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Coping strategies and associated factors among people with physical disabilities for psychological distress in Ethiopia



Coping strategies are frequently used among individuals with physical disabilities when they face adversities. Low- and middle-income countries are not investigated coping styles among psychological distress persons with disabilities despite the high prevalence of psychological distress. The aim of this study was to identify coping strategies among people with physical disabilities for their psychological distress in Ethiopia has a crucial role to improve the health status of persons with physical disabilities.


An institution-based cross-sectional study was employed among individuals living with physical disabilities at the University of Gondar staff and students from May to June 2021. All staff and students with physical disabilities were screened for psychological distress (n = 269). The census sampling technique was used to select the study participants for psychological distress. The Brief Cope with Problems Experienced (COPE-28) was used to assess coping strategies. Bivariate and multivariate linear regression analyses were used to identify factors associated with coping strategies. An odd ratio (OR) with a 95% confidence interval (CI) at P < 0.05 was computed to assess the strength of the association.


The emotional-focused coping strategy was the most frequently used when dealing with psychological distress among participants with physical disabilities. The most commonly used emotional-focused coping strategy was spirituality. In the multivariate analyses; urban residence (β = 3.05, 95% CI: 0.98, 5.12), and stigma (β = 3.10, 95% CI: 0.61, 2.83) were factors positively associated with emotion-focused coping strategy, and World Health Organization Quality of Life (WHO QOL) (β = 0.18, 95% CI: 0.13, 0.22), and stigma (β = 1.11, 95% CI: 0.61, 2.83) were factors significantly associated with problem-focused coping. Urban residence (β= -0.96, 95% CI: -1.69, -0.22) was negatively associated with dysfunctional coping strategy, but WHO QOL (β = 0.35, 95% CI: 0.32, 0.38) was positively correlated with dysfunctional coping.


In this study revealed that spirituality is the most frequently used coping strategy among the study participants. Urban residents, stigma, and WHO QOL significantly correlated with coping strategies among such patients. The Ministry of Health, Ministry of Education, and other concerned organizations may find the present findings useful to strengthen the coping styles to minimize psychological distress among people with physical disabilities.

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Globally, more than one billion or 15% of the world’s population are estimated to live with disabilities. About 80% of them lived in developing countries. It is more prevalent among women than men. Individuals with physical disabilities affected forty-five million people worldwide of them 90% living in developing countries [1,2,3]. According to the World Bank and World Health Organization(WHO) report, there are fifteen million people with disabilities in Ethiopia [4]. Throughout the world, people with disabilities have poor health outcomes, low education achievements, less financial participation, barriers in accessing services, and higher rates of poverty than people without disabilities [3, 5,6,7].

Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to negative aspects of the interaction between an individual and that individual’s factors (environment and personal factors) [8]. Thus problems are a complex phenomenon, reflecting an interaction between a person’s body and the features of the society in which he/she lives [3, 9].

Coping is the ability to adjust, adapt and meet a challenge successfully. It also entails contending or dealing successfully with a challenging event [10]. Noted that coping means when one constantly changes her/his behavioral and thought effort that people adopt to master, reduce or minimize stressful events in order to manage some specific external demands that have been judged as tasking or exceeding the resources of the person [11, 12]. Or it is the reduction of tension and restoration of equilibrium [13]. There are two most commonly widely used types of coping. Coping is directed at managing or altering the problem causing the distress is problem-focused and coping is directed that regulating the emotional response to the problem is emotion-focused [13, 14]. A spiritual-focused coping strategy is finding meaning and purpose in adversity through a strong relationship with God [15].

The concept of positive coping has been associated with lower levels of psychological distress, whereas negative coping has been associated with higher levels of psychological distress [16].

It plays both independent and interactive roles in influencing physical and mental health conditions [17]. People with disabilities are confronted by using different supporting materials. These include; wheelchairs, artificial limbs, inaccessible to appropriate technology, and difficulty in repairing, and maintaining accessible devices [18]. Coping strategies are important to improve social and physical barriers to people with disabilities [19]. It is different among females and males. Males have to control stress, either overcoming or fleeing it and females are not easily cope with psychological stress due to natural conditions [20].

Different studies revealed that there are several coping strategies among individuals with disabilities for their psychological distress. These include; sought of social support, problem-solving, physical exercise, avoidance, using social media, watching movies, and relationship with others [21,22,23]. Social support and problem-focused coping strategies play an important role to increase life satisfaction and the personal growth of people with disabilities [24].

