Illness perceptions in dialysis patients and their association with quality of life

The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions and quality of life were assessed with the IPQ-R and the SF-36 in 91 HD and 42 PD patients participating in the NECOSAD-study. Compared to HD patients, PD patients experienced more personal control and had a better understanding of the illness. Illness perceptions explained from 17 to 51% of the variance in quality of life scores. Perception of more symptoms, more consequences and lower personal control were associated with lower well-being. The concept of illness perceptions is useful in understanding the impact of ESRD and of dialysis treatment on quality of life. Interventions aimed at providing more knowledge about ESRD and dialysis, and provision of skills to coping with the illness and its consequences may improve quality of life in dialysis patients.     

When Meaning Matters: Coping Mediates the Relationship of Religiosity and Illness Appraisal with Well-Being in Older Cancer Patients

When individuals face serious, traumatic illnesses such as cancer, religion can contribute to their coping processes and psychosocial adjustment. In the current study, we examined the relationship between religiosity conceptualized as the religious meaning system, illness appraisal, and psychological well-being with religious and nonreligious coping as potential mediators of this relationship among older cancer patients. In a cross-sectional design, 215 older Polish patients (60–83 years of age; 80% Catholic, 9% Protestant) with gastrointestinal cancer completed measures of religiosity, illness appraisal, religious coping, nonreligious coping, and psychological well-being. Using structural equation modeling analysis, we found support for our model depicting a mediated relationship between religiosity, illness appraisal, and psychological well-being. Three forms of coping—negative religious, problem focused, and meaning focused—were key mechanisms in the relationship between the religious meaning system, positive and negative illness appraisal, and psychological well-being. These findings suggest that both religious factors (religiosity and religious coping) and nonreligious factors (illness appraisal and nonreligious coping) can operate together in influencing older cancer patients’ well-being.     

Production of spontaneous and posed facial expressions in patients with Huntington's disease: Impaired communication of disgust

Several studies have reported impairment in the recognition of facial expressions of disgust in patients with Huntington's disease (HD) and preclinical carriers of the HD gene. The aim of this study was to establish whether impairment for disgust in HD patients extended to include the ability to express the emotion on their own faces. Eleven patients with HD, and 11 age and education matched healthy controls participated in three tasks concerned with the expression of emotions. One task assessed the spontaneous production of disgust-like facial expressions during the smelling of offensive odorants. A second assessed the production of posed facial expressions during deliberate attempts to communicate emotion. The third task evaluated HD patients’ ability to imitate the specific facial configurations associated with each emotion. Foul odours induced fewer disgust-like facial reactions in HD patients than in controls, and patients’ posed facial expressions of disgust were less accurate than the posed disgust expressions of controls. The effect was selective to disgust; patients had no difficulty posing expressions of other emotions. These impairments were not explained by compromised muscle control: HD patients had no difficulty imitating the facial movements required to display disgust. Viewed together with evidence of difficulty in other aspects of disgust in HD, the findings suggest that a common substrate might participate in both the processing and the expression of this emotion.     

Do similar patient and spouse perceptions of myocardial infarction predict recovery?

The present study examines whether the degree of congruence between the patient's and the partner's perceptions of myocardial infarction (MI) has an influence on a range of recovery outcomes in the patient. The MI perceptions of 70 Portuguese couples in which the male had suffered a first heart attack were assessed at 3 months after discharge from hospital, using the Illness Perception Questionnaire (IPQ). Several dimensions of patient recovery were assessed at 3, 6 and 12 months post-MI, using standardised measures of psychological well-being, return to work, disability, social functioning, sexual functioning, and indices of lifestyle changes. The degree of congruence in each couple's illness perceptions was assessed and related to each outcome measure. The results suggest that the degree of congruence between patients and partners in their illness perceptions was related to different dimensions of recovery at 3, 6 and 12 months. The results revealed that in couples who had similar positive perceptions of the identity and consequences of the MI, patients showed (a) better physical and psychological functioning, (b) better sexual functioning, and (c) less impact of MI on social and recreational activities. Also, similar positive perceptions of timeline were associated with lower levels of disability, and similar positive cure/control beliefs were linked with greater dietary changes. Separate analyses showed that these effects were not confounded with marital functioning. This study provides clear evidence that the degree of match/mismatch between the patient's and partner's perceptions of the MI is associated with a range of recovery outcomes.     

A Meta-Analytic Review of the Common-Sense Model of Illness Representations

A meta-analysis of empirical studies ( N = 45) adopting Leventhal, Meyer and Nerenz's (1980) Common Sense Model (CSM) of illness representations is presented. The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across illness types. A content analysis classified coping strategies into seven distinctive categories and health outcomes into six categories. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies. Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological well-being, social functioning and vitality and negatively related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality. The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.     

