The stress of being chronically ill: from disease-specific to task-specific aspects

The relationship between family conflict resolution methods and depressive symptoms in patients with chronic diseases

BACKGROUND

Individuals with chronic diseases are more sensitive to depressive symptoms and stress compared to the general population. The complexity and unpredictability of these diseases necessitate family involvement in their management. However, long-term disease can exhaust both patients and their families, leading to conflicts and increased stress, thus exacerbating depressive symptoms. This longitudinal study investigated the impact of family conflict resolution methods on depressive symptoms among chronic disease patients in Korea.

METHODS

We used data from the Korean Welfare Panel Study, collected from 2012 to 2022, analyzing 10,969 chronically ill cohabiting or married individuals. Chi-square tests were used to compare group characteristics, and generalized estimating equation models were used for regression analysis, focusing on Center for Epidemiologic Studies Depression Scale-11 scores, family conflict resolution changes, and covariates.

RESULTS

Participant groups that changed from positive to negative conflict resolution methods were more likely to have depressive symptoms than the group that did not change from positive methods (positive →  negative odds ratios (OR) =  1.34, confidence intervals (CI) =  1.24-1.44). In addition, participants who did not change from negative methods were significantly more depressed than those who maintained positive methods over time (negative →  negative OR =  1.48, 95% CI =  1.37-1.59). Uncollaborative discussions and domestic violence resolution methods were related to depressive symptoms in family conflict resolution methods.

CONCLUSION

Negative family conflict resolution methods influence depressive symptoms in individuals with chronic diseases. Even after transitioning to positive conflict resolution methods, prior negative experiences continued to impact depressive symptoms.

Nationwide trends in the prevalence and incidence of depressive disorders and their correlates among adults with disabilities in Korea from 2006 to 2017

BACKGROUND

Evidence suggests that people with disabilities are more likely to suffer from depression. Previous studies have focused on depressive disorders in specific disability types or age groups using small-scale cross-sectional samples. We investigated longitudinal trends in the prevalence and incidence of depressive disorders according to disability types and severity levels in the entire Korean adult population.

METHODS

The age-standardised prevalence and incidence of depressive disorders were investigated using National Health Insurance claims data from 2006 to 2017. The odds of depressive disorders by type and severity were examined using logistic regression after adjusting for sociodemographic characteristics and comorbidities based on merged 2006 to 2017 data.

RESULTS

Both the incidence and prevalence of depressive disorders were higher among the disabled than the non-disabled, with the prevalence gap being larger than the incidence gap. In regression analyses, adjusting for sociodemographic characteristics and comorbidities considerably reduced the odds ratios, particularly for incidence. The severity of disabilities was inversely associated with the incidence of depressive disorders. Brain injury and disabilities in major internal organs were associated with lower odds of developing depressive disorders than in non-disabled individuals.

CONCLUSIONS

A significant proportion of depressive disorders in disabled individuals are caused by financial hardships or comorbidities rather than disabilities themselves. We must pay special attention to those who cannot access healthcare services due to severe disabilities and those whose depressive disorders are misdiagnosed as intellectual disabilities. More research is required to elucidate the causal mechanisms underlying depressive disorders in people with various types and severities of disabilities.

Factors contributing to chronic obstructive pulmonary disease patients' functional performance: Structural equation modelling based on theory of unpleasant symptoms

AIM

This study aimed to predict the functional performance of patients with chronic obstructive pulmonary disease by clarifying the relationship among disease severity, uncertainty, social support, symptom experience, coping, and functional performance.

DESIGN

A model-testing design was used.

METHODS

The subjects of this study were outpatients with chronic obstructive pulmonary disease who visited the respiratory clinic of a general hospital in Seoul, Korea. The data were collected using validated instruments from July 2018 to April 2019, of which 202 questionnaires in total were used for data analysis. Collected data were analysed by using IBM SPSS v27.0 and Mplus 8.0.

RESULTS

The severity of the disease, uncertainty, and symptom experience should be reduced to improve the functional performance of chronic obstructive pulmonary disease patients. Furthermore, reduced uncertainty can improve functional performance by reducing symptom experience. Nursing interventions for the improvement of pulmonary function and reduction of symptom experience should be developed.