In Ethiopia, still unknown whether coping styles have an important impact on individuals with physical disabilities responding to psychological distress. As it is the first research attempt in Ethiopia, it is supposed to bring fresh insight into the field and serve as the basis for future researchers in the country. In Ethiopia, coping strategy has not been studied among individuals with physical disabilities living with psychological distress. Still, people who are exposed to different mental health conditions associated with their disabilities were investigated for the status of the coping styles of their mental well-being with different psychological distress, very little attention has been given to buffering psychological distress and associated factors in people exposed to different stressful events linked with their disability, which is the common problem in developing countries, and Ethiopia context particular. Therefore, the current study conducted to assess coping strategies and associated predictors among students and staff with physical disabilities at the University of Gondar in northwest Ethiopia has a vital role to overcome psychological distress by the participants and mental health professionals.

Methods and materials

Study design and period

An institution-based cross-sectional study design was conducted among students and staff with physical disabilities at the University of Gondar from May to June 2021.

Study area

The University of Gondar was established in 1954, and hence this is the oldest medical training institution in the country. The University has five campuses. As we got the information from the Master card foundation and disability directorate, on all campuses around 44 masters and 178 undergraduate students with physical disabilities have been attending their classes. More than 71 individuals with physical disabilities have been employed at the University of Gondar.

Study population

All students and staff with physical disabilities were living at the University of Gondar during the study period.

Inclusion and exclusion

All students and staff whose age ≥ 18 years and they are living with physical disabilities were included in the study and all students who were on withdrawal and staff who were on annual/maternal/sick leave were excluded.

Sampling technique

The census sampling technique was used to recruit the study participants at the University of Gondar. A total of 269 study samples were identified and screened for psychological distress symptoms by using a Kessler psychological distress scale (K-10). Those who scored ≥ 20 were probable psychological distress. After the screening, ninety-three participants with physical disabilities were eligible to assess their coping strategies.

Data sources and measurements

Data were collected using an interviewer-administered structured questionnaire, which contain several other explanatory variables-including; socio-demographic factors (sex, marital status, education, occupation, residency), psychosocial factors (stigma, WHO QOL, perceived social support, suicidal behaviors, WHO Disability Assessment Schedule-2 (WHODAS-2), types of disabilities(visual, legs and others)s, clinical factors( presence of chronic illnesses), and substance use factors(Alcohol and Khat). The following instruments were employed. The coping strategy was assessed by using the Brief-COPE scale. The scale has 28 items that assess the degree to which a participant utilizes a specific coping strategy. The 28 items are being categorized into 14 coping strategies. The scale has three subscale; problem-focused, emotion-focused and avoidant coping. Respondents rate items on a 4-point Likert scale, ranging from 1 “I have not been doing this at all” to 4 “I have been doing this a lot.” It was used to assess coping styles for mental illness in our country [25,26,27,28,29,30,31]. In this study, cronbach’s alpha was 0.857.

We measured functional impairment using the 12 items WHODAS-2 having; six domains(cognition, self-care, getting along, life activities, mobility, and participations) that are reported the five-point Likert scale from 0 = no difficulty to 4 = very severe difficulty based on the severity of problems [32,33,34]. The instrument has been validated among disabilities in Ethiopian setting [35]. In this study, cronbach’s Alpha was 0.8.

Social support was assessed using the Oslo 3-item social support scale which was used in several studies. It provides a brief measure of social support and functioning and is considered to be one of the best predictors of mental health. It covered different levels of social support by measuring the number of people the respondents feel close to, the interest and concern shown by others. The Oslo-3, total scores were calculated by adding up the raw scores for each item. The score scale ranges from 3 to 14 and three broad categories: “poor social support” 3 to 8, “moderate support” 9–11, and “strong support” 12–14 [36,37,38].

Stigma was assessed by using an eight items of stigma scale for chronic illness (SSCI-8) [39]. It comprises eight items rated on a five-point Likert scale from one (never) to five (always). Total score range from eight to forty, with a cutoff score greater than eight indicating the presence of stigma [40, 41].

Substance related factors were assessed using WHO’s Alcohol, smoking, and substance involvement screening test (ASSSIS), and its internal consistency was in a good range (Cronbach’s Alpha = 0.80) with the sensitivity of 80%, and specificity of 71% [42].