Action‐semantic and syntactic deficits in subjects at risk for Huntington's disease

Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre‐clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients’ children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above‐mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first‐degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects’ overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.     

Krankheitsbelastung bei chronisch entzündlichen Darmerkrankungen

Background

Psychosocial distress is considerable in inflammatory bowel disease (IBD). The aim of this study was to assess the association of illness perceptions with disease-specific distress in patients with IBD in the context of various medical and psychological parameters.

Method

A total of 62 patients suffering from IBD were examined for illness perceptions using the illness perception questionnaire revised (IPQ-R), medical parameters and affective parameters using the hospital anxiety and depression scale (HADS) in a cross-sectional study. Associations with disease-specific distress were assessed.

Results

In multiple regression analyses illness perceptions and also physical well-being were identified as significant predictors of disease-specific distress and showed significant effects on the explanation for the amount of variance (R²=0.70).

Conclusion

Even in the context of various medical and psychological parameters illness perceptions showed significant associations with disease-specific distress in patients with IBD.     

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.     

MARITAL SATISFACTION AMONG MOTHERS OF INFANTS WITH CONGENITAL HEART DISEASE: THE CONTRIBUTION OF ILLNESS SEVERITY,ATTACHMENT STYLE,AND THE COPING PROCESS

This study examined the contribution of illness severity and attachment style to marital satisfaction among mothers of infants with Congenital Heart Disease (CHD) as well as the mediating role of cognitive appraisal and ways of coping with motherhood tasks. Eighty-five mothers of newborns with CHD rated their attachment style 2 weeks after the infant's CHD diagnosis and two physicians rated the severity of the disease. One year later, mothers completed self-reports scales tapping marital satisfaction, appraisal of motherhood tasks, and ways of coping with these tasks. The severity of infant's disease and mothers’ attachment anxiety and attachment avoidance were related to less marital satisfaction. Moreover, whereas illness severity and attachment anxiety had direct effects on marital satisfaction, the negative effects of attachment avoidance were mediated by the appraisal of motherhood in threatening terms and the reliance on emotion-focused coping. The interconnections between attachment style, the process of coping with the stress of a chronic illness, and marital satisfaction were discussed.     

Community,Context, and Coping: How Social Connections Influence Coping and Well-Being for Military Members and Their Spouses

Military members and their spouses (n = 223 families) were selected from an Active Duty Army installation and assessed with regard to their connections with the military community, their levels of coping with military culture demands, and their reports of individual (depression and life satisfaction) and family well-being. Guided by the contextual model of family stress and the social organization theory of action and change, results from a structural equation model indicated that military community connections, for both military members and their civilian spouses, were related to coping with the military culture and its demands, which in turn was related to both individual and family well-being. Unique actor and partner effects also emerged where both active duty military members' and their civilian spouses' perceptions of military community connections influenced the civilian spouses' satisfaction with military life, but only the active duty military members' community connections influenced their military-specific coping. Additionally, the associations between military-specific coping and individual and family well-being only had actor effects. When examined within the context of important military culture elements, namely rank and extent of military transitions (deployment and relocation), these core findings linking communities to coping and well-being were unchanged. Implications for theory, future research, and practice are shared.     

Family Coping During Hospitalization of Children with Chronic Illnesses

Information about family coping when a child with a chronic illness is hospitalized for procedures related to his or her illness is needed. The current research presents the results of two pilot studies designed to assess family resilience and coping, during a hospitalization for medical procedures for a child with a chronic condition. Sixty-one parents participated in the first study and reported on their child’s hospital experiences and completed a survey designed to assess family coping. Twelve mothers and one grandmother completed interviews examining their perceptions of their coping, siblings’ coping, and coping of the child with an illness for study two. Results of Study 1 indicated parents’ perceived the family as resilient. Cognitive strategies were used to see the hospital stay as positive for the child or to accept what had to occur as having the possibility of improving the child’s life. Some of the mothers mentioned financial stress as being difficult for the family. Results of Study 2 also supported resilient functioning for mothers, siblings, and children with illnesses. Mothers reported they stayed strong for their child. Siblings could serve as protectors, helpers, and companions and were described as adapting well. Children with illnesses used distraction (e.g., play, art, music) to facilitate their coping. Findings of this study indicated parents perceived the family as coping well and supporting the child with an illness. Future research will need to assess perceptions of siblings and fathers and assess family members’ perspectives at different times over the course of children’s illnesses.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Accurate and biased perceptions of responsive support predict well-being

