Planning a Stigmatized Nonvisible Illness Disclosure: Applying the Disclosure Decision-Making Model

This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.     

Counsellors' focus on competitive employment for people with severe mental illness: an application of the theory of planned behaviour in vocational rehabilitation programmes

Although the evidence-based Individual Placement and Support programme highlights the importance of the vocational rehabilitation (VR) counsellors' focus on competitive employment during career counselling, studies have shown that counsellors do not always target such jobs. This study examines which determinants affect the counsellors' intentions using an extended version of the Theory of Planned Behaviour. Cross-sectional data of 263 VR counsellors of three public employment services were analysed using structural equation modelling. A path model comprising attitudes, prior behaviour, and subjective and moral norms explained 69% of the variance in intentions. The findings indicate that counsellors focus more on competitive employment when they (1) view the placement in a competitive job as positive, (2) experience support and (3) have prior relevant experiences.     

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.     

Managing multiple chronic conditions in Singapore – Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis

Objective: Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore.

Design: This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients.

Methods: Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis.

Results: Key caregiving challenges identified were managing diet, care recipients’ emotions and mobility dependence. Patients’ emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients’ erratic appetite, caregivers’ lack/poor understanding of the dietary guidelines and caregivers’ low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role.

Conclusion: This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers’ health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.     

What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model

Objective: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.

Design: Longitudinal observational study in adults with type 2 diabetes.

Main outcome measures: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.

Results: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.

Conclusions: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.     

Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal’s self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Moving from “I” to “We”: A Grounded Theory Analysis of Couple Therapy with Liver Patients and Their Partners

Prior research indicates that couples who cope with chronic illness from a relational “we” orientation experience more positive outcomes than couples that cope individually; however, little prior research identifies clinical processes that promote reciprocity or how societal gender processes are involved. This grounded theory analysis of 25 videotaped therapy sessions with six heterosexual couples coping with chronic liver disease (LD) used a feminist-informed relational lens to focus on the clinical processes involved in shifting from an individual to a relational orientation. Findings identified three contextual barriers to attaining a “we orientation”: (a) autonomy discourse, (b) illness-related power, and (c) gendered power. Analysis detailed therapist actions that decreased the impact of barriers to reciprocity and fostered relational coping. Clinical implications attend to complex intersections among gender, caregiving, and contextual barriers to reciprocity.