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.     

Illness representations and emotion in people with abnormal screening results

The present study examined the relationship of cognitive and emotional representations of illness specified by self-regulation theory on emotional responses of patients with abnormal screening results. Participants were 660 women who received an abnormal cervical smear and 701 men and women who received an abnormal colorectal cancer screening result. Participants completed postal questionnaires containing measures of illness representations and specific emotions. Factor analyses of cause components produced three factors for each sample, corresponding to psychological stress, biological, and behavioural causes. Regression analyses showed that, after controlling for demographic variables, perceived consequences, illness identity, and causal attributions to psychological stress explained significant variance in emotion. Emotional representations also accounted for unique variance in emotional responses. Results indicate congruence in the relationships between illness representations of an emotionally salient event and emotion in patients from the two cancer screening programmes and support the internal validity of self-regulation theory.     

Illness representations and matching labels with symptoms

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subject's daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.     

Illness representations,coping and psychological adjustment to Parkinson's disease

The present study reports an application of the common sense model (CSM) of illness representations to the prediction of psychological distress in people with Parkinson's disease (PD). The study sought to (i) examine cross-sectional and prospective associations between illness representations, coping and psychological distress, and (ii) test the hypothesis that coping would mediate any relationships between illness representations and psychological distress. Patients with PD (n = 58) completed the Illness Perception Questionnaire-Revised, the Medical Coping Modes Questionnaire and the Hospital Anxiety and Depression Scale. Patients (n = 57) were followed-up at 6 months. Illness representations explained large amounts of variance in time 1 anxiety (R ² = 0.42) and depression (R ² = 0.44) as well as additional variance in time 2 anxiety (ΔR ² = 0.12) and depression (ΔR ² = 0.09) after controlling for baseline scores. In addition, avoidance mediated the effect of emotional representations on time 1 anxiety, and acceptance-resignation mediated the effects of both consequences and emotional representations on time 1 depression. The present study therefore provides partial support for the mediational model outlined in the CSM, as significant mediation effects were found only in the cross-sectional analyses.     

Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer.

This longitudinal study examined predictors of mammography use among women with a family history of breast cancer participating in a risk assessment and surveillance program (N = 213). Assessed were background variables (age, prior mammography utilization), cognitive variables (perceived vulnerability), and affective variables (cancer worry and general distress). Results of logistic regression analyses predicting adherence 1 year after baseline contact, in which variables of prior utilization, feelings of vulnerability, and general distress were controlled for, indicated that cancer worry and age were significant predictors of mammography adherence. Results suggest that moderate levels of cancer worry facilitate, rather than undermine, adherence. The results have implications for the construction of educational messages that should be designed to acknowledge feelings of cancer-specific worry and to provide guidance in health protective behaviors.     

Illness representations in patients with multimorbid long-term conditions: qualitative study

Most research on illness representations explores how patients view single conditions, but many patients report more than one long-term condition (known as multimorbidity). It is not known how multimorbidity impacts on patient illness representations. This exploratory qualitative study examined patients' representations of multimorbid long-term conditions and sought to assess how models of illness representation might need modification in the presence of multimorbidity. We explored two major issues: (1) the impact of multimorbidity on patient representations of their individual conditions and (2) the representation of multimorbidity itself. Twenty eight adults with at least two long-term conditions (mean of 4) were interviewed. The presence of multimorbidity impacted on patient illness representations in relation to the dimensions of identity, perceived cause, coherence and consequences. Representations of multimorbidity itself concerned representations of the burden of medication and perceived priorities among conditions and synergies and antagonisms between conditions and their management. The results have implications for the measurement of multimorbidity (through scales such as the Illness Perception Questionnaire) and the use of illness representations in the design and delivery of interventions to improve health behaviour and outcomes of patients with multiple long-term conditions.     

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.     