The current research examined effects of accurate and biased perceptions of romantic partners’ responsive support provision on perceivers’ well-being. Perceivers discussed a personal problem with their romantic partners (“targets”). Perceivers’ perceptions of targets’ responsive support following the discussion were related to external indicators of targets’ behavior, but these perceptions also were predicted by perceivers’ sentiments toward targets, suggesting that processes underlying perceivers’ perceptions were a blend of both accuracy and bias. In addition, both accurately perceived and biased perceptions of targets’ responsiveness predicted perceivers’ personal well-being (i.e., affect, coping, self-efficacy) and interpersonal well-being (i.e., more positive sentiments toward targets) immediately after the support interaction, 2 weeks later, and 6 months later. Results suggest that accurate and biased cognition during interpersonal interactions can have important consequences for perceivers’ personal and interpersonal well-being through effects on perceived partner responsiveness.     

Perceptions of Control and Causality as Predictors of Compliance and Coping in Hemodialysis

In the present study we examined the relationships among hemodialysis patients' perceptions of control over their health, attributions of causality, and staff ratings of coping and compliance. Patient responses to questions posed during a semi-structured interview were predictors entered into multiple regression analyses with coping and compliance ratings as criterion variables. Results indicate that having tried to prevent kidney failure and not succeeding predicts poor compliance and poor coping. Perceived control is associated with positive coping but is unrelated to compliance. Finally, patients who wondered, "Why me?" but had not arrived at an answer received the poorest coping and compliance ratings from staff. Results are discussed in light of current theory regarding the beneficial effects of perceived contingency between actions and outcomes, and the need to find a meaning for one's illness.     

Nurses' Evaluations of Patient Attributions for the Cause and Future of Their Illness1

It was hypothesized that evaluations of patients' attributions for the cause and future of their illnesses would be seen as more realistic when these attributions coincided with subjects' views on the cause and future of the patients' illness. It was also thought that of the two, i.e., cause and future attributions, future attributions would be more pertinent for the observer when evaluating the adjustment of the patient. One hundred and twenty-eight female nurses assessed the health interviews of four patients through the use of questionnaires. The first hypothesis was supported in the case of causal attributions, but it was found that patients who accepted responsibility, regardless of nurses' views, were seen as more realistic. The second hypothesis was fully supported with future attributions indicating level of coping and causal attributions indicating level of emotional support needed. These findings have implications for caretakers' perceptions of the adaptiveness, for patients of serious illness, of control attributions.     

Parental relationships and coping with life stress

Abstract

The primary goal of this investigation was to explore how the quality of parent-student relationships relates to coping style by examining multiple aspects of this relationship–including support and conflict–and by examining the contribution that both parents' and students' perceptions of their relationship make to students' coping reports. We found that perceptions of conflict and depth in the parent-child relationship were each associated with different styles of coping. Moreover, parents' and students' perceptions each accounted for unique variance in students' coping reports. Greater perceived depth (both parent and student reports) predicted higher problem-focused scores, while students' perceptions of conflict predicted higher emotion-focused coping scores. Specific support provisions reported by students and parents also related differentially to the specific coping styles. Finally, the extent to which parents and students reported coping in a similar fashion was predicted by the quality of their relationship.     

Perceptions of Hospitalization by Children with Chronic Illnesses and Siblings

Understanding children’s perceptions of their illnesses and functioning when they are undergoing medical procedures remains an important area for research. Further research about siblings’ perceptions will also provide knowledge about how they are coping with a brother or sister’s chronic illness. The current study examined the perceptions of children with illnesses and their siblings using a play interview. Themes in the data indicated resilience in child functioning for both patients and siblings. Children with chronic illnesses could experience pain, which often related to fears and other negative feelings about hospitalization and potentially doctors or nurses, if they were administering painful procedures. Distraction and prayer were coping tools for patients. However, most patients believed their illness and recovery would be a “long journey.” Brothers and sisters of children with chronic illnesses could experience loneliness. A more common report was a strong desire to help and be a support for a brother or sister with an illness. Support from parents was critical for both patients and siblings and both typically enjoyed child life activities. A member-checking process, with a different group of children with illnesses and siblings, was used to audit themes discovered after reviewing play interviews. The audit process supported the positive and negative themes in the data. In the future, examining the impact of magical thinking on outcomes and conducting studies after the children have gained distance from medical trauma will be important. Moreover, increasing a focus on resilience as a hallmark of children’s functioning remains another area for further research.     

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.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients’ perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients’ medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients’ coping behaviour with regard to ADEs.     

The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.