Patients’ quality of life was assessed by using 26 items of the WHOQOL-BREF questionnaire. The questionnaire consists of two parts. The first, part evaluates the individual’s overall perceptions of quality of life and the person’s overall perception of health. The second part evaluates the four domains: physical health, psychological health, social, and environmental health. Domain scores are scaled in a positive direction (i.e. higher scores correspond to a better quality of life). The QOL raw scores are transformed into a range between 0 and 100. The overall QOL is computed as the average of the score of the four domains. The higher mean score indicates better QOL and vice versa [43].

Suicidal ideation and attempts were measured according to the WHO Composite International Diagnostic Interview (CIDI) questionnaires. If the participant provided a “Yes” answer to the question, (“During their disabilities, have you ever seriously thought about committing or attempted suicide, respectively?” they were considered to have suicidal ideation or attempt, respectively [44].

Data processing and analysis

The completed questionnaire was checked for completeness and then was coded, recoded, and entered into Epi-info version seven statistical programs and then exported to SPSS version 21 for analyses. Both descriptive and analytical procedures were used. Descriptive statistics like frequency, percentage, mean and standard deviation (SD). After all variables fulfilled the chi-square (categorical variables), computed mean, independent sample t-test, one way ANOVA and then checked their collinearity diagnostic, and independent from other Variable Inflation factors (VIF was less than 2 and tolerance greater than 0.2 and less than 0.989) and simple linear and multiple linear regression analysis stepwise methods employed to identify factors associated with coping strategies whose P-values were < 0.2 level. Finally, the variables that had an independent association with coping strategies were declared based on 95% CI and P-value < 0.05. Model fitness was checked by using Adjusted R square from 0.43 to 0.89 at f-test 0.0001 to 0.05). An adjusted unstandardized β coefficient was used to describe the association with coping strategy.


Socio-demographic characteristics of participants

The mean age of the respondents was 24.67 ± 5.48 years. Out of the participants, 87.1% (n = 81) were single, and 91.4% (n = 85) were Orthodox Christian followers. The majority of the study population, n = 81(87.1%) degree and above educational holders, nearly 90% (n = 81) were students and more than two-thirds of the study population got ≤ 3799 Ethiopian birrs, and more than 50% (n = 52) of participants were rural resident (Table 1).

Table 1 Socio-demographic characteristics among individuals with physical disabilities at the University of Gondar, Northwest Ethiopia, 2021(N = 93)

Psychosocial and health-related characteristics of respondents

Of the participants, more than 50% (n = 49) had visual impairment, and one in three of the respondents had both legs disability. Nine in ten participants were stigmatized due with physical disabilities, and 55.9% (n = 52) had intermediate social support. A small number of n = 17(18.3%) and n = 20(21.5%) respondents were chewed khat and suicidal ideation, respectively. The mean and the standard deviation of the overall WHO QOL and WHODAS-2 were 39.1 ± 12.5 and 24.35 ± 8.25, respectively. The mean and SD of psychological distress were 26.52(5.87) (Table 2).

Table 2 Distribution of psychosocial and health related characteristics among individuals with physical disabilities at the University of Gondar, Northwest Ethiopia, 2021(N = 93)

Coping strategies

The two most common coping strategies were “Giving up trying to deal with it,” and “Using alcohol or other drugs to help me get throw it.” were reported to be used ‘a lot’ by n = 60; 64.5% and 60.2% (n = 56) participants, respectively. The least frequently used coping strategies were accepting the reality of the fact and taking action from 28 item of brief COPE (Table 3). Table 4: illustrates that a brief COPE 28 item is comprised of 14 subscales, each of which assesses the degree to which a respondent utilized a specific coping strategy. Each of the fourteen scales is comprised of two items; total scores on each scale range from 2 (minimum) to 8 (maximum). Higher scores indicate increased utilization of that specific coping strategy. In this subscale, the spiritual coping style has been the most frequently used coping strategy among the respondents with physical disabilities. Table 5; illustrates the possible score of coping strategy, the sample mean coping strategy score of 41.15(SD = 11.34). The mean score of the sample can be understood as lower. The mean and SD score of problem-focused, emotion-focused, and dysfunctional coping strategies were 11.46(SD = 3.26), 13.61(SD = 5), and 15.28(SD = 4.53), respectively.

