Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants’ General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.     

Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus

Abstract

The study examined the role of illness perceptions and self-efficacy in diabetic regimen adherence and metabolic control among young patients with Insulin Dependent Diabetes Mellitus (IDDM). Sixty-four outpatients with Insulin Dependent Diabetes completed measures of illness perceptions, generalised and diabetes specific self-efficacy and a self-report measure of adherence. Metabolic control (HbAlc) was also assessed. Control, identity and consequences components of illness perceptions were significantly correlated with self-efficacy expectancies. Control beliefs were consistently associated with self-reported adherence across all treatment aspects and accounted for 39% of the predicted variance in total adherence. The associations of the other psychological predictors examined, varied depending on the regimen area. Multiple regression analysis showed that 30.8% of the variance in HbAlc assays was explained by patients' diabetes specific self-efficacy, consequences and identity. Our findings suggest that patients' beliefs are useful predictors of physiological and behavioural outcomes in diabetes self-management and should thus be the focus of routine clinical assessments and future interventions.     

Coping with type 1 diabetes through emerging adulthood: Longitudinal associations with perceived control and haemoglobin A1c

Objective: This study, which is part of a larger longitudinal study focusing on the biopsychosocial functioning of emerging adults with type 1 diabetes, examined how perceived personal control, coping and HbA_1c relate to one another over time.

Design and main outcome measures: Emerging adults with type 1 diabetes (18–30 years old) participated in a two-wave longitudinal study spanning five years (N = 164 at Time 1). At both times, patients completed questionnaires on perceived control and coping (i.e. diabetes integration, avoidant coping and passive resignation). HbA_1c values were obtained from treating clinicians. We investigated the directionality of effects using cross-lagged path analysis.

Results: Higher HbA_1c values predicted relative decreases in diabetes integration and increases in avoidant coping five years later. Feeling less in control over diabetes predicted the use of passive coping over time. Passive coping predicted a relative decrease in perceived control five years later.

Conclusion: These findings indicate that tackling poor glycaemic control is not only important to avoid medical complications but also to prevent patients from resorting to more avoidant coping strategies. Furthermore, given the longitudinal interplay between perceived control and passive coping, it is important that intervention efforts include both cognitive and behavioural components to be effective.     

Illness representations and psychological distress in patients undergoing coronary artery bypass graft surgery

Preoperative psychological distress has been shown to predict both postoperative distress and subsequent cardiac morbidity in patients undergoing coronary artery bypass graft (CABG) surgery. This study assessed the associations between illness perceptions and psychological well-being among 56 patients awaiting CABG surgery using the Profile of Mood States (POMS) and the Illness Perception Questionnaire-Revised (IPQ-R). Patient perceptions of their illness as chronic were associated with reduced beliefs in both personal control over illness and efficacy of treatment, and increased perceived consequences of illness in terms of life functioning. In addition, psychological distress regarding illness was significantly correlated with psychological distress in general. Reduced illness coherence was also associated with increased psychological distress. Preoperative psycho-education aimed at helping patients better understand their illness, treatment, and its effects may reduce psychological distress, and perhaps improve future well-being as a result.     

Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes

Objective: This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning. Design: Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14–25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling. Main Outcome Measures: Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA_1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child’s treatment adherence. Patients and parents reported on psychological control and overprotection. Results: The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients’ depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA_1c-values. Conclusion: These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers’ and fathers’ roles throughout adolescence and emerging adulthood.     

