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 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.     

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

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

Illness Perception Mediates the Effect of Illness Course on the Quality of Life of Mexican Patients with Psychosis

Learning about possible factors influencing, positively or negatively, the Quality of Life (QoL) of patients with psychosis is an important task for both, research and treatment. The study examined the association of illness course with QoL in a sample of Mexican patients with psychosis. It was hypothesized that illness perception would mediate the relation of illness course to QoL. Sixty-one (56 % female) patients were interviewed and assessed for illness course (relapses, residual symptoms, and diagnosis), QoL, and illness perception. Mediation analyses (simple and multiple) with bootstrapping procedures were applied, including residual symptoms as the predictor of QoL, and illness perception dimensions as candidate mediators. Residual symptoms, rather than a relapsing course or a diagnosis of schizophrenia, have a diminishing effect in the subjective QoL. This effect is fully mediated by illness perception, particularly by the cognitive and the emotional representations. Results underscore the importance that patients’ beliefs have on their perceived QoL, encouraging further research and development of interventions targeting illness perceptions.     

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

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

Illness Perceptions and Health: Innovations and Clinical Applications

Using a self-regulatory process, individuals act upon their cognitive and emotional representations of health threats to actively manage their health. Leventhal’s common-sense model describes cognitive representations of illness that include perceptions about the identity, timeline, consequences, control and cause of illness. Research has shown that individuals’ illness perceptions predict health behaviours and functional outcomes, particularly when perceptions are specific. Psychometric assessments of illness perceptions need to have the ability to detect specific and idiosyncratic perceptions and emotions; methods include rating scales and patients’ drawings of their illness. Recent randomised trials have demonstrated that interventions can change illness perceptions and improve health outcomes in patient groups, including those with normal test-results, and that family members also benefit from such interventions. These innovations inform clinical applications for improving patient health.     

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.     

Relationship of Illness Severity with Health and Life Satisfaction in Patients with Cardiovascular Disease: The Mediating Role of Self-efficacy Beliefs and Illness Perceptions

Guidelines for cardiovascular rehabilitation from different countries underline the importance of psychological factors in the achievement of improved clinical conditions and quality of life in patients with cardiovascular disease (CVD). Nevertheless, little research has been performed to identify the specific factors that greatly affect or foster patients’ quality of life. The aim of the current study was to investigate the contribution of illness perceptions (IP) and self-efficacy beliefs (SE) on the impact exerted by illness severity on health and life satisfaction in patients with CVD undergoing a rehabilitation program. The study had a cross-sectional design and involved 116 patients (mean age = 65.6 years; SD = 10.0 years; 79.3 % men). Illness severity was measured in terms of left ventricular ejection fraction (LVEF) at the discharge from the cardiology department, whereas psychological factors were assessed one week later. The results showed no relationships among LVEF and the two indicators of health and life satisfaction; moreover, these two variables are differently influenced by IP and cardiac risk factors SE (χ²(1) = 0.96, p = n.s.). Findings provide important suggestions for the implementation of interventions aimed at bettering patients’ quality of life, underlying the importance of working on IP and SE to improve levels of health and life satisfaction in patients with CVD.     

Psychological factors and use of antiepileptic drugs: pilot work using an objective measure of adherence

Given the current emphasis on the "concordance" prescribing model, a study was designed to determine the influence of patients' beliefs about epilepsy, beliefs about medication and a range of neuroepilepsy variables on drug adherence among a sample of epilepsy patients. A special feature of the study was the use of a credible objective measure of drug adherence. Psychological health was also assessed. Thirty-seven patients were recruited from a local epilepsy clinic. Beliefs about epilepsy (illness representations), beliefs about epilepsy medication, anxiety, depression, neuroepilepsy status and adherence were all measured. Data were collected via clinical interview and questionnaire methods. Adherence with drug treatment was determined by an objective measure using low-dose phenobarbital as an indicator of adherence and, or, measurement of antiepileptic drug levels. Neither illness representations nor beliefs about epilepsy drugs were related to adherence. With the exception of time since last seizure, which was positively related to adherence, neuroepilepsy variables were unrelated to adherence. A number of significant associations between cognitive representations of epilepsy and mood were found.     

Associations between sleep variables and ostensibly paranormal experiences and paranormal beliefs: A scoping review

Night-time is a period of great significance for many people who report paranormal experiences. However, there is limited understanding of the associations between sleep variables and seemingly paranormal experiences and/or beliefs. The aim of this review is to improve our understanding of these associations while unifying a currently fragmented literature-base into a structured, practical review. In this pre-registered scoping review, we searched for relevant studies in MEDLINE (PubMed), PsycINFO (EBSCO), Web of Science and EMBASE using terms related to sleep and ostensibly paranormal experiences and beliefs. Forty-four studies met all inclusion criteria. All were cross-sectional and most investigated sleep paralysis and/or lucid dreaming in relation to ostensibly paranormal experiences and paranormal beliefs. Overall, there were positive associations between many sleep variables (including sleep paralysis, lucid dreams, nightmares, and hypnagogic hallucinations) and ostensibly paranormal experiences and paranormal beliefs (including those of ghosts, spirits, and near-death experiences). The findings of this review have potential clinical implications such as reducing misdiagnosis and treatment development and provide foundations for further research. Our findings also highlight the importance of understanding why so many people report ‘things that go bump in the night’.     

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

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

Illness perception in individuals with atopic dermatitis

Accumulating evidence suggests that in order to understand and respond to the difficulties presented by illness, patients construct their own "common sense" cognitive model of illness. This study set out to examine self-help group members, and students' beliefs about their atopic dermatitis (AD) and to investigate their relationship with symptom report and clinical and demographic variables. A total of 284 participants with AD undertook a self-assessment of their disease severity and completed the Revised Illness Perception Questionnaire. The most frequent symptoms associated with AD were itching, sleep difficulties and pain. The most commonly reported triggers of AD were stress, hereditary factors and emotional state. Over 75% of participants believed that their condition would be chronic. Self-help group members reported more significant consequences of the condition, a greater emotional impact, while the student group felt they had more personal control of their AD. Multiple regression analyses indicated that illness beliefs, in particular perceived consequences associated with AD and personal control, accounted for a significant proportion of the variance in emotional response to the condition. This study suggests that participants' beliefs and emotional response are more strongly associated with the meaning they ascribe to their condition rather than its severity.     

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

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

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.     

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.     

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

Abstract

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

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.     

Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study

Abstract

Objective: This qualitative study sought to identify and describe patients’ variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis.

Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients’ perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients.

Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients’ beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons.

Conclusions: Beliefs about severity are influenced by patients’ fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

Perceived Control and Psychological Adjustment in Gay Men With AIDS1

The relationship of control beliefs to psychological adjustment was investigated in a sample of 24 gay men diagnosed with AIDS, participants in the University of California, Los Angeles site of the Multicenter AIDS Cohort Study (MACS). Distinctions between generalized contingency beliefs and specific competence beliefs and between personal and vicarious control beliefs were included in the questionnaire and interview measures administered. The results support these distinctions and indicate that beliefs in personal control over day-to-day symptoms and over course of illness were positively related to adjustment, whereas beliefs in control by others over course of illness and over medical care and treatment were negatively related to adjustment. These relationships appeared to be strongest for men who reported poorer health. These associations were not accounted for by locus of control beliefs, negative affectivity, or time since diagnosis with AIDS.