Table 3 Frequency of 28 items coping strategies among participants with physical disabilities for psychological distress symptoms at the University of Gondar northwest Ethiopia, 2021 (N = 93)
Table 4 Mean (SD) of 14 subscale coping strategies among participants with physical disabilities for psychological distress symptoms at the University of Gondar northwest Ethiopia, 2021 (N = 93)
Table 5 Descriptive statistics of coping domains among participants with physical disabilities for psychological distress symptoms at the University of Gondar northwest Ethiopia, 2021 (N = 93)

Relationship between factors and coping strategy

Sub-sample tests were formed based on the samples of categorical variables by using independent sample t-test, one-way ANOVA and post hoc pair-wise comparisons were employed to examine if a significant differences existed as the function of the variables. The independent sample t-test between female (mean = 14.68; SD = 4.66) and male (M = 12.65; SD = 5.13) produced a statistical mean difference in the emotional-coping strategy (t[90]=-1.99, p < 0.05), rural resident (M = 11.73; SD = 4.7) and urban resident (M = 16;SD = 4.2) yielded a statistical mean difference on emotional-coping strategy (t[89]=-4.5, p < 0.0001). Stigma (M = 14.22; SD = 4.72) and no stigma (M = 9.5; SD = 4.5) a statistical mean difference on emotional-coping (t[14] =-3.2) at p < 0.02). The independent sample t-test between stigma (M = 11.8; SD = 3.18) and no stigma (M = 9.17; SD = 2.9) produced a statistical mean difference on problem-coping strategy (t[15] =-2.7; p < 0.001). Finally, independent sample t-test between female (M = 16.29; SD = 4.37) and male (M = 14.37; SD = 4.5) yielded a statistical mean difference on dysfunctional coping (t[90]=-2.09; p < 0.04).

Factors associated with coping strategy

In simple linear regression; sex, residence, stigma, income, suicidal attempt, alcohol use, psychological distress, WHO QOL, and WHODAS-2 were factors nominated further multiple linear regression analysis model because these predictors have satisfied preliminary assumptions to become candidate factors with coping strategy at P < 0.2 in simple linear regression. After controlling potential confounding factors in multiple linear regression analysis, findings showed that urban residence, stigma and WHO QOL were factors significantly associated with coping strategies P-value less than 0.05.

In the multiple linear regression analyses; urban residence β = 3.05(0.98–5.12), and stigma β = 3.01(1.80–7.64) were positively associated with an emotion-focused coping strategy. Stigma β = 1.11(0.61–2.83), and WHO QOL β = 0.18(0.13–0.22) were factors positively associated with a problem-focused coping strategy. Urban residence β=-0.96(-1.69-0.22) was negatively associated with dysfunctional coping strategy, but WHO QOL β = 0.35(0.32–0.38) was positively associated with dysfunctional coping strategy (Table 6).

Table 6 Simple and multiple linear regression of coping strategies and associated factors among respondents with physical disabilities for psychological distress at University of Gondar, northwest Ethiopia, 2021(N = 93)


Coping is the expending conscious effort to solve personal and interpersonal problems and seeking to master, minimize or tolerate psychological distress associated with persons with physical disabilities. Persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments whose interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

In this study, the overall mean coping strategy score was lower than the mean value of the total mean score of coping, but the subscale of emotional-focused coping was the highest coping strategy mean score compared with the subscale of problem-focused and avoidant coping strategies. In contrast of this study, the study did in India understanding coping with distress due to physical disabilities revealed that a problem-focused coping strategy significantly reduced the level of psychological distress [45].

Dysfunctional/avoidance coping strategies were negatively impacted psychological distress with participants with physical disabilities, which was supported by another study on physical disabilities [46]. There are positive and negative coping mechanisms used by individuals with physical challenges [47].

In this study, spiritual coping was the most frequently used coping style among study participants which was consistent with coping strategies among Poland students with physical disabilities revealing that beliefs about oneself, the world, and basic hope to contribute to explaining variations in the nature and strength of persons coping strategies [48]. In the present study, spirituality is the most frequently used coping strategy among the participants from the emotional-focused subscale. Which was supported by another study in Ethiopia, spiritual coping was the most frequently used coping strategy among psychologically distressed women [49]. Spirituality coping mechanism was significantly predictive of good mental health [50]. It has also been found to act as a resource for coping for people with physical disabilities [51]. There were many studies that supported spirituality was a good coping mechanism for psychological distress among respondents with physical disabilities [52,53,54]. Spirituality influences people’s ability to cope with stresses which practices are related to greater life satisfaction, happiness, positive affect, and other showing of well-being [55].

