Psychological impact of illness intrusiveness in epilepsy - comparison of treatments

Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these is the concept of illness intrusiveness, the disruption of lifestyles and activities attributable to constraints imposed by chronic disease and its treatment. This study tested the illness intrusiveness theoretical framework in epilepsy and compared the impact of pharmacological and surgical treatments on illness intrusiveness and QOL. Cross-sectional data compared three epilepsy groups (N = 145): (a) 40 patients admitted for presurgical evaluation to an Epilepsy Monitoring Unit; (b) 52 patients treated pharmacologically; and (c) 53 post-surgical patients. Illness intrusiveness differed significantly across epilepsy patients with the differences primarily related to seizure control. Illness intrusiveness varied inversely with seizure control (p < .05). Seizure freedom, whether achieved by surgical or pharmacological treatments, was associated with maximal reduction of illness intrusiveness. Increased illness intrusiveness correlated significantly with decreased QOL and increased depressive symptoms. Perceived control over diverse life domains correlated positively with QOL and psychosocial outcomes. Path analysis supported the validity of the illness intrusiveness theoretical framework in epilepsy. Illness intrusiveness is an important determinant of the psychosocial impact of epilepsy and its treatment. Effective pharmacological or surgical treatment may reduce illness intrusiveness in epilepsy. Findings also offer encouragement that QOL in epilepsy, as in other chronic conditions, may be enhanced by multidisciplinary bio-psychosocial efforts. Health care providers should consider multifaceted interventions to reduce illness intrusiveness and, thereby, improve QOL.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Do stigma and its psychosocial impact differ between Asian-born Chinese immigrants and Western-born Caucasians with head and neck cancer?

Stigma appears to influence emotional distress and well-being in cancer survivors, but cross-cultural differences have been ignored. Previous studies suggest that stigma may be especially relevant for survivors of Asian origin. However, their study designs (e.g. focused on female cancers, qualitative designs, and an absence of comparison groups) limit the strength of this conclusion. We hypothesized that (1) Asian-born Chinese immigrants (AI) would report more perceived cancer-related stigma than Western-born Caucasians (WBC); and (2) the impact of stigma on emotional distress and well-being would be greater in AI as compared to WBC. Head and neck cancer survivors (n = 118 AI and n = 404 WBC) completed measures of well-being, emotional distress, and a three-item indicator of stigma in structured interviews. The majority of respondents (59%) reported one or more indicators of stigma. Stigma correlated significantly with emotional distress (r = .13, p = .004) and well-being (r = ?.09, p = .032). Contrary to our hypotheses, WBCs and AIs did not differ in reported stigma nor did we detect differences in its psychosocial impact. Stigma exerts a deleterious psychosocial impact on head and neck cancer survivors. It did not differ significantly between AI and WBC survivors.     

What is the value of mentoring in a small business? Using narrative evaluation to find out

The paper examines the case of one small business manager (Alistair) and the value he gave to a mentoring intervention demonstrated by the use of narrative evaluation. Doubts about the efficacy of orthodox approaches to evaluation when applied to management development activities lead to the view that narratives are more appropriate. Narrative evaluation techniques are applied to a story told by Alistair, the Managing Director of a small business in Sheffield, concerning his view of his involvement in a mentoring programme. Alistair's initial reservations about the value of the programme are revealed rhetorically through a range of arguments. After such doubts, through a process of conversation, the story reveals how Alistair is able to find value from mentoring.     

Do allogeneic bone marrow transplant candidates match coping to controllability of pre-treatment stressors?

According to the Person x Situation theoretical framework, people adjust their coping to address the unique challenges of encountered stressors. Whether their strategies fit or appropriately address these stressor challenges influences adjustment. We examined the fit between pre-treatment stressors reported by hematological cancer patients awaiting allogeneic bone marrow transplantation (alloBMT) and their coping responses. Stressors were categorized as controllable versus uncontrollable; coping responses were categorized as problem- versus emotion-focused versus mixed (i.e., elements of both coping types). We hypothesized that patients would employ coping responses that fit the controllability of stressors (i.e., a match between stressor and coping response): problem-focused coping for controllable stressors and emotion-focused coping for uncontrollable stressors. In qualitative interviews, pre-BMT patients (10 men, 7 women) described encountered stressors and how they coped with them. Every reported stressor was linked with its associated coping response, resulting in a stressor-coping pair. We determined the proportion of total stressor-coping pairs in which the coping response matched the controllability of its linked stressor. Most stressor-coping pairs involving uncontrollable stressors showed the hypothesized match with emotion-focused or mixed coping. Contrary to hypotheses, fewer stressor-coping pairs that involved controllable stressors matched with problem-focused or mixed coping. Rather, these pairs were more likely to link controllable stressors with emotion-focused coping (i.e., mismatch between stressor controllability and type of coping). AlloBMT candidates may appraise the pre-treatment stage, globally, as permitting very little control. Coping efforts may consequently emphasize regulation of negative emotions (i.e., emotion-focused coping).     

Factors related to marriage and career plans in unmarried women

Career and marriage plans of female unmarried undergraduates were examined and systematically related to other variables. All respondents indicated their plans for a career, marriage, and children. In addition, they completed the Personality Research Form, a standardized personality measure that assesses traits relevant to functioning in a variety of situations. Results showed that while the majority of respondents planned on having a career and family, their priority was the family. Career commitment, as measured by perceived importance of career, was a significant predictor of the woman's educational, career, and family plans. The more respondents aspired to the full-time career model, the less traditionally feminine were their personalities.Grateful acknowledgment is made to the Canada Council for its financial support through grant #410-77-0241.Formerly a psychology student and is presently studying law.     

Illness intrusiveness and quality of life in end-stage renal disease: comparison and stability across treatment modalities

Investigated the degree to which chronic, life-threatening illness and its treatment interfere with continued involvements in valued activities and interests--that is, illness intrusiveness--and its impact on quality of life in end-stage renal disease. Data were collected on two occasions separated by a lag of 6 weeks. Mixed analyses of variance indicated that life domains were affected differentially across treatments. Perceived illness intrusiveness correlated significantly with treatment time requirements, uremic symptoms, intercurrent nonrenal illnesses, fatigue, and difficulties in daily activities. Significant quality-of-life differences were observed across treatment modalities for satisfaction/happiness and pessimism/illness-related concerns but not for depression/distress. Perceived illness intrusiveness correlated significantly with each of these quality-of-life measures. Results were stable over time. These findings substantiate the construct of illness intrusiveness as a mediator of the psychosocial impact of chronic, life-threatening illness.