Association between quality of life of adolescents with type 1 diabetes and parents’ illness perception as evaluated by adolescents

Children and adolescents account for half of all cases of type 1 diabetes, which is one of the most common pediatric chronic diseases. The disease’s effects and the treatment/disease-management protocols patients must follow can lead to a marked deterioration in quality of life, especially for adolescents. Patients’ illness perceptions have been shown to impact their quality of life, but do other people’s illness perceptions also have an effect? The present study addressed this question by investigating possible links between the quality of life of adolescent patients with type 1 diabetes and illness perceptions, measured in terms of the adolescents’ self-perceptions, parents’ self-perceptions, and the adolescents’ evaluations of their parents’ perceptions. We asked 41 adolescents (M = 13.9 years; SD = 1.9) who had been undergoing treatment for type 1 diabetes for at least a year (M = 6.6 years; SD = 3.7) to complete the Diabetes Quality of Life for Youth Questionnaire-Short Form (DQOLY-SF) and the Illness Perception Questionnaire-Revised (IPQ-R). They completed the IPQ-R twice, once to state their own opinions (self-report) and once to give their evaluations of their parents’ perceptions. At the same time, but in a different room, their parents (N = 47) completed the IPQ-R (self-report). Quality of life was predicted by gender (p < .05) and by the parents’ emotional representations (p < .01) and perceptions of consequences (p < .01) as evaluated by the adolescents. This new approach provides new insights into the impact of parents’ perceptions on the quality of life of adolescents with type 1 diabetes.     

Illness perceptions account for variation in positive outlook as well as psychological distress in rheumatoid arthritis

Psychological distress in rheumatoid arthritis (RA) is associated with adverse clinical outcomes, and appears highly related to patients' illness perceptions. This study aimed to investigate the association between illness perceptions, psychological distress, positive outlook and physical outcomes in RA. Two hundred and thirty patients aged >18 years and prescribed at least one disease-modifying anti-rheumatic drug (DMARD) were recruited from outpatient clinics across Hertfordshire (England). Patients completed a questionnaire that assessed psychological distress and positive outlook (depression, anxiety and positive outlook scale), illness perceptions (IPQ-R) and functional disability (health assessment questionnaire). Information regarding prescribed medication and disease activity [disease activity score (DAS28)] was collected from medical notes. Psychological distress, but not positive outlook, was associated with functional disability and DAS28. After controlling for sex, age and DAS28, perceptions of greater symptomatology (identity) and lesser understanding of RA (coherence) were significantly associated with increased psychological distress. Perceptions of greater treatment control were associated with greater positive outlook, but only for those with low DAS28. Coherence was also associated with positive outlook. These findings indicate that illness perceptions may influence psychological distress and positive outlook in RA patients, and may therefore be a useful basis for future psychological interventions.     

Mediation and moderation of the effects of watching the angiography screen on patients

It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients’ personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.     

Associations Between Hypochondriacal Symptoms and Illness Appraisals,and Their Moderation by Self‐Focused Attention

Hypochondriacal symptoms are associated with cognitive biases in the ways that illness is appraised. Self‐focused attention (SFA) may augment or reduce these biases. Using a healthy sample, this study examined relationships between hypochondriacal symptoms, assessed using the Illness Attitudes Scale; and illness appraisals, assessed using the Illness Perception Questionnaire–Revised. Participants were exposed to an SFA manipulation or a non‐SFA control, were given a health message about influenza, and were asked to imagine having the disease. Hypochondriacal symptoms were linked to higher symptom perceptions, greater perceptions of personal and treatment control, and higher disease coherence. SFA augmented the relationship between hypochondriacal symptoms and personal control. Findings are discussed in terms of illness appraisal biases and attentional components of these biases.     

Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes

Perceived control over diabetes may serve to buffer the relationship between adolescents’ experience of daily negative affect and daily problems with diabetes. In a daily diary study including 209 adolescents (ages 10.5–15.5) with type 1 diabetes, we examined how daily affect related to daily fluctuations in experience of diabetes problems, and whether perceptions of control moderated these daily associations. Using hierarchical linear modelling, we found that day-to-day experiences of negative affect were associated with more frequent daily diabetes problems. Perceptions of treatment control moderated associations between negative affect and number of problems; negative affect was more strongly associated with number of problems among teens perceiving lower versus higher treatment control over their illness. The same pattern of association was not apparent for personal control. Results suggest that perceived treatment control may help to buffer detrimental associations between negative affect and adolescents’ ability to successfully manage their diabetes.     