In the present study, the remarkable findings were obtained. The relationship between coping and psychological distress is not direct relation, but they might be importantly influenced by other factors [56]. Stigma was positively associated with the emotional and problem-focused coping strategies subscale. Stigma contributes to the discrimination and exclusion experienced by people with disabilities in all aspects of their lives due to lack of awareness and understanding regarding causes of disability, misconceptions about cause of disabilities often result from cultural and religious beliefs [57, 58]. Disability has its stigma pervasive in every society, but in parts of Africa and Asia, discrimination towards people with physical disabilities can be particularly oppressive. This in turn their coping styles like emotions or to solve problems were associated with disability [59]. The ability to use a positive coping strategy was connected with lower self-stigma, while negative coping strategies associated with increased stigma [60].

In the current study, quality of life among respondents with physical disabilities was positively correlated with problem-focused and avoidant/dysfunctional coping strategy subscales. Coping style can play a role in health-related quality of life associated with people with physical disabilities [46]. Quality of life was positively associated with coping style items; such as support and venting, positive reframing and acceptance, active coping, and self-distraction, in contrast, denial, humor, religion, and self-blaming were negatively associated with quality of life [61]. Coping styles correlated negatively with all quality of life domains except the mental health domain among persons with physical disabilities [62]. The quality of life and coping strategies are positively associated; supposed to be adaptive coping strategies [63] and improving the quality of life among adolescents with physical disabilities may focus on the reduction of life stress by increasing the variety of social and personal resources [64].

Another significant factor in this study, being living in the urban was correlated with emotional-focused and avoidant coping styles. Those who are living in urban were higher mean value of coping strategies than rural residents [65]. In urban adolescents have many options to solve the problem or cope with stress [65]. Rural residents was lower severity of physical distress and greater satisfaction than their counterparts from large cities [66]. Patients living with chronic medical diseases in Poland, and those who were living in rural areas had a low levels of psychological distress due to their social interaction and spirituality [66].


One of the most limitations of this study is social desirability bias. Despite a new qualitative study in Ethiopia, it has a small sample size of psychological distress among participants with physical disabilities. Moreover, other limitation is that it was not possible to explain the cause and effect relationship between psychological distress and coping strategies due to the cross-sectional nature of the study. The prospective study could help to elucidate whether coping styles predispose persons with physical disabilities or the consequence of psychological distress.


In summary, this is the first study on coping strategies for psychological distress among respondents with physical disabilities at University of Gondar. Spiritual coping was the most frequently used coping strategy. The urban residence and stigma were positively correlated with emotional-focused coping strategies. Stigma and WHO QOL were factors significantly associated with problem-focused coping strategy and WHO QOL was positively correlated with avoidance coping style, but the urban residence was negatively associated with dysfunctional coping. The Ministry of Health, Ministry of Education, and other concerned organizations may find the present findings useful to strengthen the coping styles to minimize psychological distress among people with physical disabilities. Researchers should conduct a further study on coping styles and associated factors among persons with physical disabilities of psychological distress by using different approaches, including other study design and variables such as cohort study designs in this area as well as different parts of the county for further exploration of coping strategies.

Availability of data and materials

The dataset during and/or analyzed during the current study available from the corresponding author on reasonable requests.


  1. Swaine A, Spearing M, Murphy M, Contreras-Urbina M. Exploring the intersection of violence against women and girls with post-conflict statebuilding and peacebuilding processes: a new analytical framework. J Peacebuilding Dev. 2019;14(1):3–21.

    Article  Google Scholar 

  2. Elwan A. Poverty and disability: a survey of the literature. Washington, DC: Social Protection Advisory Service; 1999.

    Google Scholar 

  3. World Health Organization. World report on disability 2011. World Health Organization; 2011.

  4. Seelman KD. The world health organization/world bank’s first world report on disability. Int J Telerehabilitation. 2011;3(2):11.

    Article  Google Scholar 

  5. She P, Livermore GA. Material hardship, poverty, and disability among working-age adults. Soc Sci Q. 2007;88(4):970–89.

    Article  Google Scholar 

  6. She P, Livermore GA. Long-term poverty and disability among working-age adults. J Disabil Policy Stud. 2009;19(4):244–56.

    Article  Google Scholar 

  7. Houtenville AJ, editor. Counting working-age people with disabilities: what current data tell us and options for improvement. WE Upjohn Institute; 2009.

  8. Leonardi M, Bickenbach J, Ustun TB, Kostanjsek N, Chatterji S. The definition of disability: what is in a name? The Lancet. 2006;368(9543):1219–21.

