The association between illness perception and quality of life among Chinese adults with epilepsy: The mediating role of coping style

The relationship between self-efficacy, illness-related fear, and intolerance of uncertainty in patients who have epilepsy in eastern Türkiye: A path analysis

BACKGROUND

The effects of psychological factors such as self-efficacy, illness-related fear, and intolerance of uncertainty on illness management and quality of life of patients who have epilepsy have important roles in understanding the health behaviors of individuals.

AIM

The present study was conducted to examine the relationship between self-efficacy, illness-related fear, and intolerance of uncertainty in patients who have epilepsy and to investigate the mediating role of illness-related fear in the relationship between self-efficacy and intolerance of uncertainty.

METHOD

This cross-sectional and correlational study had a descriptive design and was conducted with 150 epilepsy patients who met the inclusion criteria and applied to the neurology clinic of a university hospital. The study population comprised epilepsy patients who applied to the Neurology Clinic of a university hospital in eastern Türkiye between May 2024 and August 2024. The data were collected by using the Personal Information Form, Epilepsy Self-Efficacy Scale, Illness-Related Fear Scale, and Mishel Uncertainty in Illness Scale - Community Form. The Structural Equation Modeling and Bootstrapping Methods were used to analyze the study data. The study was reported following the STROBE Recommendations.

RESULTS

Based on the findings, self-efficacy was found to negatively affect intolerance of uncertainty about the illness (b = -0.384, 95 % CI [-0.462 to -0.306], p < 0.01) and illness-related fear (b = -0.449, 95 % CI [-0.544 to -0.344], p < 0.01). Also, illness-related fear was found to positively affect intolerance of uncertainty (b = 0.688, 95 % CI [0.586 to 0.789], p < 0.01). The indirect effect of self-efficacy on intolerance of uncertainty through illness-related fear (b = -0.309, 95 % CI [-0.444 to -0.210], p < 0.01) was found to be negative and significant and the total effect (b = -0.693, 95 % CI [-0.789 to -0.597], p < 0.01) was also negative and significant. Self-efficacy explained 34 % of the illness-related fear and 59 % of the total intolerance of uncertainty in the model. The estimated effects were calculated with 5000 repeated operations and were evaluated to be significant because the indirect effects did not include zero in the 95 % Confidence Interval.

CONCLUSION

The results of the present study showed that self-efficacy has a direct negative impact on intolerance of uncertainty in patients who have epilepsy and that fear related to the illness plays mediating roles in this effect.

Illness perception, psychological distress, and quality of life in patients with alopecia: a cross-sectional study from Riyadh, Saudi Arabia

BACKGROUND

Alopecia, a condition marked by hair loss, includes androgenic alopecia (AGA), alopecia areata (AA), telogen effluvium (TE), and scarring alopecia, each with a unique pathophysiology that profoundly impacts psychological well-being, self-image, and quality of life (QoL), leading to anxiety and depression. Understanding illness perception and its connection to QoL and mental health in comorbid Saudi patients, especially in patients with the simultaneous presence of more than two medical conditions, remains limited. We aimed to assess Saudi patients' perception of different types of alopecia and explore the relationship between illness perception, QoL, psychological factors, and comorbidities.

METHODS

A cross-sectional survey was conducted at King Khalid University Hospital, Riyadh, from December 2023 to March 2024. Ninety-nine adults with confirmed alopecia diagnoses completed validated questionnaires, including the Brief Illness Perception Questionnaire (BIPQ), the Dermatology Life Quality Index (DLQI), the Patient Depression Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Scale (GAD-7). Statistical analysis included regression models to determine predictors of QoL impairment.

RESULTS

the most common type of alopecia was AGA (47.5%), followed by AA (30.3%), scarring alopecia (16.2%), and TE (6.1%). Median scores for BIPQ and DLQI were 49.0 and 6.0, respectively, indicating moderate illness perception and QoL impact. Anxiety and depression levels were generally mild, though scarring alopecia patients reported higher emotional distress. Negative illness perception was strongly associated with reduced QoL and higher anxiety and depression scores. Factors such as illness perception, anxiety, and mental health conditions were significant predictors of QoL impairment.

