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PubMedDate not supplied

Emotional, cognitive, and behavioral characteristics of medical outpatients: a preliminary analysis.

The authors examined the relationship among emotional, cognitive, and behavioral factors in 65 new outpatients attending neurology and cardiology clinics. The patients completed the Hospital Anxiety and Depression Scale, the Illness Perception Questionnaire, the Somatosensory Amplification Scale, the Private Body Consciousness Scale, and the Health Anxiety Questionnaire. A principal component factor analysis revealed two factors, somatosensory amplification/anxiety and depression/pessimism, that together accounted for 44% of the variance. The factors the authors identified may be useful as a basis for understanding different patterns of illness behavior. The use of these factors may help to rationalize and refine the large number of existing measures and simplify the assessment process, as well as contributing to the development of treatment interventions.

Adolescent↗

PubMed2004

Psychological health in early pregnancy: relationship with nausea and vomiting.

The psychological health of women in early pregnancy was investigated in a sample of 273 women (mean gestational age 12.8 weeks, SD=2.8) using the General Health Questionnaire (GHQ) and mood and illness perception visual analogue scales, and compared with the prevalence and severity of nausea and vomiting as measured using the Nausea and Vomiting in Pregnancy Instrument (NVPI). Using a cut-off of 4/5 for the GHQ, 50.5% of pregnant women were found to have potential psychiatric problems. However, perceived mental health and physical illness was significantly better than anticipated. The severity of nausea and vomiting correlated independently with GHQ subscales for somatic symptoms, social dysfunction, anxiety/insomnia and severe depression. The contradiction between high GHQ scored and high perceived wellbeing might be explained through cognitive processing. Nausea and vomiting in early pregnancy is associated with psychiatric morbidity. The causal relationship between the two conditions has not been established.

Adolescent↗

PubMed2004

Using the IPQ and PMDI to predict regular diabetes care-seeking among patients with Type 1 diabetes.

OBJECTIVES: The objectives were, first, to identify factors associated with regular diabetes care-seeking and, second, to compare the performance of the Illness Perception Questionnaire (IPQ) and a modified version of the Personal Models of Diabetes Interview (PMDI) in predicting care-seeking. METHOD: This was a cross-sectional study involving 42 patients who had not attended hospital diabetes clinic for a period of 18 months or more and 42 matched controls receiving specialist care. Differences in illness representations between clinic attenders and non-attenders were examined. Due to the variability in care-seeking between non-attenders (ranging from no contact with health professionals to regular general practitioners care), participants were then reclassified for further analyses into those receiving regular care from either hospital diabetes clinic or general practice (n = 52) and those receiving no regular care (n = 32). RESULTS: Patients not seeking regular care held more negative views of the control, course and consequences of diabetes than those who received regular care. Regression analyses showed that the most important construct was treatment effectiveness. Treatment effectiveness (PMDI) and control (IPQ) dimensions were associated with clinic attendance. PMDI constructs of treatment effectiveness, threat and worries were associated with regular care-seeking. CONCLUSIONS: IPQ and PMDI results were generally consistent. In order to understand diabetes care-seeking behaviour it is important to measure beliefs about the benefits of treatment recommendations in addition to those of the disease itself. Emotional and cognitive responses to diabetes should be assessed.

Adult↗

PubMed2004

Predictors of outcome in fatigued employees on sick leave: results from a randomised trial.

OBJECTIVE: The main objective of this study was to identify predictors of fatigue caseness, work resumption and chronic fatigue syndrome (CFS)-like caseness in a sample of fatigued employees on sick leave. METHODS: For 12 months, 151 fatigued employees on sick leave, 44% of whom met research criteria for CFS at baseline, were followed. Measures included fatigue, health aspects, psychological problems, burnout, causal attributions and self-efficacy. Logistic regression analysis was used to determine associations between predictor variables at baseline and outcome at follow-up. RESULTS: After 12 months, 43% of the patients were no longer fatigue cases, and 62% had resumed work. Recovery from fatigue caseness was predicted by stronger psychological attributions and other perception-related factors, whereas work resumption was predicted by lower age, male sex, CFS-like caseness and less cognitive difficulties. Lower physical functioning scores were predictive of (the development of) CFS-like caseness. CONCLUSION: Recovering from persistent fatigue and work resumption seem to result from different underlying processes and do not necessarily fall together. As many factors associated with outcome in fatigue reflect illness perception, the prevention of persistent fatigue and CFS may partly be achieved by the modification of perception.