    Article  Google Scholar 

  9. Rimmer JH, Marques AC. Physical activity for people with disabilities. The Lancet. 2012;380(9838):193–5.

    Article  Google Scholar 

  10. Folkman S, Lazarus RS. If it changes it must be a process: study of emotion and coping during three stages of a college examination. J Personal Soc Psychol. 1985;48(1):150.

    Article  CAS  Google Scholar 

  11. Tennen H, Affleck G, Armeli S, Carney MA. A daily process approach to coping: linking theory, research, and practice. Am Psychol. 2000;55(6):626.

    Article  CAS  Google Scholar 

  12. Affleck G, Tennen H. Construing benefits from adversity: adaptotional significance and disposltional underpinnings. J Pers. 1996;64(4):899–922.

    Article  CAS  Google Scholar 

  13. Hagemann O. Victims of violent crime and their coping processes. Critical issues in victimology: international perspectives. New York: Springer Publishing Co; 1992. pp. 58–67.

    Google Scholar 

  14. Roth S, Cohen LJ. Approach, avoidance, and coping with stress. Am Psychol. 1986;41(7):813.

    Article  CAS  Google Scholar 

  15. Baldacchino D, Draper P. Spiritual coping strategies: a review of the nursing research literature. J Adv Nurs. 2001;34(6):833–41.

    Article  CAS  Google Scholar 

  16. Terry D, Hynes G. Coping: pitfalls and promise. Ann Rev Psychol. 2004;55:745–74.

    Article  Google Scholar 

  17. Jacobs JM, Carver CS. Personality and Coping. The Wiley Encyclopedia of Health Psychology. 2020:411–20.

  18. Bates PS, Spencer JC, Young ME, Rintala DH. Assistive technology and the newly disabled adult: adaptation to wheelchair use. Am J Occup Therapy. 1993;47(11):1014–21.

    Article  CAS  Google Scholar 

  19. Stuntzner S, Hartley M. Resilience, coping, & disability: the development of a resilience intervention. Vistas Online; 2014.

  20. Verma R, Balhara YPS, Gupta CS. Gender differences in stress response: role of developmental and biological determinants. Industrial psychiatry journal. 2011;20(1):4.

    Google Scholar 

  21. Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Psychological distress and coping amongst higher education students: a mixed method enquiry. PLoS ONE. 2014;9(12):e115193.

    Article  Google Scholar 

  22. Kim J, Han A, Piatt JA, Kim J. Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities. Health Promotion Perspectives. 2020;10(4):401.

    Article  Google Scholar 

  23. Werner EE, Smith RS. Journeys from childhood to midlife: risk, resilience, and recovery. Cornell University Press; 2001.

  24. Kim J-H, McKenzie LA. The impacts of physical exercise on stress coping and well-being in university students in the context of leisure. Health. 2014;6(19):2570.

    Article  Google Scholar 

  25. Yusoff N, Low WY, Yip CH. Reliability and validity of the brief COPE scale (English version) among women with breast cancer undergoing treatment of adjuvant chemotherapy: a malaysian study. Med J Malaysia. 2010;65(1):41–4.

    CAS  Google Scholar 

  26. Cooper C, Katona C, Livingston G. Validity and reliability of the brief COPE in carers of people with dementia: the LASER-AD study. J Nerv Ment Dis. 2008;196(11):838–43.

    Article  Google Scholar 

  27. Bacanli H, Surucu M, Ilhan T. An investigation of Psychometric Properties of coping Styles Scale brief form: a study of validity and reliability. Educational Sciences: Theory and Practice. 2013;13(1):90–6.

    Google Scholar 

  28. Snell DL, Siegert RJ, Hay-Smith EJC, Surgenor LJ. Factor structure of the brief COPE in people with mild traumatic brain injury. J Head Trauma Rehabil. 2011;26(6):468–77.

    Article  Google Scholar 

  29. Carver CS. You want to measure coping but your protocol’too long: consider the brief cope. Int J Behav Med. 1997;4(1):92–100.

    Article  CAS  Google Scholar 

  30. Doron J, Trouillet R, Gana K, Boiché J, Neveu D, Ninot G. Examination of the hierarchical structure of the brief COPE in a french sample: empirical and theoretical convergences. J Pers Assess. 2014;96(5):567–75.

    Article  Google Scholar 

  31. Mohanraj R, Jeyaseelan V, Kumar S, Mani T, Rao D, Murray KR, et al. Cultural adaptation of the brief COPE for persons living with HIV/AIDS in southern India. AIDS Behav. 2015;19(2):341–51.