CONCLUSION

Our findings underscore the psychological impact of alopecia and highlight the importance of addressing both physical symptoms and mental health in patient care. Thus, Targeted interventions focusing on illness perception and emotional well-being are crucial for improving outcomes.

Exploring the relationship between illness perception, self-management and quality of life among HIV-positive men who have sex with men

AIMS

This study aimed to explore the mediating effect of self-management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM).

DESIGN

A cross-sectional study.

METHODS

We explored the effect of illness perception and self-management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL.

RESULTS

Among 300 Chinese HIV-positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0-54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = -0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self-management health practices and the chronic nature of the self-management domain played a parallel role in mediating the relationship between illness perception and QOL.

CONCLUSION

Our study demonstrated that SM was a significant factor influencing QOL among HIV-positive MSM. Focusing on daily self-management health practices and the chronic nature of self-management could be the potential key targets for enhancing HIV self-management strategies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study emphasized the role of SM in the well-being of HIV-positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The relationship between illness perception and vision-related quality of life among Chinese patients with diabetic retinopathy: the mediating role of resignation coping style

BACKGROUND

Maladaptive illness perception and coping strategies have been linked to illness-related quality of life in patients with chronic diseases. However, the impact of illness perception and coping strategies on vision-related quality of life (VRQOL) in patients with diabetic retinopathy (DR), a significant microvascular complication of diabetes mellitus, remains unclear. This study aims to evaluate the associations among illness perception, coping styles, and VRQOL in Chinese patients with DR, and to explore the mediating role of coping styles in the relationship between illness perception and VRQOL.

METHODS

This cross-sectional study included 303 adult Chinese with DR recruited from a general Grade-A tertiary hospital in Hunan, China. All participants completed clinical and demographic questionnaires. The Brief Illness Perception Questionnaire (BIPQ), the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25), and the Medical Coping Modes Questionnaire were respectively adopted to assess the illness perception, VRQOL and coping styles. The BIPQ total scores were converted to logit scores using Rasch analysis. The NEI-VFQ-25 composite scores were converted to estimated person measures based on Rasch analysis and the method of successive dichotomizations. The relationships among these variables were assessed through independent-sample t-test, one-way analysis of variance, correlation analyses and multiple linear regression analysis, while SPSS Process model and the bootstrap analysis were utilized to evaluate the mediating effect.

RESULTS

Illness perception was positively correlated with resignation coping style (r = 0.33, P < 0.001) and negatively correlated with VRQOL (r = -0.43, P < 0.001). Resignation coping style was negatively correlated with VRQOL (r = -0.38, P < 0.001). Illness perception significantly predicted resignation coping style (t = 5.91, P < 0.001) and resignation coping style significantly predicted VRQOL (t = -5.30, P < 0.001). The mediating effect through resignation coping was - 0.49 (95% CI: -0.75 to -0.27), accounting for 21.08% of the total effect of illness perception on VRQOL.

CONCLUSION

The study revealed that the resignation coping style partially mediated the relationship between illness perception and VRQOL among DR patients. Specifically, DR patients may accept their worsening circumstances without attempting to change them due to their perception that their illness is threatening and beyond control. This resignation coping strategy could, in turn, lead to poorer VRQOL. These findings suggest that interventions targeting the improvement of illness perception and coping strategies could enhance the VRQOL of DR patients.

Effects of social support on vision-related quality of life in older adults with dry eye disease: the chain mediating role of illness perception and coping style

Objective

This study explored the effects of social support, illness perception, coping style, and vision-related quality of life (VRQOL) in older patients with dry eye disease (DED) using a chain mediation model.

Methods

A total of 407 patients with DED from a tertiary hospital in Wuxi, Jiangsu Province, China, between June and December 2023 were selected as participants. A demographic questionnaire, the Social Support Rating Scale, the Brief Illness Perception Questionnaire, the Medical Coping Modes Questionnaire, and the National Eye Institute Visual Functioning questionnaire-25 were all given to them to complete. IBM SPSS (version 27.0) was used for data analysis, and Model 6 of the PROCESS Macro was used to test the predicted chain mediation model.

