused coping among children has

been associated with poorer psychological adjustment and less satisfaction with

life (Ebata & Moos, 1994; Gil et al., 1991; Tyc et al., 1995).

In regard to managing an illness or disability, lower self-esteem has been

linked to increased severity of impairment among adolescents with a chronic

illness. Low self-esteem may influence children’s confidence in their ability to

manage their disability or illness and may increase social withdrawal and self-

criticism (Garralda & Rangel, 2004; Gil et al., 1991; Spirito, Francis, Overholser,

& Frank, 1996). Indeed, the influence of self-esteem on anxiety may be mediated

by such situation-specific factors.

Results of this study also suggest that, consistent with previous literature (e.g.,

Bagley et al., 1997; Kumar & Lal, 2006), not only coping but also cognitive

variables, such as GSE and self-esteem, are important and valid constructs among

adolescents and indeed among children as young as 10. Thus, older children

and adolescents appear to have acquired self-reflective cognitive abilities and

the experience base to develop GSE beliefs about their abilities, as well as

general feelings of self-worth. Indeed, these constructs are sufficiently developed

to predict important indexes of well-being in this population. This finding is

consistent with arguments that developmental models should consider the role

of experience (Crisp et al., 1996).

Of course, conclusions of this study are tempered by several limitations.

Due to the cross-sectional design, longitudinal research is needed to determine

whether coping, GSE, and self-esteem predict future life satisfaction and anxiety.

Generalizability of the study findings may also be limited due to the small

sample size and utilization of children who attended one particular camp. Future

studies in this area may benefit from soliciting multiple sites to increase sample

size and generalizability. In addition, because over 82% of the sample was

Caucasian, the findings are limited in its generalizability to other racial groups.

Finally, the response rate was low, and respondents may have differed from

non-volunteers. For example, respondents may have had less severe disabilities,

higher self-esteem, or greater life satisfaction than non-volunteers. Furthermore,

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all instruments were self-report; and the CSIS, which we used to measure the

self-esteem of 4 participants age 10 or 11, has been used infrequently in the

literature. Although, in theory, our findings should generalize across persons with

different levels of self-esteem and other variables, and although these findings

are consistent with the literature, future studies should strive to obtain higher

response rates. Future studies that include a more diverse sample will increase

the applicability of this research to other populations.

This study suggests that self-esteem may directly increase life satisfaction

and decrease anxiety. In addition, lower levels of emotional reaction coping

may contribute to greater life satisfaction and lower anxiety, and higher dis-

tance coping may lead to lower anxiety. Reducing use of emotional reaction

coping and increasing GSE, self-esteem, and use of distance coping, then, may

help children and adolescents with chronic illnesses or disabilities deal more

effectively with the stresses of illness and disability and may ultimately lead to

higher life quality and well-being. Examples of maladaptive emotion-oriented

coping include telling oneself that the problem will never happen again, wishing

that one could change the event or how one felt, blaming oneself, worrying, or

taking out one’s feelings on other people.

Future studies should examine these contentions, as well as the possibility,

suggested by findings in this study, that self-efficacy, self-esteem, and emotional

reaction coping are particularly important in fostering psychological adjustment.

Studies that include larger samples, and clinical trials that compare treatments

that target these variables to treatments that focus on alternative targets of change

(e.g., self-acceptance or development of social support), would be especially

helpful in confirming the importance of the tested models to children with

disabilities and chronic illnesses.

Implications for Practice

Cognitive-behavioral forms of therapy or psychoeducation have been found to

be highly effective in treating children and adolescents with chronic diseases

or illnesses (Beale, Bradlyn, & Kato, 2003; Last, Stam, van Nieuwenhuizen, &

Grootenhuis, 2007), as well as depression (Haby, Tonge, Littlefield, Carter, &

Vos, 2004), anxiety disorders (In-Albon & Schneider, 2006), and many other

problems. For example, a cognitive-behavioral treatment that included cognitive

restructuring, behavioral contracting, relaxation and hypnosis, and other ele-

ments resulted in significant improvements in anxiety, pain, fatigue, functional

disability, somatization, and parental report of internalizing behaviors among

children with juvenile primary fibromyalgia syndrome (R. B. Rosenberg, 2005).

Similarly, when combined with standard medical care, short-term family cogni-

tive behavioral treatment results in significantly less child- and parent-reported

child abdominal pain (but no difference in functional disability or somatization)

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among children with recurrent abdominal pain, compared to standard medical

care alone (Robins, Smith, Glutting, & Bishop, 2005).

These findings are consistent with theory and evidence from the adult lit-

erature (e.g., Butler, Chapman, Forman, & Beck, 2006) indicating that therapy

focused on teaching coping skills and cognitive restructuring (e.g., identification,

disputation, and replacement of dysfunctional beliefs) can be effective in reduc-

ing fear and anxiety as well as self-blame, wishful thinking, and other elements

of emotion-oriented coping. For example, helping children with disabilities to

recognize negative emotions as potential cues for the presence of negative

beliefs, such as “I’ll never succeed because of my disability,” and to replace

such beliefs with more adaptive and realistic beliefs, such as “I’m smart and

capable and my disability won’t prevent me from succeeding,” can potentially

reduce emotion-oriented coping while increasing self-efficacy and self-esteem.

Sensitizing parents, teachers, and health care professionals to the importance

of children’s coping, self-esteem, and self-efficacy may also help to provide

children with chronic illnesses or disabilities vital opportunities to learn and

practice strategies that will ultimately lead to greater psychological well-being

(see Alvord & Grados, 2005)

Mental health professionals, then, should strive to help children and ado-

lescents with chronic illnesses or disabilities to reduce the use of emotional

reaction coping and to increase the use of distance coping. Self-efficacy has

proven particularly malleable via activities such as provision of mastery expe-

riences, modeling, and verbal persuasion (see Bandura, 1997). Given the direct

influence of GSE on self-esteem, and the indirect influence of GSE on anxiety,

counselors should pay particular attention to interventions designed to augment

GSE (see Eden & Aviram, 1993; Eden & Kinnar, 1991). Modeling, role playing,

and information gathering may help to provide an environment for children

to effectively master skills, promote self-efficacy and self-esteem, and thereby

lower anxiety and increase life satisfaction (see Bandura, 1997).

In addition, establishing and achieving valued goals may foster life satisfac-

tion (see Lent, 2004). The perceived capacity to create pathways to salient goals,

and to motivate oneself to use those pathways, has been linked to self-efficacy,

self-esteem, psychological adjustment, and physical health (see Snyder, 2002).

Thus, helping clients to set and work toward goals in important realms such as

school, extracurricular activities, work, and personal relationships may lead to

mastery experiences that greatly augment self-efficacy and self-esteem, hence

increasing life satisfaction and reducing anxiety.

Although our study found no evidence for the effects of acceptance coping,

other studies have found that direct forms of coping such as problem-solving

coping, task-oriented coping, and acceptance coping can be quite helpful. In-

corporating medically related information, as well as psychoeducational aspects,

into the therapy session may foster such forms of coping. Thus, it is particularly

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important that therapists acquire additional knowledge pertaining to medical

procedures and the specific disability or illness of their clients. Utilizing this

information with children may promote direct forms of coping and increase

positive health management behaviors, such as medication adherence (Green-

house, Meyer, & Johnson, 2000). Utilization of these strategies in the context

of a collaborative counseling approach may lead children with disabilities or

illnesses to the sought-after goals of lower anxiety and higher life satisfaction.

ACKNOWLEDGMENT

The authors contributed equally to this project.

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