    Article  Google Scholar 

  32. World Health Organization. World Health Organization disabilty assessment schedule: WHODAS II. Phase 2 field trials. Health services research. 2000.

  33. Senturk V, Hanlon C, Medhin G, Dewey M, Araya M, Alem A, et al. Impact of perinatal somatic and common mental disorder symptoms on functioning in ethiopian women: the P-MaMiE population-based cohort study. J Affect Disord. 2012;136(3):340–9.

    Article  Google Scholar 

  34. Agenagnew L, Mamaru A, Hailesilassie H, Mekuriaw B, Dawud B, Abdisa E, et al. Disability among patients with mental illness in Jimma Town, Southwest Ethiopia, 2017, community based crosssectional study. J Mental Health Hum Behav. 2019;24(1):27.

    Article  Google Scholar 

  35. Denu ZA, Yassin MO, Bisetegn TA, Biks GA, Gelaye KA. The 12 items Amharic version WHODAS-2 showed cultural adaptation and used to measure disability among road traffic trauma victims in Ethiopia. BMC Psychol. 2021;9(1):1–11.

    Article  Google Scholar 

  36. Abiola T, Udofia O, Zakari M. Psychometric properties of the 3-item oslo social support scale among clinical students of Bayero University Kano, Nigeria. Malaysian J Psychiatry. 2013;22(2):32–41.

    Google Scholar 

  37. Worku A, Desalegn GT, Getnet B. Depression and the associated factors among traumatized patients admitted at University of Gondar and Felege-Hiwot comprehensive specialized hospital. Ethiopia: Northwest; 2021.

    Book  Google Scholar 

  38. Getnet B, Medhin G, Alem A. Symptoms of post-traumatic stress disorder and depression among eritrean refugees in Ethiopia: identifying direct, meditating and moderating predictors from path analysis. BMJ open. 2019;9(1):e021142.

    Article  Google Scholar 

  39. Ballesteros J, Martínez-Ginés ML, García-Domínguez JM, Forero L, Prefasi D, Maurino J, et al. Assessing stigma in multiple sclerosis: psychometric properties of the eight-item Stigma Scale for Chronic illness (SSCI-8). Int J MS care. 2019;21(5):195–9.

    Article  Google Scholar 

  40. Molina Y, Choi SW, Cella D, Rao D. The stigma scale for chronic illnesses 8-item version (SSCI-8): development, validation and use across neurological conditions. Int J Behav Med. 2013;20(3):450–60.

    Article  Google Scholar 

  41. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-.

    Article  CAS  Google Scholar 

  42. Onifade P, Bello A, Abiodun O, Sotunsa J, Ladipo O. Psychometric properties of alcohol smoking and substance involvement screening test (assist V3. 0) among university students. J Addict Behav Ther Rehab. 2014;3(3):2–7.

    Google Scholar 

  43. Group W. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403–9.

    Article  Google Scholar 

  44. Kessler RC, Üstün TB. The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121.

    Article  Google Scholar 

  45. Pande N, Tewari S. Understanding coping with distress due to physical disability. Psychol Developing Soc. 2011;23(2):177–209.

    Article  Google Scholar 

  46. Cerea S, Ghisi M, Pitteri M, Guandalini M, Strober LB, Scozzari S, et al. Coping strategies and their impact on quality of life and physical disability of people with multiple sclerosis. J Clin Med. 2021;10(23):5607.

    Article  CAS  Google Scholar 

  47. Abraham BK. Coping strategies for physically challenged children. Int J Innov Res Med Sci. 2018;3(09):2455.

    Article  Google Scholar 

  48. Byra S, Ćwirynkało K. Coping strategies in students with physical disabilities–predictive role of self-esteem, general self-efficacy and basic hope. Hrvatska revija za rehabilitacijska istraživanja. 2018;54(2):1–11.

    Article  Google Scholar 

  49. Azale T, Fekadu A, Medhin G, Hanlon C. Coping strategies of women with postpartum depression symptoms in rural Ethiopia: a cross-sectional community study. BMC Psychiatry. 2018;18(1):1–13.

    Article  Google Scholar 

  50. Pakenham KI, Sofronoff K, Samios C. Finding meaning in parenting a child with Asperger syndrome: correlates of sense making and benefit finding. Res Dev Disabil. 2004;25(3):245–64.

    Article  Google Scholar 

  51. Olson MM, Dollahite DC, White MB. Involved fathering of children with special needs: relationships and religion as resources. J Relig Disabil Health. 2002;6(1):47–73.

