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.     

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.     

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.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal’s self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).     

The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery

Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients’ psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.     

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.     

Illness perceptions and coping explain well-being in patients with Huntington's disease

This study sought to investigate the contribution of illness perceptions and coping mechanisms to the explanation of well-being of patients with Huntington's disease (HD). We investigated the Leventhal et al. assumption of the Self-regulation Model that coping mediates the relationship between illness perceptions and patients’ well-being. Illness perceptions, coping, and well-being in 77 HD patients were assessed with validated questionnaires; motor performance and cognitive performance were assessed with Huntington's disease-specific measures. The assumption that illness perceptions influence HD patients’ well-being via coping was not supported. The results indicate that both coping and illness perceptions made a major contribution to the explanation of variance in HD patients’ psychosocial well-being. Variance in their physical well-being was explained by illness perceptions mainly. The need to conduct further research on the interrelationships between illness perceptions, coping, and well-being in this patient category is discussed.     

Discrepancies between patients' and partners' perceptions of unsupportive behavior in chronic obstructive pulmonary disease

The literature on chronic diseases indicates that partner support, as perceived by patients, contributes to well-being of patients in either a positive or a negative way. Previous studies indicated that patients' and partners' perceptions of unsupportive partner behavior are only moderately related. Our aim was (1) to investigate whether discrepancies between patients' and partners' perceptions of two types of unsupportive partner behavior-overprotection and protective buffering-were associated with the level of distress reported by patients with chronic obstructive pulmonary disease (COPD) and (2) to evaluate whether the direction of the differences between patients' and partners' perceptions was associated with distress (i.e., whether patient distress was associated with greater patient or greater partner reports of unsupportive partner behavior). A cross-sectional study was performed using the data of a sample of 68 COPD patients and their spouses. Distress was assessed using the Hopkins Symptom Checklist-25. Patients' and partners' perceptions of unsupportive partner behavior were assessed with a questionnaire measuring overprotection and protective buffering. Distress was independently associated with patients' perceptions of protective buffering and discrepancies in spouses' perceptions of overprotection. Regarding the direction of the discrepancy, we found that greater partner reports of overprotection as compared with patient reports were related to more distress in COPD patients. Our study showed that patients' distress was associated not only with patients' perceptions, but also with discrepancies between patients' and partners' perceptions of unsupportive partner behavior.     

Psychological,physical, and interpersonal correlates of emotional expressiveness,conflict, and control

This article examines the relations between emotional expression, conflict over expression, and emotional control and psychological and physical distress. Fifty married couples completed two mail-in surveys containing the Emotional Expressiveness Questionnaire (EEQ), the Ambivalence Over Emotional Expression Questionnaire (AEQ), and the Emotional Control Questionnaire (ECQ), as well as measures of psychological and physical well-being. They also made expressiveness and well-being ratings of their spouses. AEQ and ECQ scores were significantly positively correlated with measures of psychological distress and questionnaire measures of physical discomfort. In addition, AEQ scores for items dealing explicitly with anger predicted visits to health-care provider for illness. EEQ scores did not predict either psychological distress or physical symptoms. AEQ scores were also positively correlated with spouse's symptoms and alcohol use. Wives' expressiveness ratings for their husbands were negatively correlated with a number of indices of psychological distress, while husbands' ratings of wives' expressiveness were positively correlated with measures of distress. Generally, expressiveness, inhibition, and conflict over expression in one spouse did not consistently predict well-being of the other. Implications of these findings for future research in the area of emotion and illness as well as in relationship satisfaction are discussed.     

Social Comparison and the Subjective Well-Being of Cancer Patients

Although cancer patients may suffer from more physical and psychological distress than healthy persons, they seem not to differ in subjective well-being. In this article the influence of social comparison on the relation between physical distress and subjective well-being was examined among cancer patients. LISREL analyses provided support for the following model: First, the psychological distress that resulted from physical distress induced a need for comparison. This need, in turn, affected the frequency of downward comparison. Whereas psychological distress negatively affected perceptions of how well one was doing in comparison with others, selectively comparing downward had the reverse impact, contributing to a feeling of relative well-being. Unexpectedly, these relative evaluations also seemed to be affected directly by the amount of physical distress patients experienced. Finally, although both the amount of physical and psychological distress had strong direct effects on subjective well-being, the perception of how well one was doing compared to most others explained an additional significant amount of variance. Interestingly, this model was also supported in a healthy control group, suggesting that we are dealing here with a general behavioral model that suggests that social comparison processes may contribute to well-being when well-being is threatened by stress.     