Adult↗

PubMed2002

Users' understanding of medical knowledge in general practice.

Much emphasis is now being placed on the quality of medical care, and various ways are being developed to assess the medical knowledge of general practitioners. It is increasingly recognised that the users perspective on health care is important, and that the views of health care professionals do not and cannot represent patients' views. In order to explore whether or not a large-scale survey, which asked people to rate their doctors' medical knowledge, yielded meaningful results, this paper draws on findings from a study involving in-depth interviews with 26 lay people who had already completed the General Practice Assessment Survey questionnaire. When completing the questionnaires, patients had been asked to consider the 'technical care' provided by their general practitioners and to make a judgement about their doctors' medical knowledge. When interviewed at a later date, some people explained that they defined medical knowledge as knowledge of 'disease and treatments', while others defined it as knowledge of the 'whole person', and some defined a knowledgeable doctor as one who would acknowledge uncertainty. Patients appeared to have made judgements about their general practitioners' medical knowledge based on many factors, such as their experience of illness, perceptions of professional training, contact with other health care professionals in both primary and secondary care, and exposure to the media. The paper discusses the nature of medical knowledge, and concludes that although patient surveys are useful for the evaluation of interpersonal care and access to care, asking patients about their general practitioners' medical knowledge may yield invalid results. This is partly because patients defined medical knowledge in different ways, and partly because it appears that relatively few patients had enough knowledge about their own particular illnesses, or about possible alternative treatments, to make informed judgements about their general practitioners' medical knowledge.

Clinical Competence↗

PubMed2003

Predictors of outcome in a fatigued population in primary care following a randomized controlled trial.

BACKGROUND: The objective of this study was to examine factors that predicted outcome in a chronically fatigued group of patients who were randomized to cognitive behaviour therapy or counselling in primary care. METHOD: Illness perceptions, attributions, fatigue, disability and demographic variables were recorded at assessment and levels of fatigue and disability were measured at 6 months post randomization. Logistic regression was used to examine associations. RESULTS: Factors that predicted a poor outcome (four or more on the fatigue questionnaire) were: poor social adjustment at assessment; the patients self-report that they had never seen the GP for an emotional reason; a physical illness attribution; and, a long perceived future illness duration. CONCLUSIONS: Patients who are more psychologically minded are more likely to improve with psychological treatments in primary care. General practitioners need to assess this before referring to an appropriate therapist.

Adolescent↗

PubMedDate not supplied

Differences between African Americans and whites in their perceptions of Alzheimer disease.

To design optimal health services and education programs for Alzheimer disease (AD), it is important to understand cultural differences in perceptions of the disorder. In this study, we investigated differences between African Americans and whites in their beliefs, knowledge, and information sources regarding AD. We distributed a written questionnaire through lay and professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white, 39% African American; 78% female; mean age 47 years; 33% with family history of AD). The questionnaire assessed the following: (1) illness beliefs, (2) factual knowledge, (3) sources of information, and (4) perceived subjective threat of AD. African Americans and whites were generally similar in their beliefs about common symptoms, prominent risk factors, and the effectiveness of treatments for AD (although whites expressed greater certainty in these beliefs than African Americans). In comparison to whites, African Americans showed less awareness of facts about AD, reported fewer sources of information, and indicated less perceived threat of the disorder. These preliminary findings suggest important distinctions between African Americans and whites in their knowledge about, and conceptualization of, AD. Follow-up studies with more representative samples and more fully validated measures will be necessary to confirm these differences. Health psychologic research suggests that such differences in illness perceptions could shape response to disease burden, assessment and diagnosis, and available health care options.

Adult↗

PubMed2004

The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus.

OBJECTIVE: This study examined the interrelationships of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in adults with Type 2 diabetes. METHODS: One hundred eighty-four consecutive patients with Type 2 diabetes mellitus completed the Illness Perception Questionnaire (IPQ), the Well-Being Scale (WBQ) and the Short Form 36 Health Survey Questionnaire (SF-36). Demographic characteristics, details of diabetes status (duration of diabetes, treatments and complications) and glycosylated haemoglobin (HbA1c) were recorded. RESULTS: Depression was correlated with greater perceived symptom load (r = .48, P < .01), worse anticipated consequences (r = -.41, P < .01) and perceived lack of control of diabetes (r = .28, P < .01). After controlling for demographic and illness characteristics, personal illness representations relating to symptom load and anticipated consequences were independently associated with the SF-36 physical functioning score, contributing an additional 15% to the variance. WBQ depression and anxiety scores, along with IPQ control and consequences, were independently associated with SF-36 mental function score, contributing a further 51% to the variance after controlling for demographic and illness details. Neither IPQ nor WBQ scales were associated with HbA1c after controlling for demographic and medical illness details. CONCLUSION: Anxiety, depression and negative beliefs about illness influence physical and mental functioning, but not metabolic control in patients with diabetes.

