Capturing coping with symptoms in people with a diagnosis of schizophrenia: introducing the MACS-24.

In order to assess coping with psychotic symptoms, the Maastricht Assessment of Coping Strategies (MACS), 24 symptom version, was developed as a refinement of the previous MACS-13. Associations between type of coping and the experienced level of control over psychotic symptoms were examined using MACS-24.MACS-24 was administered to 32 individuals with a diagnosis of schizophrenia. For each of 24 symptoms, experience of distress, type of coping and the resulting degree of perceived control were assessed. Coping types were reduced to two contrasting coping factors: symptomatic coping and non-symptomatic coping (combining active problem solving, passive illness behaviour, active problem avoiding, and passive problem avoiding).Mean level of distress and perceived control (range: 1-7) were, respectively, 4.2 [standard deviation (SD) = 1.9] and 4.2 (SD = 1.9). The association between distress and perceived control was negative [beta = -0.28; 95% confidence interval (95%CI) = -0.41 to -0.15]. Type of coping interacted with perceived control (p = 0.005), in that symptomatic coping was negatively associated with perceived control [odds ratio (OR) over seven levels = 0.82, 95%CI = 0.71-0.94], whereas for non-symptomatic coping a positive association was apparent (OR over seven levels = 1.10, 95% CI = 1.03-1.19).Previous contrasts between symptomatic and non-symptomatic coping were replicated using MACS-24, suggesting clinical validity and utility.