Effect of couple illness perception congruence on psychological adjustment in women with rheumatoid arthritis.

OBJECTIVE: To characterize similarities and differences in illness perceptions between women with rheumatoid arthritis (RA) and their husbands, and examine whether illness perception congruence predicted wives' subsequent psychological adjustment. DESIGN: Women with RA and their husbands (N=190 couples) recruited from community and clinical settings completed mailed surveys at baseline and 4-month follow-up. MAIN OUTCOME MEASURES: Data for this investigation included illness perceptions in partners and illness severity, marital variables, and psychological adjustment in wives. RESULTS: In general, wives and husbands had similar views of RA. Couple congruence concerning women's personal control over RA and its cyclic nature predicted better psychological adjustment in women 4 months later. Post hoc tests showed better psychological adjustment in wives from couples with similar optimistic beliefs about personal control, illness coherence, and RA consequences, when compared to those in couples with similar pessimistic beliefs. Furthermore, when partners disagreed about RA's consequences, wives fared better when husbands overestimated rather than underestimated their beliefs. In contrast, couple congruence about the emotions and timeline of RA was unrelated to adjustment. CONCLUSION: It may be important for husbands to understand wives' views on their control over RA and its cyclic nature. Furthermore, wives may benefit when they share optimistic views with their husbands about RA, and when their husbands avoid underestimating RA's consequences. Developing interventions to enhance partners' illness understanding may be beneficial.     

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 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.     

Personal mastery predicts pain,stress, fatigue,and blood pressure in adults with rheumatoid arthritis

Among individuals with rheumatoid arthritis (RA), stress-associated disease flare can severely impact well-being. Psychological factors such as personal mastery may buffer an individual from the negative effects of those flares. We tested the hypothesis that a high sense of personal mastery would prospectively predict stress reactivity. Measures of pain, perceived stress, fatigue, and mean arterial pressure (MAP) were collected before, during, and after two interpersonal stressors conducted on 73 individuals with RA. Factor analysis of the personal mastery scale yielded two independent factors: a 5-item “fatalism” component and a 2-item “control” component. Individuals with high fatalism scores reported overall greater joint pain at baseline and those scoring high on control exhibited lower MAP, and reported less stress and fatigue at baseline. After controlling for baseline differences, those high in control exhibited greater MAP increase during stress, and less drop in pain when compared to those low in control. These results suggest that individuals high in control may be more susceptible to the effects of acute stress; however, the overall beneficial aspects of high control outweigh the acute negative effects. Personal mastery may play a role in the experience of pain, stress, and fatigue for people with RA.     

"I Know Just How You Feel": The Validity of Healthy Women's Perceptions of Breast-Cancer Patients Receiving Treatment

The accuracy of healthy women's perceptions of how breast-cancer patients cope with treatment was assessed in this study. Standardized questionnaires measuring distress, coping, and illness perceptions were completed by 78 women undergoing postsurgical treatment for primary breast cancer. The patients' responses were then compared with assessments made by a matched community sample. The results showed a marked incongruity between healthy women's perceptions and actual patients' experiences of the disease and its treatment. Community women overestimated patients' distress, perceived the consequences of breast cancer to be more severe, and were more likely to believe that patients used denial and disengagement strategies. The discrepancy in findings has implications for the appropriateness of the support offered to patients by healthy women.     

Illness perceptions or recurrence risk perceptions: What comes first? A longitudinal cross-lagged examination among cardiac patients

Objectives: Previous research suggested that illness perceptions provide the basis for illness risk perceptions through an inductive reasoning process. This study aimed to assess the direction of relationships between illness and recurrence risk perceptions over time, among cardiac patients.

Design: A longitudinal study was conducted among 138 patients undergoing coronary angioplasty. Self-report questionnaires measured perceived recurrence risk and illness perceptions one day and one month after catheterisation.

Results: Cross-lagged Panel Model Analyses revealed that higher perceptions of timeline, consequences and emotional representations of illness at hospitalisation were associated with higher recurrence risk perceptions one month later. Perceived personal control was the only illness perception with bi-directional associations: higher perceived personal control at hospitalisation was associated with higher recurrence risk perceptions one month later; and higher recurrence risk perceptions at hospitalisation was associated with lower personal control one month later.

Conclusions: The findings suggest that the associations between recurrence risk and illness perceptions can only partly be explained by inductive reasoning. Halo effects and defensive processes are suggested as complementary explanations for the observed associations between risk and illness perceptions.     

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.     

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.     

