常人疾病观及其对医患关系的影响

常人疾病观是普通人对于某一疾病的认知、解释和态度的集合。与专业医务人员相比, 普通人更关注心理、家庭和社会因素而非生物学因素的致病作用, 就医选择多元而并不遵循标准化的就医模式, 同时更愿意将疾病体验视为个人生活的特殊问题加以建构性理解。常人疾病观与科学医学观之间的不一致性可能降低患者的就医满意、对医信任和医嘱依从性, 从而影响治疗效果。立足中国社会的医学文化与医疗制度, 研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 可为改善当下中国医患关系紧张现状提供有益建议。     

Bulimia Nervosa: Professional and Lay People's Beliefs About the Causes

This study examined the explanatory models of bulimia nervosa (BN) held by members of professionals in the medical, psychological, and allied health fields; the general public; and female university students. The participants (N = 787) were presented with 44 potential causal explanations for BN and were asked to rate the importance of each in the development of this condition on a 5‐point rating scale (“unimportant” to “extremely important”). Principal component analysis identified four causal components. These were interpreted as corresponding to (1) socio‐cultural pressure, (2) eating and dieting practices, (3) family dynamics, and (4) psychological vulnerability. A high degree of consistency in the mean ratings for the four causal components was observed among the professional groups. However, important differences were found between the professional and the lay respondents in their beliefs about the role of socio‐cultural pressure, eating and dieting practices, and family dynamics in the development of BN. The congruence in beliefs among the professionals groups would contribute to the ease of interdisciplinary collaboration required in the multi‐modal treatment approach to BN. However, the differences observed between the professional and lay groups may have implications for educational and preventative strategies for BN.     

Lay beliefs about the efficacy of self-reliance,seeking help and external control as strategies for overcoming obesity,drug addiction,marital problems,stuttering and insomnia

Abstract

This study was concerned with peoples' beliefs about the importance of twenty-four different contributors towards overcoming five relatively common personal health problems, namely: obesity, drug addiction, marital difficulties, stuttering and insomnia. One hundred and twenty-two subjects completed a five-page questionnaire indicating how effective each of these contributors were to overcoming the problems as specified. Factor analysis revealed an interpretable structure similar to previous studies (Luk and Bond, 1992): the emerging three factors were labelled ^'self-reliance”, “seeking help” and “external control”. Multiple regression showed that few individual difference variables as measured were related to perceived relevance of the different contributors. The results were discussed in terms of subjects' beliefs concerning the value of self-reliance as opposed to seeking help, and in relation to the importance of understanding lay beliefs about the efficacy of different forms of intervention.     

No blank slates: Pre-existing schemas about pharmaceuticals predict memory for side effects

Objectives: Attribution of symptoms as medication side effects is informed by pre-existing beliefs about medicines and perceptions of personal sensitivity to their effects (pharmaceutical schemas). We tested whether (1) pharmaceutical schemas were associated with memory (recall/recognition) for side effect information (2) memory explained the attribution of a common unrelated symptom as a side effect.

Design: In this analogue study participants saw the patient leaflet of a fictitious asthma drug listing eight side effects.

Main outcome measures: We measured recall and recognition memory for side effects and used a vignette to test whether participants attributed an unlisted common symptom (headache) as a side effect.

Results: Participants who perceived pharmaceuticals as more harmful in general recalled fewer side effects correctly (r_{Correct Recall} = ?.273), were less able to differentiate between listed and unlisted side effects (r_{Recognition Sensitivity} = ?.256) and were more likely to attribute the unlisted headache symptom as a side effect (r_{side effect attribution} = .381, ps < .01). The effect of harm beliefs on side effect attribution was partially mediated by correct recall of side effects.

Conclusion: Pharmaceutical schemas are associated with memory for side effect information. Memory may explain part of the association between pharmaceutical schemas and the attribution of unrelated symptoms as side effects.     

Social representations of health and illness: the case of the Chinese community in England

This paper reports results from a qualitative study on social representations of health and illness among the Chinese community in England. It is assumed that representations of health and illness are grounded in cultural frameworks and are constructed through communication, social interaction and the practices of daily life. Our findings show that in spite of differences related to age and degrees of acculturation, Chinese people in England share a common representational system with respect to health and illness. This system is based on the traditional notions of “balance” and “harmony” between the interdependent forces of Yin and Yang. Health results from balance, whereas illness is brought about by disequilibrium. It is through these traditional Chinese concepts that Western biomedical knowledge is incorporated, producing a mixed representational field where Chinese and Western knowledge co‐exist. This representational field is transmitted through the most fundamental dimensions of culture: food, language and kinship relations. We conclude by showing that social representations of health and illness are inseparable from the struggles over identity experienced by the Chinese people in England. Copyright © 1999 John Wiley & Sons, Ltd.     

Adherence to pharmacological treatment of non-malignant chronic pain: The role of illness perceptions and medication beliefs

The objective was to identify the degree to which illness perceptions and medication beliefs explain variations in reported adherence to medication prescribed for the treatment of non-malignant chronic pain and to test the applicability of an extended version of the self-regulatory model to the chronic pain population. A cross-sectional design included 217 clinic patients completing validated questionnaires assessing their illness perceptions, medication beliefs and reported adherence to medication. Perceptions of illness (pain) as chronic, uncontrollable and unremitting were associated with greater adherence, fewer medication concerns and a belief that treatment was necessary. Structural equation modelling supports an extended SRM for chronic pain. It suggests that patients holding perceptions of serious consequences of pain and high emotion levels have more concerns about medication and are less adherent. Perceptions of serious illness consequences are also associated with stronger beliefs about the necessity of medicines and greater adherence. Beliefs about illness and medication are associated with adherence to treatment in chronic pain and this can be explained by an extended SRM. Results are preliminary and require replication. Further studies should explore the role that emotion has on coping strategies in chronic pain. Interventions should focus on altering unhelpful beliefs that reduce adherence.     