Results

The positive association between social support and VRQOL demonstrated the mediation role of illness perception and coping style. Social support affected VRQOL via three pathways: illness perception (effect = 0.190), confrontational coping style (effect = 0.103), and a combination of illness perception and confrontational coping style (effect = 0.067), accounted for 23.60%, 12.80%, and 8.32% of the total effect, respectively.

Conclusion

Social support in older patients with DED can significantly and positively predict the VRQOL. In addition to the independent mediating effect of illness perception and confrontational coping style, a chain-mediating effect exists between social support and VRQOL. The study serves as a valuable strategy for healthcare professionals to prevent and intervene in VRQOL for older patients with DED in the future.

Trajectory and predictors of family function in caregivers of stroke survivors: A longitudinal study of the first 6 months after stroke

AIMS

This study aimed to investigate the trajectory and predictors of family function in caregivers of stroke survivors during the first 6 months after the first episode of stroke.

DESIGN

Longitudinal study.

METHODS

A total of 288 primary caregivers of patients with first-time stroke were recruited from seven tertiary hospitals in China between July 2020 and March 2021. The following characteristics were assessed by caregivers at hospitalization (T0) and at 1 month (T1), 3 months (T2) and 6 months (T3) after the stroke: family function, general self-efficacy, social support, coping style, caregiver burden, and sociodemographic and clinical data.

RESULTS

Family function scores among caregivers of stroke survivors were highest in the resolve dimension and lowest in the growth and adaptation dimensions within the first 6 months. The percentages of families with low functioning were 34.7%, 33.3%, 24.8% and 17.7% at T0, T1, T2 and T3, respectively. The generalized estimating equation model revealed that family function in caregivers increased over the first 6 months (Exp(B) = 1.415-2.689, p < .05). The following factors were identified as predictors of family functioning: caregiver's age, education, residential district, self-efficacy, social support utilization and caregiver burden.

CONCLUSIONS

Family function of caregivers of stroke survivors gradually increased during the first 6 months after stroke. However, some families demonstrated poor functioning. Caregivers' age, education, caregiver burden, self-efficacy and social support utilization could predict family function over time.

IMPACT

Empirical data on family function in families of stroke survivors are important for developing psychosocial interventions that can help families adapt to stroke. This study found that families of stroke survivors were likely to be dysfunctional in the first 6 months after stroke, particularly in family growth and adaptation. Therefore, reducing caregiver burden and promoting self-efficacy and social support utilization can help restore family functioning early after stroke.

PATIENT OR PUBLIC CONTRIBUTION

Stroke caregivers from seven hospitals in China were involved in this study and had the right to be informed of the main findings. A few patients were informed of the research results, who contributed to the dissemination.

The mediating role of coping styles in illness perception and self-management in patients with obstructive sleep apnea

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) has become a chronic disease that threatens human health. Self-management in patients with OSA can influence their quality of life, and illness perception and coping styles are relevant facilitators of self-management, but this specific relationship has not been adequately studied. The purpose of this study was to investigate the current status and relationship between illness perception, coping styles, and self-management behaviors in patients with OSA, and how coping styles mediate this relationship.

METHODS

This is a cross-sectional study. Conducted between September 2022 and March 2023, the study involved patients aged ≥18 years old in two hospitals who were diagnosed with OSA. The survey was conducted using the demographic characteristics questionnaire, the Brief Illness Perception Questionnaire, the Simple Coping Style Questionnaire, and the Self-management Behavior Questionnaire of patients with obstructive sleep apnea. Spearman's correlation analysis was used for correlation analysis and multiple linear regression and structural equation models were used for mediation effect testing.

RESULTS

There were 282 valid questionnaires, with a 94 % valid response rate. Higher levels of self-management behaviors were associated with low negative illness perceptions, high positive coping, and low negative coping. The study also demonstrated that the mediating effect accounted for 25.65 % (-0.049/-0.191) of the overall effect.