The relation of illness representations to the 'end-stage' appraisal of outcomes through health status, and the moderating role of optimism

The aim of this study was to examine an important pathway suggested by the common sense model (CSM): the relation of illness representations to the 'end-stage' appraisal of outcomes through health status. A further aim was to examine the moderating role of optimism in this relationship. One hundred and six chronic cardiac patients completed questionnaires about illness representations and dispositional optimism at baseline, and health status and illness-related helplessness (as an indicator of the 'end-stage' appraisal of outcomes) at a follow-up interview, 6 months later. Indirect (mediation) as well as conditional indirect (moderated mediation) effects were examined using bootstrapped models. According to the results, the effect of illness representations on helplessness was mediated by at least one of the health measures used. Also, most of these indirect relations were conditional on the values of optimism. That is, optimism moderated the 'illness representations-health status-"end-stage" appraisal of outcomes' relationship, as the mediating effects were absent at higher levels of optimism. These findings can provide us with a more comprehensive picture of adaptation to illness, as well as of the ways the illness-related information is being processed by patients. Thus, they have significant implications for theory, research and practice.     

Healthcare's greatest challenge: providing services for people with severe mental illness in managed care

The delivery of services for people with severe mental illness (SMI) is described as healthcare's most difficult challenge because SMI patients suffer from the combined effects of conditions that have 1) a chronic course, 2) disabling consequences, and 3) a high risk of poverty. The fundamental advantages of managed care for persons with chronic, disabling conditions are discussed along with an examination of how well these assumptions hold in actual practice for persons with SMI. The legal risks assumed by clinicians in managed care are reviewed, including the inherent risk of discriminating against high cost enrollees, such as patients with SMI. Finally, recommendations are made regarding the measures that might be taken to increase the "match" between the principles of managed care and the specialized needs of people with severe mental illness.     

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

OBJECTIVE: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia). DESIGN: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry. RESULTS: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry. The hypothesis that illness perceptions mediate the relationship between a person's experience of venous thrombosis and perceived risk and thrombosis worry could not be confirmed. CONCLUSIONS: Further research should refine the IPQ-R for populations at risk of a disease and examine the value of the CSM in explaining the relationship between risk perception, worry, and health behavior.     

Social Comparison Among Individuals With Rheumatoid Arthritis1

This study examined the types of social comparisons made by individuals with rheumatoid arthritis (RA) and the role these comparisons play in illness adjustment. Seventy-five women with RA were interviewed. The interview included measures of social comparison preferences assessed within two different contexts: the establishment of standards for desired performance and the experience of performance difficulties. Perceived ability, satisfaction with ability, and psychological adjustment also were assessed. We found that when respondents were experiencing performance difficulties they compared more frequently with other RA patients than with individuals not affected by RA. However, when establishing standards for desired performance, the latter type of comparison was more common. Further, respondents' comparison preferences were not related to perceptions of ability, but were related to satisfaction with ability. Greater satisfaction was associated with comparison with individuals not affected by RA when establishing standards for desired performance and comparison with other RA patients when experiencing performance difficulties. Satisfaction, in turn, was positively related to psychological adjustment.     

Adaptation in patients with chronic rheumatoid arthritis: application of a general model.

We derived a model of appraisal, coping, and adaptation in patients with rheumatoid arthritis (RA) from the more general theory of Lazarus and Folkman (1984) and examined this model using a longitudinal data set spanning 4 years and involving 239 RA patients (of whom 157 contributed to the primary analyses, with the remainder contributing to various follow-up analyses). This model attempted to identify the short- and long-term adaptational consequences of coping as well as the antecedents (appraisals, beliefs, social support, disease activity, etc.) that promote particular coping styles. Interrelations among the variables were examined using path-analytic techniques. Many observed relations were consistent with the model. Significant relations were subjected to more stringent analyses examining the ability of hypothesized causal variables to predict changes in outcome variables 1 year later. These analyses provided additional support for many observed relations and suggested the existence of a vicious cycle involving helplessness appraisals, passive coping with pain, and psychosocial impairment that promotes maladaptation in the face of RA. Theoretical implications, strengths, and limitations of the study are discussed.     

A Systematic Review of the Literature Exploring Illness Perceptions in Mental Health Utilising the Self-Regulation Model

Psychologists have utilised a range of social cognition models to understand variation in physical health and illness-related behaviours. The most widely studied model of illness perceptions has been the Self-Regulation Model (SRM, Leventhal, Nerenz, & Steele, 1984). The illness perceptions questionnaire (IPQ) and its revised version (IPQ-R) have been utilised to explore illness beliefs in physical health. This review examined 13 quantitative studies, which used the IPQ and IPQ-R in mental health in their exploration of illness perceptions in psychosis, bipolar disorder, eating disorders, depression and adolescents experiencing mood disorders. Across these studies the SRM illness dimensions were largely supported. Mental illnesses were commonly viewed as cyclical and chronic, with serious negative consequences. Perceptions regarding chronicity, controllability and negative consequences were associated with coping and help seeking, while engagement with services and help seeking were also related to illness coherence beliefs. Treatment adherence was linked to beliefs that treatment could control one’s illness. Whilst a major limitation of the reviewed studies was the use of cross-sectional designs, overall the applicability of the SRM to mental health was supported. The IPQ and IPQ-R were shown to be valuable measures of illness perceptions in mental health, offering implications for clinical practice.     