Aged↗

PubMed2001

A family history of breast cancer: women's experiences from a theoretical perspective.

Individuals at increased risk of developing breast cancer due to their family history of the disease face a number of uncertainties. Personal cancer risk estimates are imprecise and current methods for early detection or prevention are not 100% effective. It is therefore not surprising that adverse psychosocial outcomes have been described within this population. Research attempting to predict the incidence of distress and dysfunction in individuals at increased risk of cancer has been largely a-theoretical and has overlooked a number of potentially important predictive variables. In particular, the influence of personal experience of cancer through involvement with affected relatives has been neglected. There are strong theoretical grounds for hypothesising that dimensions of personal experience may influence response to cancer risk. This paper discusses the potential impact of personal experience on risk perception, illness representations and decision-making. Systematic research in this area may improve predictions of outcome of cancer genetic counselling and inform the clinical process.

Breast Neoplasms↗

PubMed1987

Psychological predictors for return to work after a myocardial infarction.

The relationships between a return to work (RTW) 6 months after a myocardial infarction and selected personality traits, emotional reactions, health knowledge and beliefs, expectations and global health perceptions have been examined in a prospective study of 249 patients below 67 yr of age. Patients' in-hospital expectations of their future work capacity proved to be a strong predictor for RTW. In addition, level of anxiety and depression during hospitalization and level of cardiac lifestyle knowledge were independently associated with RTW. These effects could not be explained by demographic, work-related, or medical factors. It is concluded that patients' early illness perceptions and affective reactions influence later work resumption. Outcome-specific expectancy measures may be the most effective methods for early identification of patients needing rehabilitation efforts after an acute somatic disease.

Adaptation, Psychological↗

PubMed2002

Illness representation, coping and outcome in irritable bowel syndrome (IBS).

OBJECTIVE: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. In an attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies. METHOD: All members of the IBS Network (an independent charitable support network based in the UK) were invited to participate via their quarterly newsletter, and 209 completed questionnaires were returned. Participants completed the Illness Perception Questionnaire (IPQ), the COPE, and the Hospital Anxiety and Depression Scale (HADS), and rated their quality of life and their satisfaction with their health. RESULTS: The reporting of serious consequences was associated with lower quality of life and lower satisfaction with health, and with higher scores for anxiety and depression (p <.001). Weaker control beliefs were related to lower quality of life, lower satisfaction with health, and higher depression scores (p <.01). Lower illness scores were associated with more satisfaction with health (p <.01), but not with quality of life (p >.05). Psychological causal attribution of IBS was positively correlated with anxiety (p <.001) and depression (p <.01). Path analyses based on multiple linear regression demonstrated that (1) the reporting of serious consequences was a strong independent predictor of outcome; (2) coping mediated the link between representation and outcome; and (3) when predicting depression, coping strategies predicted coping independently of representation dimensions. CONCLUSIONS: The findings indicate that the illness representations of IBS sufferers can have significant implications for outcome. Therapeutic interventions based on illness representations may prove useful for treatment.

Journal Article↗

PubMed1998

Patient satisfaction with clinical trial participation.

OBJECTIVE: To assess satisfaction of patients who participate in clinical trials requiring informed consent and to analyse factors determining patient satisfaction. SETTING: The survey took place in 26 clinical trials at the University Hospital Maastricht (azM), The Netherlands. DESIGN AND STUDY PARTICIPANTS: A personal interview and telephone questionnaire were used consecutively (n= 135; 135 out of 172=78.5% response rate) to measure patient's expectancies before starting the trial during the informed consent procedure and to evaluate aspects of trial participation. An additional control group of 34 patients was interviewed only by telephone (100% response). MEASURES: Satisfaction was assessed in two distinct ways: first, by measuring the patient's subjective evaluation of several aspects of trial participation; secondly, by comparing prior expectations and subsequent evaluations. Patient satisfaction was subdivided with respect to medical-technical, interpersonal and organizational aspects of trial participation. Changes in patient's health and illness perceptions were regarded as confounding factors in the relationship between satisfaction and its possible causes. RESULTS: Although patient satisfaction was quite high, dissatisfaction with aspects of trial participation became apparent when both prior expectations and subsequent evaluations were compared with each other. CONCLUSION: Prior expectations and general attitudes towards medical care and research before entering the trial have an impact on satisfaction with aspects of trial participation (10-20% explained variance). No linear relationship was found between perceived improvements in health and illness conditions and patient satisfaction with trial participation.