The illness perception questionnaire: A new method for assessing the cognitive representation of illness

Abstract

The Illness Perception Questionnaire (IPQ) is a new method for assessing cognitive representations of illness. The IPQ is a theoretically derived measure comprising five scales that provides information about the five components that have been found to underlie the cognitive representation of illness. The five scales assess identity - the symptoms the patient associates with the illness, cause - personal ideas about aetiology, time-line - the perceived duration of the illness, consequences - expected effects and outcome and cure control - how one controls or recovers from the illness. The IPQ has a specific number of core items but allows the user to add items for particular patient groups or health threats. Data is presented supporting the reliability and validity of the IPQ scales in different chronic illness populations.     

The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Treatment hurts: Lay theories of graded exposure in the treatment of four anxiety disorders

Objective: This paper concerned the perceived suffering/side effects caused by various well-known treatments for personal problems. It looked at whether people understood whether potentially painful treatments that confront negative aversive affect were effective or not.

Method: In total, 106 participants completed a long questionnaire assessing the ‘psychological pain’ ratings of 30 psychotherapy treatments, varying in fear exposure, for four relatively common anxiety disorders: social phobia, agoraphobia, post-traumatic stress disorder, and obsessive compulsive disorder.

Results: Factor analytic results revealed four clear factors underlying lay efficacy beliefs of psychotherapy interventions, varying in fear exposure: talking therapies, fear confrontation, fear avoidance, and alternative therapies. Talking therapies were rated the most effective across all disorders, but also the most painful. Fear avoidance therapies were rated the least effective and, along with alternative medicine, the least painful. Treatments involving fear exposure were rated the most painful. Regression analysis revealed talking therapies to be rated more efficacious by younger subjects than older subjects.

Conclusion: Most people seem able to differentiate between the efficacies of interventions for different anxiety disorders and hold consensually held optimistic conceptions about the usefulness of psychotherapy treatments and counseling that involve fear exposure, despite knowledge of the psychophysical side effects that these therapies often entail. They favored talking cures over others, but that may have been due to misleading items in the questionnaire.     

Microaggressions: The experience of individuals with mental illness

The main objective of the study was to investigate the types of microaggressions experienced by individuals with mental illness (MI) based on this marginalized group status. This study included 4 focus groups, comprised of 18 individuals diagnosed with MI(es). The researchers qualitatively identified four themes (a) conveying stereotypes against individuals with MI (i.e. assumptions of inferiority, seeking attention or being dramatic, assumptions of coldness, bringing MI upon themselves, and using MI as an excuse), (b) invalidating the experience of having a MI (i.e. doubting existence, doubting severity, and avoiding acknowledgment of the MI), (c) defining a person by their disorder, and (d) misuse of terminology. Participants revealed the main perpetrators (i.e. family, friends, and professionals) of the microaggressions. The researchers discuss: how the identified themes compare to the three categories of microaggressions (i.e. microinsults, microinvalidations, and microassaults); similarities and differences between the current results and previously identified racial, gender, and sexual orientation microaggressions perpetrated in daily interactions and in therapeutic settings; and the perpetrators of microaggressions as they relate to prejudicial attitudes and social distance. Finally, the authors make recommendations for practitioners and researchers.     

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.     

Examining adversarial growth in illness: The factor structure of the silver lining questionnaire (SLQ-38)

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.     

The temporality of illness: Four levels of experience

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient.     

Self-regulated learning among teacher education students: Motivational beliefs influence on the use of metacognition

In the present study, we examined the relationships between motivational beliefs (self-efficacy, task value, and control of learning beliefs) and use of metacognitive learning strategies among teacher education students in Uganda. The sample comprised of 649 students selected from seven universities. Data were collected using several scales from the modified Motivated Strategies for Learning Questionnaire, and analysed using Structural Equation Modelling. Task value and self-efficacy independently and significantly predicted students’ reported use of metacognition. Students’ self-reported self-efficacy and task value explained 38% of the variance in their use of metacognition. The evidence suggests interventions aimed at improving teacher education students’ metacognitive skills to focus on enhancing their efficacy and value beliefs.     

The typology of parricide and the role of mental illness: Data-driven approach

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.     

Using Social Representations Theory to Examine Lay Explanation of Contemporary Social Crises: The Case of Ireland's Recession

Social actors operate under a basic imperative to construct explanations for the events that surround them. Many issues that dominate the societal agenda today are not available to direct perception, derive from traditionally expert domains and are relatively remote from immediate local experience. This presents a challenge for lay explanation of these issues. Social representations theory offers a useful framework through which the construction of lay explanation for such issues can be examined. The current study recruited this theoretical framework to investigate lay explanations of the recent economic recession in Ireland. Data consisted of semi‐structured interviews with 14 members of the public and a web‐based survey (N = 138). The data suggested that explanations for the recession could be organised into three major themes: Power, Ordinary People and Fatalism. Strictly economic explanations were eschewed; instead, people drew upon a wide range of ideas about society, politics, morality, public spheres and personhood. The implications of these findings for understanding lay explanation of contemporary social crises are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Mental illness,religion, and the rational mind: The case of Clifford W. Beers

This article focuses on the mental illness of Clifford W. Beers, who pioneered mental hospital reform in the United States in the early decades of the twentieth century, and the encouragement Beers received from William James in this endeavor. It argues that James supported Beers because he personally identified with the younger man's struggles with mental illness and with the high value that he placed on the vital importance of the rational mind in regaining one's sanity.