Personality and Illness Adaptation in Adults with Type 1 Diabetes: The Intervening Role of Illness Coping and Perceptions

Inspired by the common sense model, the present cross-sectional study examined illness perceptions and coping as intervening mechanisms in the relationship between Big Five personality traits and illness adaptation in adults with Type 1 diabetes. A total of 368 individuals with Type 1 diabetes (18–35 years old) completed questionnaires on personality, diabetes-related problems, illness perceptions, and illness coping. First, Neuroticism, Agreeableness, and Conscientiousness predicted patients’ illness adaptation, above and beyond the effects of sex, age, and illness duration. Second, illness coping was found to be an important mediating mechanism in the relationship between the Big Five and illness adaptation. Finally, perceived consequences and perceived personal control partially mediated the relationship between the Big Five and illness coping. These findings underscore the importance of examining patients’ personality to shed light on their daily functioning and, hence, call for tailored intervention programs which take into account the personality of the individual patient.     

Reminders of an agentic ingroup buffer disease uncontrollability

Chronic illness has negative impacts beyond those on physical health. In particular, because it is often experienced as uncontrollable, chronic illness might reduce people's general sense of personal control and, subsequently, personal well-being. Drawing on recent theory and research, we proposed and tested in four experiments (N_total = 1323) a potential buffer to these negative effects: thinking about an agentic social ingroup in one's life. In Study 1, patients suffering from a chronic illness that was either high or low in medical disease controllability were asked either to think about an agentic ingroup or a personal issue. Low perceived disease-related control was associated with low perceived personal control only when participants' personal self, but not when their ingroup, was salient. In three follow-up vignette studies, we asked participants to take the perspective of a person who suffered from a health problem of low medical disease controllability and attended a self-help group that was described as either high or low in agency. The findings supported the predicted buffering effect: participants who reflected on a target suffering from a low control disease thought that the target would experience more personal control when the agentic (vs. the nonagentic) self-help group was salient. These findings suggest ingroups can serve as a source of personal control in the context of health-related threats to the extent that they are perceived as agentic. Thus, focusing on agentic properties of (health-related) ingroups might be a promising novel strategy when designing effective group-based interventions to cope with chronic illness.     

Type A Behavior and Diabetic Control: Implications of Psychological Reactance for Health Outcomes1

According to laboratory research, Type A coronary-prone individuals are sensitive to threats to their personal control and react to such threats with active and often stressful coping responses. The present investigation tested the prediction that these features of Type A behavior would interfere with blood glucose regulation in insulin-dependent diabetes mellitus patients. Two independent hypotheses were investigated. Because elevated sympathetic arousal, a concomitant of stressful coping, is associated with elevated glucose levels, it was predicted that Type A diabetics experiencing high levels of life stress would display poorest blood glucose control (indexed by Hemoglobin A₁c). The second hypothesis was derived from the observation that Type As are more likely than Type Bs to respond to control threats with reactance in order to restore the perception of control. Given that illness or treatment can reduce personal control, it was predicted that Type A diabetics would be most reactant and, thus, most medically noncompliant. To test these hypotheses, 37 Type 1 diabetics were assessed for Type A behavior, life change, attributional style, desire for control (both within treatment and in general), and specific perceptions of and actions to their diabetes. Type As were more likely than Type Bs to show poor blood glucose control. However, for patients in general, and Type As in particular, blood glucose regulation was not related to life stress. Rather, those Type As who displayed poor glucose control made more extreme self-attributions about the cause of their diabetes, were angrier about it, and felt they should fight it. The implications of these findings for a reactance-Type A model of medical compliance are discussed.     

Illness perceptions or recurrence risk perceptions: What comes first? A longitudinal cross-lagged examination among cardiac patients

Objectives: Previous research suggested that illness perceptions provide the basis for illness risk perceptions through an inductive reasoning process. This study aimed to assess the direction of relationships between illness and recurrence risk perceptions over time, among cardiac patients.