    Article  Google Scholar 

  52. Rahnama P, Javidan A, Saberi H, Montazeri A, Tavakkoli S, Pakpour A, et al. Does religious coping and spirituality have a moderating role on depression and anxiety in patients with spinal cord injury? A study from Iran. Spinal Cord. 2015;53(12):870–4.

    Article  CAS  Google Scholar 

  53. Kasi PM, Naqvi HA, Afghan AK, Khawar T, Khan FH, Khan UZ, et al. Coping styles in patients with anxiety and depression. ISRN PsychiatrY. 2012;2012:128672.

    Google Scholar 

  54. Krägeloh CU. A systematic review of studies using the brief COPE: Religious coping in factor analyses. Religions. 2011;2(3):216–46.

    Article  Google Scholar 

  55. Koenig H, MCCOLLOUGH M, Larson D. Handbook of Religion and Health. New York: Oxford Univ. Press; 2001.

    Book  Google Scholar 

  56. Levin DM. Psychological adjustment among the physically disabled: the role of social support and coping strategies. 1982.

    Google Scholar 

  57. Stuntzner S. Resiliency and coping with disability: the family after. 2015.

    Google Scholar 

  58. Stuntzner S, Hartley M. Stuntzner and Hartley’s life enhancement intervention: developing resiliency skills following disability. 2014.

    Google Scholar 

  59. Didi A, Soldatic K, Frohmader C, Dowse L. Violence against women with disabilities: is Australia meeting its human rights obligations? Australian J Hum Rights. 2016;22(1):159–77.

    Article  Google Scholar 

  60. Holubova M, Prasko J, Hruby R, Latalova K, Kamaradova D, Marackova M, et al. Coping strategies and self-stigma in patients with schizophrenia-spectrum disorders. Patient Prefer Adherence. 2016;10:1151.

    Article  Google Scholar 

  61. Rohwerder B. Disability stigma in developing countries. 2018.

    Google Scholar 

  62. Aiyegbusi A, Ishola T, Akinbo S. Pain coping strategies with functional disability and quality of life in patients with knee osteoarthritis in Lagos, Nigeria. J Appl Sci Environ Manage. 2018;22(12):1931–6.

    Google Scholar 

  63. Fairfax A, Brehaut J, Colman I, Sikora L, Kazakova A, Chakraborty P, et al. A systematic review of the association between coping strategies and quality of life among caregivers of children with chronic illness and/or disability. BMC Pediatr. 2019;19(1):1–16.

    Article  Google Scholar 

  64. Alriksson-Schmidt AI, Wallander J, Biasini F. Quality of life and resilience in adolescents with a mobility disability. J Pediatr Psychol. 2007;32(3):370–9.

    Article  Google Scholar 

  65. Srivastava S, Singh J, Srivastava OP. Stress and coping style of urban and rural adolescents. Int J Tech Res Appl. 2014;2(5):217–20.

    Google Scholar 

  66. Ziarko M, Mojs E, Kaczmarek I, Warchol-Biedermann K, Malak R, Lisinski P, et al. Do urban and rural residents living in Poland differ in their ways of coping with chronic diseases. Eur Rev Med Pharmacol Sci. 2015;19(22):4227–34.

    CAS  Google Scholar 

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First of all, we would like to thank the University of Gondar, disability directorate office for organizing this research program. Secondly, our heartfelt thanks also extend to the University of Gondar, disability office staffs for their assistance to get the data of participants. Finally, we would like to thank our study participants for their cooperation in providing the information.


The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The funder has no role in writing the manuscript.

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GT conceived the study and was involved in the study design, reviewed the article, analysis, report writing, and drafted the manuscript. TA, SS, YM, TK, DA, and ES were involved in the study design, analysis and drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Getachew Tesfaw Desalegn.

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Ethical approval and ethical clearance were obtained from the Institutional Review Board (IRB) and the ethical clearance committee of the University of Gondar. Ref. No. 1914/04/2020. Participants were informed about the aim of study and advantage of study; confidentiality, there is no risk of being participants and they have full right to stop in the middle of the interview. The risk and the benefit of the study were clearly explained to the participants through the information sheet before obtaining their consent. Written informed consent was obtained from each study participant prior to participation. All methods were carried out in accordance with 1964 declaration of Helsinki.

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Desalegn, G.T., Zeleke, T.A., Shumet, S. et al. Coping strategies and associated factors among people with physical disabilities for psychological distress in Ethiopia. BMC Public Health 23, 20 (2023).

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