CONCLUSION

Illness perceptions in OSA patients were negatively related to positive coping styles, positively related to negative coping styles, and negatively related to self-management. This study suggests that coping styles of OSA patients mediate illness perception and self-management.

Relationship between quality of life, fear of disease progression, and coping styles in patients with pulmonary hypertension: A network analysis

A poor quality of life (QoL) in patients with pulmonary hypertension (PH) is often associated with emotional disturbances and the ability to cope. Little is known, however, about the intrinsic links among the QoL, fear of disease progression (FoP), and coping styles in patients with PH. The purpose of this study was to elucidate the relationships among QoL, FoP, and coping styles in patients with PH. We conducted a cross-sectional survey of 247 patients from a tertiary hospital in Jinan, China and analyzed the relationships using network analysis. Participants completed the World Health Organization's Quality of Life Questionnaire, Fear of Disease Progression Questionnaire and Simple Coping Style Questionnaire during the survey period. The total QoL, positive coping, and negative coping scores were 46.55 ± 10.46, 31.75 ± 6.85, and 18.75 ± 4.66, respectively. The QoL psychological domain had the strongest centrality, deserving more attention than other domains. The coping styles were bridge nodes that connected the whole network, where negative coping and social family FoP, and positive coping and both social and psychological QoL had the strongest positive correlations. There were no significant sex-based or age-based differences in the networks. To improve QoL and psychological well-being in people with PH, healthcare professionals must focus on issues beyond the patient's physical health. Specifically, they should focus on positive coping styles, while developing interventions to promote positive coping and reduce negative coping styles.

Investigation of illness perception and pregnancy avoidance in sexually active women with epilepsy

AIM

The aim of the study was to examine the perception of illness and avoidance of pregnancy in sexually active women with epilepsy.

METHODS

This study was completed with 82 women with epilepsy who were sexually active and who were admitted to the neurology clinic and outpatient clinic between June and September 2022. The descriptive information form, Brief Illness Perception Questionnaire (IPQ-B), and Pregnancy Avoidance Scale (PAS) were used to collect the data.

RESULTS

The mean age of the patients in the study was 32.96 ± 5.92 years and the mean disease duration was 11.19 ± 7.46 years. Among the patients, 75.6% had previous pregnancies, 70.7% did not have miscarriage or abortion, 69.5% previously gave birth, 61% used a contraceptive method (condom, intrauterine device (IUD), pills, etc.) in their last sexual intercourse, 52.4% had good communication with their spouses, 20% had two children, 51.2% had three or more seizures, and 86.6% used antiseizure medications (ASMs). The mean PAS score of the patients was 2.31 ± 1.14 and the mean IPQ-B score was 35.10 ± 13.16. The regression analysis found that the perception of illness was a significant positive predictor of avoidance of pregnancy and explained 17% of it.

CONCLUSION

Women with epilepsy avoided pregnancy and had negative illness perceptions. Moreover, negative illness perception increased pregnancy avoidance in women with epilepsy.

Factors associated with illness representations in adults with epileptic and functional seizures: A systematic review

Illness representations refer to a person's beliefs about their health condition and are thought to influence clinical outcomes. By understanding factors related to illness representations, potentially modifiable targets for psychological intervention can be identified. The aim of this systematic review was to synthesise the literature on factors associated with illness representations in people with epilepsy and functional seizures. Three electronic databases (Psychinfo, EMBASE, and Proquest (Theses and dissertations)) were searched for studies that reported on associations between Illness Perception Questionnaire scores (or variations thereof) and biopsychosocial factors in people with epilepsy or people with functional seizures. Seventeen studies met inclusion criteria and were assessed with a bespoke quality appraisal tool. Overall, there was moderately strong evidence for an association between more threatening illness representations and poorer clinical outcomes relating to seizure characteristics, distress, coping, and quality of life; the evidence for these relationships was stronger for people with epilepsy than functional seizures. There was no clear difference between the illness representations of the two groups. The results of this review highlight the clinical importance of illness representations in people with seizure disorders, as well as opportunities for further research.

Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study

BACKGROUND

Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy.

METHODS

This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data.

RESULTS

The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation.

CONCLUSION

The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.