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre

Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.

Common sense model of self-regulation for understanding adherence and quality of life in type 2 diabetes with structural equation modeling

OBJECTIVES

The objective of the present study was to test the Common Sense Model of self-regulation (CSM) for its relevance for improving adherence and quality of life in type 2 diabetes.

METHODS

A sample of 253 patients with type 2 diabetes was recruited. They completed questionnaires about their perceptions regarding diabetes, coping strategies, therapeutic adherence and quality of life. Their HbA1c levels were also collected. Structural equation modeling (SEM) was used to check the adequacy of our theoretical model (CSM) with the patient data.

RESULTS

The final model indicated that perceptions were directly and indirectly related to health outcomes through coping strategies and adequately matched the data (χ² / df = 561/ 220 = 2.55; RMSEA = 0.08; PCFI = 0.66; PGFI = 0.70). Moreover, the model appeared to be identical for both types of treatment (oral and injectable).

CONCLUSIONS

Illness perceptions and coping strategies, or, more specifically, how patients accept disease and think they are able to manage it, significantly affect therapeutic adherence and quality of life in type 2 diabetes.

PRACTICE IMPLICATIONS

These results pave the way for developing psychological treatments aimed at improving patient acceptance and internal resources (e.g. use of autobiographical memory, Acceptance and Commitment Therapy).

Comorbid depression in medical diseases

Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.

Living with a chronic disease: A quantitative study of the views of patients with a chronic disease on the change in their life situation

Objectives:

Chronic diseases have an impact on and change patient’s lives which means that they need to find ways to cope with the new situation. The aim was to describe how the chronic disease has influenced patients’ views of their life situation.

Methods:

The study was quantitative in design with data collected using a semi-structured questionnaire. Descriptive statistics were used to compare similarities and differences between patients with asthma-allergy, diabetes mellitus, cancer and inflammatory rheumatoid arthritis.

Results:

Changes in their life were experienced as a negative outcome for the majority of participants. Support can be in the form of interpersonal support from various persons, but also from activities and beliefs/religion. Family and friends as well as healthcare professionals were identified as being most supportive. Sadness and worry were the most common emotions among the participants and their surrounding networks.

Conclusion:

People with a chronic disease have to live with the consequences the disease has for their life situation. They need to find strategies to cope with the negative outcome in their new life. Support from their own network and healthcare professionals can be helpful in the new life situation.

Vision-related quality of life and symptom perception change over time in newly-diagnosed primary open angle glaucoma patients

To evaluate the change over time of vision-related quality of life (QoL) and glaucoma symptoms in a population of newly-diagnosed primary open angle glaucoma (POAG) patients. Multicenter, prospective study. Consecutive newly-diagnosed POAG patients were enrolled and followed-up for one year. Follow-up visits were scheduled at 6 and 12 months from baseline. At each visit, vision-related QoL and glaucoma-related symptoms were assessed by the means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Glaucoma Symptom Scale (GSS), respectively. Trends over time for NEI-VFQ-25 and GSS scores were evaluated with longitudinal linear mixed models. One-hundred seventy-eight patients were included in the analysis. At baseline, early to moderate glaucoma stages were associated with higher scores for most GSS and NEI-VFQ-25 items, while lower best-corrected visual acuity was associated with lower scores for 4 of the 12 NEI-VFQ-25 items. During the follow-up, all the GSS scores, the NEI-VFQ-25 total score, and 7 of the 12 NEI-VFQ-25 scores significantly improved (p < 0.05). In multivariate model, higher increases of most GSS and NEI-VFQ-25 scores were modeled in patients with low scores at baseline. Vision-related QoL and glaucoma-related symptom perception significantly improved during the one-year follow-up in this population of newly diagnosed POAG patients.

Coping strategies in young and adult haemophilia patients: A tool for the adaptation to the disease

INTRODUCTION

Chronic diseases, after diagnosis, involve changes that have to favour coping with the new situation. The resources used will help control, manage and adapt to the disease. The psychological aspects may be influencing how the individual faces the situation.