Illness representations,pain and physical function in patients with rheumatic disorders: between- and within-person associations

Objectives: Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

Design and main outcome measures: This secondary analysis is based on data from N?=?186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

Methods: To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

Results: On both the between-person level (r?=?|0.21|???|0.44|) and the within-person level (r?=?|0.15|???|0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

Conclusion: IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.     

Measuring illness representations in breast cancer survivors (BCS) prescribed tamoxifen: Modification and validation of the Revised Illness Perceptions Questionnaire (IPQ-BCS)

Objective: The Revised Illness Perceptions Questionnaire (IPQ-R), widely used to assess illness perceptions, may fail to measure unique characteristics of different illnesses. This study modified and validated the IPQ-R for breast cancer survivors to provide detailed understanding of the specific illness perceptions held by these patients.

Design: Initial modifications were made following qualitative interviews and were revised in a think-aloud study. The modified scale was tested in 753 breast cancer survivors prescribed tamoxifen. Modifications included adding a tamoxifen consequences scale and adapting the timeline scales to measure beliefs around risk of recurrence and cure. A confirmatory factor analysis was conducted on the modified questionnaire and an exploratory factor analysis on the causal beliefs scale. Test–retest reliability, internal consistency and construct validity were also examined.

Results: The proposed eight-factor structure showed acceptable model fit, with high loadings and good reliability for all subscales. Correlations between subscales were consistent with theory and previous research.

Conclusions: The IPQ-BCS is valid and reliable, and provides unique understanding of specific perceptions held by this population, including beliefs surrounding risk of recurrence and consequences of ongoing hormonal treatment. Identifying these perceptions will aid development of interventions targeting depression, fear of recurrence and medication non-adherence.     

Genes and family environment in familial clustering of cancer

Familial clustering of a disease is defined as the occurrence of the disease within some families in excess of what would be expected from the occurrence in the population. It has been demonstrated for several cancer types, ranging from rare cancers as the adenomatosis-coli-associated colon cancer or the Li-Fraumeni syndrome to more common cancers as breast cancer and colon cancer. Familial clustering, however, is merely an epidemiological pattern, and it does not tell whether genetic or environmental causes or both in combination are responsible for the familial clustering. Familial clustering may be due to genetic predisposition to the disease, but exposure to environmental factors — shared by members of some families, but not by members of other families — may also cause familial clustering and hence mimic genetic inheritance in the study of nuclear families. Based on assumptions regarding the individual steps in the biological process starting with exposure to carcinogens and ending with death from disseminated cancer we suggest that genetic and environmental factors may both be involved in most of these steps. The present paper focuses on research methodologies necessary to discriminate between the effect of genes and family environment in the development of cancer.     

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

We examined a model of stress and coping in 749 African-American women at risk for HIV infection. Women in the sample were either homeless, intravenous drug users (IVDUs) sexual partners of IVDUs, or prostitutes. A model was hypothesized based on stress and coping theory and research. Antecedents studied were personal resources, specifically self-esteem and available support. Mediators were threat appraisal and coping efforts. Outcomes studied were emotional distress and HIV risk behaviors. Structural equation modeling techniques were used to test hypothesized pathways between these variables. Forty-five percent of the variance in emotional distress in these women was explained by the model with self-esteem and avoidant coping the strongest predictors. Ten percent of the variance in risk behavior was explained by the model with emotional distress the strongest predictor. Direct and indirect pathways predicting risk behavior and distress are discussed. Implications of results for intervention and theory building are considered.     

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.     

