What are the positive consequences of illness?

Abstract

Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.     

The dimensional structure of benefit finding in multiple sclerosis and relations with positive and negative adjustment: A longitudinal study

Benefit finding is a meaning making construct that has been shown to be related to adjustment in people with MS and their carers. This study investigated the dimensions, stability and potency of benefit finding in predicting adjustment over a 12 month interval using a newly developed Benefit Finding in Multiple Sclerosis Scale (BFiMSS). Usable data from 388 persons with MS and 232 carers was obtained from questionnaires completed at Time 1 and 12 months later (Time 2). Factor analysis of the BFiMSS revealed seven psychometrically sound factors: Compassion/Empathy, Spiritual Growth, Mindfulness, Family Relations Growth, Lifestyle Gains, Personal Growth, New Opportunities. BFiMSS total and factors showed satisfactory internal and retest reliability coefficients, and convergent, criterion and external validity. Results of regression analyses indicated that the Time 1 BFiMSS factors accounted for significant amounts of variance in each of the Time 2 adjustment outcomes (positive states of mind, positive affect, anxiety, depression) after controlling for Time 1 adjustment, and relevant demographic and illness variables. Findings delineate the dimensional structure of benefit finding in MS, the differential links between benefit finding dimensions and adjustment and the temporal unfolding of benefit finding in chronic illness.     

Social support,social integration,and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST)

The present study tested whether baseline perceived social support and social integration predicted baseline and follow-up measures of health-related quality of life for 364 older adults with osteoarthritis. The findings are secondary analyses of a randomized controlled trial of an exercise intervention. Multiple regression analyses indicate that perceived social support was related to baseline measures of functioning in psychological (depressive symptoms, social functioning, and life satisfaction) and physical domains (self-rated disability, observed physical function, and perceived health), after accounting for demographic and clinical status factors. At 18-month follow-up (additionally controlling for exercise intervention and baseline outcomes), social support significantly predicted changes in psychosocial functioning, but was unrelated to changes in self-reported and observed physical health. The findings indicate that social support is an important predictor of long-term psychosocial outcomes, but is less important than baseline clinical status for physical health endpoints in this cohort of older adults. In contrast, social integration was not a consistent predictor of outcomes.     

Socio-economic health inequalities: Their origins and implications

Abstract

Evidence attests to substantial variations in health contingent on socioeconomic position. It is argued that these effects cannot be dismissed as artefact nor can they be explained, in the main, by either social selection or an unequal distribution of accepted behavioural risk factors among different social groups. The most likely explanation would seem to be social causation. However, it is continuing social and material inequality that appears most implicated; accounts which locate the effects in childhood social and material causes are far less compelling. The persistence of socioeconomic health differentials into the materially better-off social strata and the possible determining role of relative as well as absolute living standards suggest that psychological, in addition to material, variables are likely to be involved. Isolating the key psychological variables and identifying the nature of their influences will not be easy tasks, although social relations, psychological stress, uplifts, and control have emerged as possible candidates. However, psychological mediators of this sort most probably constitute surface rather than basic causes. Socio-economic inequality, it is contended, remains the basic cause, and, as such, the proper target for intervention. Psychological interventions are unlikely to yield much in the way of dividends in this context and indeed could inadvertently contribute to victim blaming.     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

Quality-of-life after penile prosthesis placed at radical prostatectomy

Abstract

The clinical and psychosocial effects of immediate penile prosthesis implantation at the time of radical prostatectomy (RP) were investigated in 97 consecutive patients and 68 partners. Prosthesis recipients reported more frequent sexual contact, fewer marital problems and slightly fewer sexual functioning problems than the RP-alone patients. There were no group differences on any sociodemographic characteristics, on disease recurrence, on physical and psychosocial functioning, or on reported depression. Patients who chose the prosthesis did, however, evidence less of a link between depression and functional limitations and between depression and marital problems. They also had lower levels of agreement with their partners in reporting their own depression, as compared to the patients who opted for RP surgery alone. We conclude that the penile prosthesis was associated with an increased frequency of sexual contact, a reduction in reported marital problems, and stylistic differences between the two patient groups in dealing with affect.     

New evidence on the reliability and validity of the pediatric oncology quality of life scale

Abstract

The present paper replicates and extends previous studies on the psychometric properties of the Pediatric Oncology Quality of Life Scale (POQOLS). The research questions were focused on (a) internal consistency; (b) relation with demographics; and (c) ability to discriminate between patient groups. Data were gathered in a Dutch-speaking Belgian sample of 73 pediatric oncology patients, drawn from the population of a university hospital. The parents completed the POQOLS, a 21-item parent-report inventory for the assessment of physical restriction, emotional distress and discomfort from medical treatment in pediatric oncology patients. The results support the psychometric quality of the POQOLS. Three of the core aspects of quality of life are tapped using sufficiently short and internally consistent subscales. The instrument is free from relations with demographics and shows good discriminant ability to differentiate between patient groups according to time since diagnosis, treatment status and diagnosis.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Finding benefit in breast cancer: Relations with personality,coping, and concurrent well-being

Cancer patients experience positive as well as adverse consequences from cancer diagnosis and treatment. The work reported here was part of an effort to characterize the experiences of benefit finding in breast cancer patients. A sample of 230 early-stage breast cancer patients completed a set of benefit finding items in the year post-surgery. This measure was then related to measures of concurrent coping, several aspects of psychosocial well-being, demographic variables, and several other personality traits. Benefit finding related positively to trait optimism, and to positive reframing and religious activity as coping reactions. Benefit finding related inversely to emotional distress, but was relatively unrelated to other measures of well-being.     

Cognitive Functioning,Behavior, and Quality of Life After Stroke in Childhood

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion).

Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN).

Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10–21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79–129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p?=?.000; Digit Span p?=?.000, Arithmetic's p?=?.007, Divided Attention p?=?.028, Alertness p?=?.002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p?=?.000; impulsivity/hyperactivity p?=?.006; psychosomatics p?=?.006). Certain aspects of quality of life were reduced (autonomy p?=?.003; parents' relation p?=?.003; social acceptance p?=?.037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p?=?.000, hand alternation p?=?.001, foot tapping p?=?.043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5–10 years) led to better cognitive outcome than lesion in the very early (0–5 years) or late childhood (10–18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis.

Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.