Homemaking-role quality and the psychological well-being and distress of employed women

This paper examines the quality of employed women's experience in the homemaking-role and its relationship to their psychological well-being and distress. The subjects (N=403) were drawn from a random stratified sample of women, ages 25 to 55, who were employed as social workers or licensed practical nurses. Positive homemaking-role experience was associated with increased psychological well-being and lowered psychological distress. These associations were affected by the quality of the subjects' experiences in the paid work-role. Thus the favorable association of positive homemaking-role quality with psychological well-being and distress was enhanced by positive paid work-role quality, suggesting that the relationship of homemaking-role quality to the psychological outcomes is influenced by the effects of paid work-role quality on psychological well-being and distress.Data for this paper were collected as part of a larger project funded by the National Institute on Occupational Safety and Health (1 RO1-OHO-1968). The initial analyses and writing of this paper took place at the Center for Research on Women, Wellesley College, and was supported by NIMH postdoctoral training grant no. MH-17058-053. We would like to express special thanks to the late Grace K. Baruch for her enthusiastic support and encouragement of this paper.     

Diabetes distress,illness perceptions and glycaemic control in adults with type 2 diabetes

The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA_1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA_1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual’s perception of personal control.     

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.     

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.     

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.     

Relationship distress in partners of combat veterans: the role of partners' perceptions of posttraumatic stress symptoms

Partners of combat veterans with posttraumatic stress disorder report elevated relationship and psychological distress, but little is known about the mechanisms by which such distress develops. In two separate samples, we examined partners' perceptions of veterans' PTSD symptoms, with a specific focus on the simultaneous associations of partners' distress with their perceptions of veterans' reexperiencing, withdrawal/numbing, and hyperarousal symptom clusters. The first sample consisted of 258 partners of Operation Enduring- and Iraqi Freedom-era veterans who completed questionnaires. The second sample consisted of 465 partners of Vietnam-era veterans who completed interviews as part of the National Vietnam Veterans Readjustment Study. In both samples, path analyses revealed that, when examined simultaneously, partners' perceptions of withdrawal/numbing symptoms were associated with greater distress, but perceptions of reexperiencing symptoms were unrelated to psychological distress and significantly associated with lower levels of relationship distress. Given the cross-sectional nature of the data in both samples, there are multiple plausible interpretations of the results. However, the pattern is consistent with an attributional model of partner distress, whereby partners are less distressed when symptoms are more overtly related to an uncontrollable mental illness. Potential clinical implications are discussed.     

Abstract versus concrete goals: personal striving level, physical illness, and psychological well-being.

This study examined the relation between personal striving level and psychological and physical well-being. Level refers to the degree of generality versus specificity of one's goal strivings. In 3 studies, 188 Ss generated lists of their personal strivings, which were then rated on specificity level. High-level striving was associated with more psychological distress, particularly depression. Low-level striving was related to higher levels of physical illness. Correlations between striving level and self-reported symptoms were generally not as strong as those between level and the more objective illness indicators. High-level strivings were seen as more difficult and requiring more effort than low-level strivings. Results are interpreted in terms of control theory, goal-setting theory, and the repressive personality style.     

Depression, Psychological Resources, and Health-Related Quality of Life in Older Adults 75 and Above

The purposes of this study were (1) to compare psychological resources and health-related quality of life between two groups of community-dwelling elders, 75 years of age and older, with similar chronic illnesses, but with varying levels of depression, and (2) to examine the relationships among depression, psychological resources, and health-related quality of life. Fifty-two elders (14 men and 38 women) were divided into mildly (n = 18) and severely (n = 34) depressed groups based on their depression scores. There were no significant differences between the two groups for demographic and illness characteristics. There were significant differences for number of medications, mastery, health perceptions, mental health functioning, and well-being. Severely depressed elders had poorer health perceptions, and decreased mastery, functioning, and well-being as compared with mildly depressed elders. An explanatory model was developed using factor analysis that fit the data well. Health perceptions and mastery had direct influences on depression, and depression directly impacted well-being.     

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.