Effect of maltreatment on preschoolers' narrative representations of responses to relieve distress and of role reversal

A total of 80 low-socioeconomic status maltreated preschoolers were contrasted with 27 nonmaltreated preschoolers on their narrative representations. The children completed story stems, taken from the MacArthur Story-Stem Battery (MSSB; I. Bretherton, D. Oppenheim, H. Buchsbaum, R. N. Emde, & the MacArthur Narrative Group, 1990), that introduced stressful family situations. Using the MacArthur narrative coding manual (J. Robinson, L. Mantz-Simmons, J. Macfie, & the MacArthur Narrative Group, 1992), coders rated portrayals of parental and child character responses, as well as participant responses, to relieve children's distress. They also rated role reversal (children caretaking their parents) from the narrative emotion coding manual (S. L. Warren, L. Mantz-Simmons, & R. N. Emde, 1993). Maltreated preschoolers portrayed parents and children as responding less often--yet themselves as stepping into the story more often to relieve children's distress--than did nonmaltreated preschoolers. Abused children (sexually, physically, or both) portrayed the most participant responses, and neglected children (with no abuse) portrayed the fewest child responses. Role reversal was associated with physical abuse.     

Psychological response to test results in an ovarian cancer screening program: a prospective, longitudinal study.

To identify the psychological impact of receipt of an abnormal yet benign screening test result, the authors examined the response to a transvaginal ultrasound screening (TVS) test for ovarian cancer (OC) in asymptomatic women (N=540) undergoing an initial TVS screening test. Interviews were conducted prior to undergoing TVS screening and at 2 weeks and 4 months following this baseline. Women receiving an abnormal yet benign TVS test result (n=33) reported elevated OC-specific, but not general, distress at 2-week follow-up. Distress returned to baseline levels at 4-month follow-up. Consistent with the monitoring process and cognitive-social health information processing models, response to an abnormal TVS result was moderated by a monitoring coping style, low optimism, and a family history of OC.     

Predictors of mental distress and poor physical health among homeless women

Abstract

We tested a latent variable path model in which situational, personal, and social resources predicted several mediators and the key health outcomes of mental distress and poor physical health among 871 homeless women. Mental distress was predicted by risky sexual behavior, less social support, avoidant coping, less self-esteem, client abuse history, social support from deviant sources, less drug self-efficacy and health care utilization. Poor physical health was predicted by a client abuse history, less drug self-efficacy, fewer perceived rewards for drug use, higher perceived costs for drug use, and a doctor visit. Current risky sexual behavior was predicted by a parent drug abuse history, less drug self-efficacy, and more social support from deviant sources. Current drug use was predicted by parent drug abuse history, less drug self-efficacy, more social support from deviant sources and by high perceived costs for drug use. Implications of results for intervention and theory are discussed.     

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.     

Work-family conflict, and psychological distress in men and women among Canadian police officers

The present study examined the relations among sex, work-family conflict, and psychological distress in 78 Canadian police officers (50 men and 28 women). The average age of the officers was 36.1 yr. (SD=8.0), and nearly one-third of the respondents had been in policing 16 years or more. Ordinary least-squares regression was conducted to examine the association of Psychological Distress scores, as measured by the K6, with four types of work-family conflict: Time-based Work-to-Family Conflict, Time-based Family-to-Work Conflict, Strain-based Work-to-Family Conflict, and Strain-based Family-to-Work Conflict. Being single and having higher perceived Strain-based Work-to-Family Conflict were associated with greater scores on Psychological Distress. No statistically significant sex differences emerged in the self-reported type or direction of work-family conflict or in the factors associated with Psychological Distress.     

Young children's representations of peers' distress: associations to children's social functioning and acceptance of distressed peers

Children's mental representations of situations involving another child's distress were examined in two studies. Study 1 examined 3- to 7-year-old children's (n= 44) ideas about what victims and bystanders would think, feel and do in hypothetical situations. In Study 2, 7- to 8-year-olds (n= 40) described their own cognitive response to situations in which they were confronted with another's distress. In both studies, representational bias was examined in relation to children's display of prosocial and aggressive behavior and in relation to their acceptance of distressed peers. Although not entirely consistent, findings indicate that three types of representational biases are associated with low levels of considerate behavior and with relatively low acceptance of distressed peers: (a) mentally representing the victim's problem without giving thought to its implications for the victim, (b) significantly reducing the emotional significance of the problem and (c) exaggerating negative aspects of the problem.