Living with the unexplained: coping,distress, and depression among women with chronic fatigue syndrome and/or fibromyalgia compared to an autoimmune disorder

Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress. It was hypothesized in the current study that levels of unsupportive social interactions and the coping styles used among those with CFS/fibromyalgia would be associated with perceived distress and depressive symptoms. Women with CFS/fibromyalgia (n = 39), in fact, reported higher depression scores, greater perceived distress and more frequent unsupportive relationships than healthy women (n = 55), whereas those with a chronic, but medically accepted illness comprising an autoimmune disorder (lupus erythematosus, multiple sclerosis, rheumatoid arthritis; n = 28), displayed intermediate scores. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia.     

More than just child’s play: symbolic expressions of illness and spirit

While spiritual well-being is integral to health, little is known about the spiritual lives of children in the context of illness. Because the spiritual is often a hidden domain of life, exploration of the topic can be challenging, especially when dealing with children. Language is not always sufficient for describing such deeply held experiences, even for adults. Therefore, finding creative ways to elicit experiences of the spiritual is important when attempting to gain a more robust understanding of this phenomenon. Drawing from a larger study that used hermeneutic phenomenology to explore spirituality among ill children, this paper provides an interpretation of ill children’s play experiences and describes how these experiences provide a means of uncovering the spiritual in children’s everyday lives as they cope with life-threatening illness. Findings also provide insight into how play can be used in the promotion of spiritual well-being.     

Not “just words”: Exposure to homophobic epithets leads to dehumanizing and physical distancing from gay men

We examined whether homophobic epithets (e.g., faggot) function as labels of deviance for homosexuals that contribute to their dehumanization and physical distance. Across two studies, participants were supraliminally (Study 1) and subliminally (Study 2) exposed to a homophobic epithet, a category label, or a generic insult. Participants were then asked to associate human‐related and animal‐related words to homosexuals and heterosexuals. Results showed that after exposure to a homophobic epithet, compared with a category label or a generic insult, participants associated less human‐related words with homosexuals, indicating dehumanization. In Study 2, we also assessed the effect of a homophobic epithet on physical distance from a target group member and found that homophobic epithets led to greater physical distancing of a gay man. These findings indicate that homophobic epithets foster dehumanization and avoidance of gay people, in ways that other insults or labels do not.     

Impulse control disorders in Parkinson’s disease: Predominant role of psychological determinants

Objectives: Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission.

Design: The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants.

Main outcome measures: One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS).

Results: Increased use of a ‘negative’ coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone.

Conclusions: This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.     

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.     

How does self stigma differ across people with psychiatric diagnoses and rheumatoid arthritis,and how does it impact on self-esteem and empowerment?

Self stigmatising attitudes have been found in people who have psychiatric diagnoses, however, research assessing self stigma in physical illnesses is rare. It is known that receiving a diagnosis of rheumatoid arthritis (RA) can affect a person’s identity and self esteem. This study aimed to compare levels of self stigma, self esteem and empowerment between people diagnosed with psychiatric illnesses and people diagnosed with RA to establish whether self stigma, and specifically endorsement of negative stereotypes, is associated with self esteem and empowerment across these two groups. A total of 202 participants (psychiatric group n = 102; RA group n = 100) were interviewed using the Internalised Stigma of Mental Illness scale (ISMI), or the Internalized Stigma of Mental Illness scale- Rheumatoid Arthritis (ISMI-RA), the Index of Self Esteem (ISE) and the Mental Health Confidence Scale (MHCS). Overall, the psychiatric group had higher self stigma scores (2.5 vs. 2.2, p < .01), lower self esteem (48.7 vs. 36.8, p < .001) and lower empowerment scores (3.8 vs. 4.3, p < .001) than the RA group. However, sizable proportions of both groups had high self stigma scores. ISMI/ISMI-RA was associated with the ISE and the MHCS. The stereotype endorsement subscale of the ISMI/ISMI-RA was not related to self esteem or empowerment in either group. Interventions that aim to decrease self stigma and increase self esteem could focus on alienation.     