AIM

To assess whether perceptions or beliefs and illness behaviour influence the choice of coping strategies for young and adult patients with haemophilia.

METHODS

Multicenter cross-sectional descriptive study. We recruited 63 patients with haemophilia A and B, adolescents, young and adults, and both types of treatment. A clinical and sociodemographic data sheet, the Coping Strategies Inventory (CSI), the Illness Perception Questionnaire-revised (IPQ-R) and the Illness Behaviour Questionnaire (IBQ) were used.

RESULTS

Patients with haemophilia use appropriate coping strategies, both cognitive and behavioural. Most of them are on-demand treatment, and despite arthropathy, they perceive good control of haemophilia. However, patients in prophylactic treatment are those employed more maladaptive coping strategies, less perception of control and hypochondriacal behaviour to the disease. The age variable may be relevant but we did not find significant differences.

CONCLUSIONS

Coping strategies used by patients with haemophilia are adequate. Although it is noted that the perception of the disease, its controllability or not, affects illness behaviour and consequently how coping with haemophilia. These are based on personal characteristics, cognitive and attitudinal dispositions that the individual consciously use to solve or face adverse situations. The analysis of coping styles of patients could be a tool for professionals to manage properly the disease.

Illness identity in young adults with refractory epilepsy

INTRODUCTION

Refractory epilepsy is an intrusive condition with important implications for daily functioning in emerging and young adulthood. The present study examined the degree to which refractory epilepsy is integrated in one's identity, and examined how such a sense of illness identity was related to health-related quality of life (HRQOL).

METHODS

A total of 121 18- to 40-year-old patients with refractory epilepsy (56.2% women) completed self-report questionnaires assessing the four illness identity states of acceptance, enrichment, engulfment, and rejection (Illness Identity Questionnaire (IIQ)); HRQOL (Quality of Life in Epilepsy Inventory - 31); and seizure frequency and severity (Liverpool Seizure Severity Scale (LSSS)). Illness identity scores were compared with a sample of 191 patients with a nonneurological chronic disease (congenital heart disease). Hierarchical regression analyses were conducted to assess the predictive value of illness identity for HRQOL when simultaneously controlling for demographic and clinical features.

RESULTS

Patients with refractory epilepsy scored higher on rejection and engulfment and lower on acceptance when compared with patients with congenital heart disease. Further, seizure severity and number of medication side-effects were positively related to engulfment and negatively to acceptance. Finally, when simultaneously controlling for various demographic and clinical variables, illness identity significantly predicted HRQOL (with engulfment being the strongest and most consistent predictor).

CONCLUSION

The extent to which patients with refractory epilepsy succeed in integrating their illness into their identity may have important implications for HRQOL. Clinicians should be especially attentive for signs that patients feel engulfed by their epilepsy.

Surgical management for venous leg ulcers: The role of hope, investment and agency

A recent systematic review suggests that minimally invasive venous surgery for the treatment of leg ulcers may have a greater impact on quality of life than traditional approaches. A total of 11 participants who had previously undergone surgical management for leg ulcers took part in semi-structured interviews regarding their experiences. Using thematic analysis, three themes were identified: 'Living in Flux', 'Perceptions of Chronicity' and 'Expectations'. Surgical treatment may not only improve patients' quality of life due to treatment of the condition but also by opening up a sense of hope, investment and agency not associated with traditional treatment approaches.

Patient-perceived self-management tasks and support needs of people with chronic illness: generic or disease specific?

BACKGROUND

Self-management is widely accepted as an essential component of chronic care. Nevertheless, little is known about patients' perceptions of self-management.

PURPOSE

This study aims to explore which self-management tasks and support needs people with chronic illness perceive for themselves, and to establish whether these tasks and support needs are disease specific.

METHODS

A nationwide representative sample of 2,064 people with chronic disease filled in the Patient Assessment of Self-management Tasks questionnaire.

RESULTS

Many respondents perceive self-management tasks in the daily management of their condition, although few indicate a need for support. Respondents who feel a need for support in one aspect of self-management are likely to feel a need for support in other aspects as well. Type of disease has a small effect on self-management tasks and even smaller on support needs.