Design: A longitudinal study was conducted among 138 patients undergoing coronary angioplasty. Self-report questionnaires measured perceived recurrence risk and illness perceptions one day and one month after catheterisation.

Results: Cross-lagged Panel Model Analyses revealed that higher perceptions of timeline, consequences and emotional representations of illness at hospitalisation were associated with higher recurrence risk perceptions one month later. Perceived personal control was the only illness perception with bi-directional associations: higher perceived personal control at hospitalisation was associated with higher recurrence risk perceptions one month later; and higher recurrence risk perceptions at hospitalisation was associated with lower personal control one month later.

Conclusions: The findings suggest that the associations between recurrence risk and illness perceptions can only partly be explained by inductive reasoning. Halo effects and defensive processes are suggested as complementary explanations for the observed associations between risk and illness perceptions.     

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhal's Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.     

Relations between symptom severity,illness perceptions,visceral sensitivity,coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10–20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ² (8) = 11.91, p = .16, χ²/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = –.28, p < .001; β = –.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.     

Living with diabetes

Management of diabetes can be affected by emotional distress in two ways: directly, via the effect of stress on glycemic control, and indirectly via effects on self-care routines. Rational-emotive therapy, along with a number of other cognitive, emotive, and behavioral tools, is an important intervention for patients who have diabetes-related distress. The authors describe personal and professional examples of the application of these tools to living rationally with diabetes.Richard R. Rubin, Ph.D. is a staff member of the Diabetes Center and the Pediatric Diabetes Clinic at the Johns Hopkins Hospital. In addition, he has a private psychotherapy practice, substantially devoted to counseling and coping skills training for people with diabetes.Susan R. Walen, Ph.D. is an Associate Professor in the Department of Psychology, Towson State University and Director of the Baltimore Center for Cognitive Therapy. She is the coauthor ofA Practitioner's Guide to Rational-Emotive Therapy.Albert Ellis, Ph.D. is the founder of Rational Emotive Therapy and president of the Institute for RET in New York City. He is the author of more than 50 books and 600 journal articles on psychotherapy topics.     

Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes

Perceived control over diabetes may serve to buffer the relationship between adolescents' experience of daily negative affect and daily problems with diabetes. In a daily diary study including 209 adolescents (ages 10.5-15.5) with type 1 diabetes, we examined how daily affect related to daily fluctuations in experience of diabetes problems, and whether perceptions of control moderated these daily associations. Using hierarchical linear modelling, we found that day-to-day experiences of negative affect were associated with more frequent daily diabetes problems. Perceptions of treatment control moderated associations between negative affect and number of problems; negative affect was more strongly associated with number of problems among teens perceiving lower versus higher treatment control over their illness. The same pattern of association was not apparent for personal control. Results suggest that perceived treatment control may help to buffer detrimental associations between negative affect and adolescents' ability to successfully manage their diabetes.     

Illness Perception Differences Between Russian- and Hebrew-Speaking Israeli Oncology Patients

Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl’s consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p < .01). Russian-speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences.     

Ethnic differences in illness perceptions,self-efficacy and diabetes self-care

This study assessed differences between Europeans, South Asians and Pacific Islanders in illness perceptions, self-efficacy, self-care, metabolic control and retinopathy in diabetes. We also evaluated the role of illness perceptions and self-efficacy in diabetes self-care and metabolic control within each group. A total of 86 Europeans, 86 South Asians, and 87 Pacific Islanders with type-2 diabetes completed self-report measures of illness perceptions, self-efficacy and self-care. Metabolic control and retinopathy data were collected from patient records. Results showed that Pacific Islanders and South Asians held shorter illness timeline perceptions compared to Europeans. Relative to both the other groups, Pacific Islanders also had elevated scores on three illness perceptions subscales: consequences, identity and emotional representations. They had lower medication-specific self-efficacy as well as poorer medication self-care, metabolic control and retinopathy. In all three groups, self-efficacy was fairly consistently related to self-care, but not to metabolic control. Illness perceptions were less consistently related to self-care, but were associated with metabolic control.