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Research suggests that the fighting spirit (FS) of patients coping with serious illness correlates with their physical health and psychological adjustment, but studies to date have operationalized FS primarily through questionnaires and have neglected the possibility that close relationships influence (or are influenced by) an individual patient's FS. This study examines the reliability and validity of an observational measure of FS, developed by the author, and its relationship to patient, spouse, and marital variables. The measure is based on an expanded definition consisting of eight dimensions: optimism, control, self-efficacy, sense of purpose, self-esteem, persistence, active participation, and adaptability. Participants were 88 couples in which one of the partners (63 men and 25 women) had congestive heart failure (CHF). As part of the Michigan Family Heart Project (Coyne, 1993), both partners participated in individual home interviews and completed questionnaires related to physical health, psychological functioning, approaches to coping with the illness, and the partners' marital relationship. Biomedical measures of illness severity were recorded concurrently from the patient's chart, and a telephone interview 9 months later provided follow-up measures of patient life satisfaction and distress. Judges reliably rated FS dimensions from audiotaped interview segments of the patient describing how he or she had coped with a recent health problem, and the composite FS measure demonstrated good internal consistency and fair convergent and discriminant validity. Although FS did not predict four-year survival, it did relate to health, psychological functioning, and the marital context, though in different ways for male and female patients. For female patients, FS appeared to be a problem-focused, spouse-involving approach associated with initial distress that improved over time; whereas for male patients, FS appeared to represent a private self-efficacy in illness management independent of problem-solving efforts and associated with initial well-being that deteriorated over time. Though preliminary, these results suggest that FS coping may have different correlates and consequences for men and women, and highlight the importance of dose relationships in managing serious illness.
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