The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults

Mental illness (MI) affects one in four people in their lifetime and a failure to seek help for MI can have grave consequences. To decrease stigma and increase help seeking, prior campaigns have promoted the biological origins of MI. Even though some research supports the efficacy of this approach, other research does not. We propose cultural differences as a partial explanation for these inconsistent results. The current study assessed ethnic differences in the relationship between perceived causes of MI, shame associated with MI and perceived family support for help seeking. White and South Asian American (SAA) undergraduate students completed an online survey (n = 177). Results indicated that SAAs were significantly more likely than whites to perceive character deficits as the cause of MI. Further, among those who had sought help for MI, ethnic differences emerged in perceptions of MI based on perceived cause. SAAs who believed that MI had biological origins perceived more shame and less family support for seeking help compared to SAAs who believed MI was due to character deficits. The converse was true for whites – those who believed that MI had biological origins perceived less shame and more family support for help seeking compared to whites who believed MI was due to character deficits. The results of the current study illuminate the role that culture plays in perceptions of MI. Further, these results have implications for interventions targeting South Asian populations and for mental health outreach in general.     

Early trauma and serious mental illness: what role does spirituality play?

For many who experience serious mental illness, spirituality and religion can be common vehicles that provide a sense of coherence and meaning to life. However, in the presence of early trauma, spiritual and religious beliefs may be enhanced or destroyed, or never develop. This paper explores the relationship between spirituality/religion, early trauma, and serious mental illness. Three case examples from a qualitative phenomenological study are presented to illustrate spiritual and religious struggles that can arise and how a person can work through these over time to use spirituality and religion as positive resources for recovery. Tentative implications for practice are offered.     

“It’s only ‘madness’ that I know”: analysis of how mental illness is conceptualised by congregants of selected Charismatic churches in Ghana

In Ghana, many individuals employ traditional and faith healing for treating illnesses. Although attitudes and knowledge of laypeople on mental illness have been explored, little is known about Christians’ knowledge and how the church influences such knowledge. The present study explored knowledge on definition, types and symptoms of mental illness, church teachings on mental illness and the influence of such teachings on the mental well-being of 86 congregants of six Charismatic churches in Ghana. Through in-depth interviews, focus group discussions and observations, we found that knowledge surrounded psychotic disorders with a few citing other DSM/ICD categories. Regarding church teachings, some churches provided education and spiritual healing, and others emphasised non-existence of, and immunity from, mental illness. Findings showed the “double-edged” role of religion in enhancing and hindering congregants’ mental well-being. The paper concludes with an argument for psycho-education on mental illness and collaboration between churches and mental health practitioners.     

A Comparison of Posttraumatic Growth After Acquired Brain Injury or Myocardial Infarction

Posttraumatic growth (PTG) is known to occur following acquired brain injury (ABI). It is not yet known to what extent PTG experiences following ABI are unique to the neurological nature of the injury. We investigated PTG in survivors of ABI or myocardial infarction (MI); MI is comparable to ABI but does not have a primary neurological element. Thirty-three ABI survivors (age M = 51.6, SD = 12.4; 52% male; years since injury M = 5.5, SD = 5.3) and 47 MI survivors (age M = 66.4, SD = 9.9; 79% male, years since injury M = 9.9, SD = 8.6) completed a survey including the Posttraumatic Growth Inventory (PTGI). Unadjusted analyses showed no significant group differences on PTGI total score (ABI M = 54.0, SD = 19.6; MI M = 54.6, SD = 23.6; d = .03, p = .902) or on any of the five subscales, but analyses adjusted for covariates showed that scores on “Relating to others” were higher in participants with ABI (unstandardized coefficient = 5.43; 95% CI .27, 10.60; p = .039). Open-ended comments revealed aspects of growth in both samples that were not directly captured by the five PTGI factors.