Autonomous motivation,cardiorespiratory fitness,and exercise in rheumatoid arthritis: Randomised controlled trial

ObjectiveRheumatoid arthritis (RA) is an autoimmune disease, characterised by high-grade systemic inflammation, pain, and swollen joints. RA patients have an increased risk for cardiovascular disease (CVD). This study examined if a 3-month individualised RA-tailored exercise programme with one-on-one Self-Determination Theory (SDT)-based support for physical activity (PA) facilitated autonomous motivation, increased PA behaviour, and induced greater improvements in cardiovascular and RA-related disease characteristics, and wellbeing in RA, compared to a standard provision tailored exercise programme.Methods115 RA patients were randomised into either the SDT-based psychological intervention + exercise programme (experimental group) or an exercise programme only (control group). Cardiorespiratory fitness (primary outcome), self-reported PA, disease characteristics, CVD risk, wellbeing, and SDT constructs were assessed at baseline (pre-intervention), 3 months (post-intervention), 6 months, and 12 months follow-up. Mixed linear modeling was used to examine within- and between participant changes in these outcome measures.ResultsIn 88 patients with complete baseline data, cardiorespiratory fitness did not change from baseline to 3-, 6- or 12 months in either group. CVD risk, disease characteristics, wellbeing, and need satisfaction did not change, with the exception of diastolic blood pressure. Significant group by time interaction effects were found for functional ability (6- & 12-months), CVD risk (6-months) and PA (3-months). Autonomous motivation increased and controlled motivation decreased more in the experimental group compared to the control group at 3 months.ConclusionsDespite improving quality of motivation for exercise, no changes in cardiorespiratory fitness or other psychological and physiological health outcomes were found. This suggests more intensive support is needed when initiating an exercise programme to achieve health benefits in RA.     

The Contribution of Attributional Style to Perceived Disability in Rheumatoid Arthritis: A Longitudinal Study

The current study investigated the influence of general causal attributions on self-reported physical disability over the course of 1 year in a sample of 42 patients with rheumatoid arthritis (RA). Participants completed measures of attributional style, pain, and disability; physician assistants completed objective measures of disability on two occasions, approximately 1 year apart. Results indicated that internal attributions for disease-unrelated negative events assessed at Time 1 were associated with lower perceived physical disability, whereas stable attributions for negative events were associated with greater perceived physical disability 1 year later. These findings are discussed in terms of behavioral and characterological self-blame models, respectively. Implications of our findings for clinical management of RA are also discussed.     

The singles scene: Safe sex practices and attitudes among at-risk heterosexual adults

Patient uncertainty is associated with conditions with no known cause or cure, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), and despite its potential role in chronic illness management, it is still a poorly understood concept. This study constitutes an in-depth investigation of patient uncertainty in SLE and RA. We conducted (i) structured interviews with a sample of rheumatology health care professionals (HCPs) (n?=?8) and (ii) in-depth, semi-structured interviews with a sample of SLE (n?=?17) and RA (n?=?15) patients. Interviews were audio-taped, transcribed verbatim and analysed thematically using detailed line-by-line coding. Patient uncertainty was conceptualised in a framework of five domains: symptoms and prognosis, medical management, self-management, impact and social functioning. Even though these five domains were present in both the SLE and RA data, there were some differences at the sub-domain level. Several sources of uncertainty were put forward by the HCPs and subsequently confirmed in the patient interviews including the illness trajectory, age, gender and timing. Patients reported uncertainty relative to various aspects of their illness, its management and impact. Finally, HCPs discussed the behavioural and psychosocial impact of uncertainty, which further suggests its important role in patient management.     

Changes over time in head and neck cancer patients’ and caregivers’ illness perceptions and relationships with quality of life

Objective: This study investigated changes in illness perceptions from diagnosis to six months later in patients with head and neck cancer (HNC) and their caregivers. The study also examined whether discrepancy in patient and caregiver perceptions at diagnosis predicted patient health-related quality of life (HRQL) at six months.

Design: Forty-two patient–caregiver dyads completed the Brief Illness Perception Questionnaire (Brief IPQ) at diagnosis and again six months later. Patients also completed a HRQL questionnaire at both time points. Analyses were performed using the Actor–Partner Interdependence Model.

Main Outcome Measure: Total patient HRQL assessed by the Functional Assessment of Cancer Therapy (FACT-H&N).

Results: Perceptions of emotional impact and illness concern reduced over time in patients and caregivers. Perceptions of treatment control and identity increased in caregivers only. After controlling for the effects of baseline HRQL, and the individual contribution of patient and caregiver illness perceptions, greater discrepancy in perceptions of timeline, personal control, and illness identity among dyads at diagnosis predicted lower patient HRQL at six-month follow-up.

Conclusion: Patients’ and their caregivers’ perceptions of HNC are dynamic over time. Greater discrepancy between patients’ and caregivers’ illness perceptions at diagnosis predict poorer subsequent patient HRQL.     

Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis

This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8-year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8-year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.     

General self-efficacy and health-related quality of life after myocardial infarction

Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.