Adult↗

PubMed1996

Mechanisms related to psychological well-being in older women with chronic illnesses: age and disease comparisons.

The influence of type of illness (breast cancer versus osteoarthritis) and age on physical health and functioning, self-system interpretive mechanisms, and women's psychological well-being were examined. Self-system interpretive mechanisms are considered mediators of the effects of physical health on psychological well-being and include social comparisons, social integration, and illness perceptions. Young-old (aged 60-74) and old-old (75 +) women, diagnosed with osteoarthritis (N = 102) or breast cancer (N = 86), who volunteered for the study were interviewed using structured self-report scales. Young-old and old-old women did not differ in terms of health status, interpretive mechanisms, or on three of five indices of psychological well-being. On the other hand, women with arthritis, regardless of age, reported more functional health problems, more symptoms, and perceived their illness as more severe, more chronic, and less controllable than women with breast cancer. Although women with arthritis and breast cancer differed significantly in terms of physical health, they did not differ on multiple measures of psychological well-being. For both groups, women who made more positive social comparisons and who had more extensive social networks had higher levels of psychological well-being, regardless of physical health problems.

Aged↗

PubMed2005

Illness representations, coping styles and mood in adults with epilepsy.

It has been generally accepted that psychosocial well-being in people with epilepsy may show an association with the type of coping strategies they adopt. However, relatively little attention has been paid to the way people with epilepsy perceive their illness (illness representations) in determining their well-being and whether these representations are related to coping strategies in determining psychological outcome. We administered the Illness Perception Questionnaire and the Ways of Coping scale and examined their relationship with anxiety and depression scores in 43 adults with chronic epilepsy. Within multiple regression analyses, whilst epilepsy variables were not significantly related to mood, after also adjusting for patients' gender, anxiety scores were best predicted by an increased relative use of escape-avoidance and a decreased relative use of distancing as coping strategies; increased depression scores were best predicted by greater relative use of escape-avoidant and self-controlling coping. Once coping factors had been accounted for, Illness Identity scores independently predicted anxiety scores, indicating that coping was not acting simply to mediate the impact of illness representations on patients' mood. However, illness representations did not independently predict depression, suggesting that in the case of negative affect, coping was acting as a mediating factor. Findings indicate the importance of aspects of epilepsy patients' cognitive representations of their illness, as well as of their coping styles in determining psychological well-being.

Adaptation, Psychological↗

PubMedDate not supplied

Changes in patients' illness representations before and after elective percutaneous transluminal coronary angioplasty.

BACKGROUND: Elective percutaneous transluminal coronary angioplasty (PTCA) is an increasingly popular treatment for coronary heart disease, but little is known about individuals' cognitive responses to this intervention. As part of adapting to living with chronic disease, individuals develop unique models, or illness representations, which enable them to "make sense" of their predicament. Inaccurate illness representations have a negative affect on patient behaviors and outcomes. OBJECTIVE: This purpose of this study was to examine changes in patients' self-reported illness representations before and after first-time elective PTCA. METHODS: In this descriptive, repeated-measures design, illness representations were evaluated in 117 consecutive patients attending a pre-PTCA clinic using the Illness Perceptions Questionnaire. Data were collected pre- and 6 to 8 months post-elective PTCA. RESULTS: A typical participant was male (75%), of European ethnicity (90%), and aged 62 years (+/-10.7). Six to 8 months post-PTCA self-reported symptom frequency (Z = 8.034, N-ties, P = .000) and duration decreased significantly (Z = 8.361, N-ties 20, P = .000) compared with pre-PTCA levels. Timeline scores increased significantly (Z = 3.46, N-ties 10, P = .001) indicating a shift in patients' representations of their disease from an acute to a chronic model. Cure/control and consequence scores decreased significantly, indicating that representations regarding personal control over their illness weakened (Z = 3.251, N-ties 18, P = .001), as did their representation of their illness as having serious consequences (Z = 5.250, N-ties 0, P = .00). CONCLUSION: Some inaccuracies in illness representations were evident, some of which evolved to more realistic representations, whereas others did not. In the era of promoting effective self-management among those living with chronic diseases a clear understanding of illness representation in the context of coronary heart disease is valuable, particularly as inaccuracies are associated with negative outcomes.

