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Biomedical subjects

K Arpin

Publications and source records attributed to K Arpin.

5 recordsLinked to original sources
PubMed1990

Prevalence and correlates of family dysfunction and poor adjustment to chronic illness in specialty clinics.

This study estimated the prevalence of poor adjustment and family dysfunction among three chronically ill clinic patient populations and assessed the biological, situational, social and psychological variables which most explained poor adjustment. Recently referred subjects were approached and 216 chronically ill subjects (from oncology, rheumatology and gastroenterology clinics) completed a Meaning of Illness Questionnaire, the McMaster Family Assessment Device, and the Psychosocial Adjustment to Illness Self-report Scale. In addition, information describing their biological, disease and socioeconomic status was obtained from the clinic record. Respondents were generally representative of other new referrals to the clinics (ineligible for the subsequent trial) in disease characteristics but uniformly came from a more advantaged socioeconomic situation and were better adjusted to illness. Subjects from the three clinics were comparable on meaning, family function and adjustment variables. The proportion of subjects with family dysfunction was 30% and with poor adjustment to illness was 36%, high by community standards. Nevertheless, healthy family functioning and high levels of positive adjustment to chronic illness prevailed and were remarkably similar across clinic settings. Severity or type of disease was not related to adjustment outcomes nor to the level of observed disability. Rather, as hypothesized, meaning given the illness, followed by family function, and disability variables combined to explain 57% of the variance in adjustment outcomes. An intervention designed to improve family function and the meaning given illness was judged suitable.

Adaptation, Psychological↗
PubMed1990

Individual correlates of health service utilization and the cost of poor adjustment to chronic illness.

It was conjectured that a small group of chronically ill in tertiary ambulatory clinics consume a large amount of health resources and that, from the perspective of the patient, psychosocial rather than disease variables would most explain their health service utilization and subsequent cost. New referrals with a chronic illness (N = 215) to one of three clinics (oncology, rheumatology, and gastroenterology) consented to participate in a subsequent trial of a psychosocial intervention designed to promote their adjustment to illness and, conceivably, to reduce their health service utilization. At baseline an inventory to describe the disease, treatment, functional capacity, prognosis, and socioeconomic situation of consenting subjects was completed. In addition, subjects completed the Psychosocial Adjustment to Illness Inventory (PAIS-SR), the Family Assessment Device (FAD), the Meaning of Illness Questionnaire (MIQ), and a Health Service Utilization Inventory designed to assess direct and indirect costs of health resources. These data were entered into a concurrent analytic survey design. Participating subjects represented a more socioeconomically advantaged and better-adjusted group of chronically ill patients compared with others referred to the tertiary clinics. They were representative of all new referrals in their use of the majority of health services. However, once hospitalized, participating subjects stayed longer and used specialists less. There was no important relationship between disease severity or prognosis and any type of service utilization, including hospitalization. Because the strongest correlate of all types of health services consumed was psychosocial adjustment to illness (r = 0.28 to 0.33), patients were partitioned into one of three categories of adjustment to illness: good, fair, and poor. The total annual cost per patient was $23,883, if poorly adjusted, compared with $9,791 if well adjusted. If cash transfers (benefits paid by different types of insurance) are added, the average 1987 annual cost per poorly adjusted subject was $31,291 per patient, compared with $13,771 for a patient well adjusted to the illness. There was a statistically significant and economically important linear gradient in 1987 treatment costs per category of adjustment. The possible economic implications for psychosocial intervention are highlighted.

Adaptation, Psychological↗
PubMedDate not supplied

The meaning of illness questionnaire: reliability and validity.

The reliability and validity of a recently developed Meaning of Illness Questionnaire (MIQ) is described. Questionnaire content was based on the work of Lazarus and Folkman (1984b). Three hundred twenty chronically ill subjects completed the 33-item MIQ and two open-ended questions. Subjects also completed the 45-item Psychosocial Adjustment to Illness--Self-Report Scale (PAIS-SR) described by Derogatis and Lopez (1983). Test-retest reliability for 70 subjects was, on the whole, substantial (kappa = .45 to 1.00) as was the ability of nurse clinicians to reliably categorize the qualitative component of the questionnaire into one of 12 categories (kappa = .64). The factor structure of the questionnaire supported the theoretical assumptions underlying the instrument. Three of the factors of meaning given the illness, R2 = .46, and/or three items, R2 = .60, had more power than coping behavior in explaining a person's adjustment to chronic illness. The questionnaire has accumulated reliability and validity in measuring a variety of concurrent yet divergent meanings that may be given an illness for three chronically ill populations--those with mixed cancer, rheumatological, and gastroenterological disorders.

Adaptation, Psychological↗