Aged↗

PubMed2005

Concepts of patients with alopecia areata about their disease.

BACKGROUND: Alopecia areata (AA) is a common and chronic skin disease with an unknown etiology. It may significantly affect the patient quality of life. This study was designed to evaluate the illness perception in patients with AA. METHODS: A questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 80 patients with AA attending a skin clinic in Tehran, Iran. The impact of age, gender, duration of disease, education, extent of disease and family history of AA were also assessed. RESULTS: Eighty patients (38 male and 42 female) with a mean age of 27.5 years (SD = 9.3) and disease duration of 7.8 years (SD = 7.7) completed the questionnaire. 76.9% of the patients believed that the role of stress was the cause of disease. 17.1 % believed genetic background to be the main cause, this found to be more frequent in patients with positive family history of AA. More than half of patients believed that their illness had major consequences on their lives and 40% of patients believed that their illness would be likely to be permanent rather than temporary, more in patients with longer duration of disease. Only 57.5% of patients considered their treatments to be effective. CONCLUSION: AA may considerably affect various aspects of patients' lives. The patient knowledge about the causes and course of this disease is limited.

Adolescent↗

PubMedDate not supplied

Childhood adversity and frequent medical consultations.

We assessed possible psychological mediators of the relationship between childhood adversity and frequent medical consultations among new outpatients at neurology, cardiology, and gastroenterology clinics. We assessed whether these differed in patients with and without organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety and Depression scale (HADS--anxiety and depression subscale scores), Illness Perception Questionnaire (IPQ--four subscales: consequences, cure, identity, timeline), Health Anxiety Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were divided into two groups according to whether they had experienced any type of childhood adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log) number of medical consultations for 12 months before and 6 months after the index clinic visits. Multiple regression analysis was used to determine mediators; this was performed separately for patients with symptoms explained and not explained by organic disease. One-hundred and twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced childhood adversity; they made a median of 16 doctor visits compared with 10 for those without adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness) and HAD depression scores were significantly associated with both childhood adversity and number of medical consultations and these variables acted as mediators between childhood adversity and frequency of consultation in the multiple regression analyses. This association was limited to patients with medically unexplained symptoms and was mediated by IPQ Identity Score (number of symptoms attributed to the patient's illness) and HAD depression score. Sexual abuse and overt neglect were the adversities most closely associated with frequent consultations. In patients with medically unexplained symptoms the association between childhood adversity and frequent medical consultations is mediated by the number of bodily symptoms attributed to the illness. Psychological treatments should be targeted at these patients with a view to reducing their frequent doctor visits.

Adult↗

PubMed2004

What patients with vitiligo believe about their condition.

BACKGROUND: Vitiligo is a common disease with an unknown etiology. It is a chronic disease which causes severe disfigurement, and so may significantly affect a patient's quality of life. This study was designed to evaluate the illness perception and quality of life in patients with vitiligo. PATIENTS AND METHODS: A questionnaire consisting of 25 questions on the causes, timeline, consequences, and control of disease was given to 80 patients with vitiligo attending a private skin clinic in Tehran, Iran, in 1999. The roles of age, sex, duration of disease, education, extent of disease, and family history of vitiligo were assessed. RESULTS: Eighty patients (22 males and 57 females, one not mentioned), with a mean age of 30 years (SD = 11 years) and a disease duration of 7.1 years (SD = 7.8 years), completed the questionnaire; 62.5% of the patients believed that stress played a role in their disease; 31.3% believed that their genetic background played a role in their disease, more so in patients with a positive family history of vitiligo. Almost one-half of patients believed that their illness had major consequences on their lives. One-half of patients believed that their illness was likely to be permanent rather than temporary, more so in patients with a longer duration of disease and a higher level of education. Only 60% of patients considered that their treatments were effective. CONCLUSION: Vitiligo may considerably affect various aspects of patients' lives. The knowledge of patients about the causes and course of their disease is limited.

Adolescent↗