CONCLUSION

Although the self-management tasks patients perceive may be partly disease specific, self-management support does not necessarily need to be disease specific.

The role of social support in women's health and recovery processes

The aim of this study was to assess the psychological state of women who have undergone surgery for breast cancer or cardiac surgery, including examination of the role of social support in both groups. The study included 48 women (mean age: 66.04 ± 8.3 years). They were divided into two groups according to diagnosis: 23 women (mean age: 69.2 ± 8.6 years) who underwent heart surgery (cardiac group, CG) and 25 women (mean age: 63.2 ± 7.0 years) treated for breast cancer and associated with the Women After Mastectomy Club (oncology group, OG). In addition to the assessment of socio-demographic variables, the following self-report questionnaires were administered: Satisfaction with Life Scale, Acceptance of Illness Scale, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory as well as Berlin Social Support Scale. In the CG, the severity of depressive symptoms was two times higher than in OG (p = .003). In both groups, there was a high percentage (80%) of women with severe symptoms of anxiety (p = .37). In both groups, the level of life satisfaction was similar (p = .58), but OG was characterized by a higher level of acceptance of the disease (p = .003). The correlation analysis showed that in both groups, social support was related differently to the parameters of emotional state. Women treated for breast cancer were in a better mental condition than women treated for heart disease. The support coming from other women in similar circumstances (Women After Mastectomy Club) seems to be more effective than the support coming from the patient's immediate environment. The results for social support ought to be interpreted not only through the prism of mean values of received support, but also with regard to the information on the sources of support.

Coping in adult patients with severe haemophilia

An adequate use of coping strategies could help patients to deal with disease-related stress. The study aim was to explore coping behaviour in adult patients with severe haemophilia and its possible determinants. Coping was assessed through three basic dimensions (task-oriented, emotion-oriented and avoidance coping), using the short version of the Coping Inventory for Stressful Situations (CISS-21). Patients' scores were compared with Dutch working men (N = 374), according to three categories: low use (<P25 of normal), average use (P25-P75) and high use (>P75). Determinants were measured using questionnaires on activities (Haemophilia Activities List), participation (Impact on Participation and Autonomy Questionnaire), physical functioning [physical component of the Dutch Arthritis Impact Measurement Scales-2 (D-AIMS2)] and socio-psychological health (psychological component of the D-AIMS2). In total, 86 adults with severe haemophilia (FVIII/IX<1%) were included. The median age was 38 years (range: 18-68) with 85% affected with haemophilia A and 75% using prophylaxis. Patients with haemophilia used task-oriented coping as frequently as the control group (P = 0.13); but used significantly less emotion-oriented coping (57% vs. 25%, P < 0.05) and avoidance coping (P < 0.05). Emotion-oriented coping showed a strong correlation with socio-psychological health (r = 0.67) and weak correlations with participation (r = 0.32) and social interaction (r = 0.29). Other associations of coping strategies with patient characteristics of health status could not be demonstrated. Overall, patients predominantly used the task-oriented approach to deal with their disease; the use of this strategy was comparable to the control group. Having a poor psychological health, less social interaction and/or less participation in daily life was associated with an increased use of emotion-oriented coping.

Self-management support needs of patients with chronic illness: do needs for support differ according to the course of illness?

OBJECTIVE

To determine whether chronically ill patients' needs for self-management support depend on their course of illness.

METHODS

Cross-sectional and longitudinal linear regression analyses were conducted using data from 1300 patients with chronic disease(s) who participated in a nationwide Dutch panel-study. Self-management support needs were assessed by the Patient Assessment of Self-management Tasks questionnaire (PAST). Course of illness was operationalized as: illness duration, patients' perception of the course of illness and changes in self-rated general health (RAND-36).

RESULTS

Self-management support needs are not related to illness duration. Patients who perceive their illness as episodic and/or progressively deteriorating have greater self-management support needs than patients who perceive their illness as stable. Deterioration of self-rated health is related to increased support needs. The effect of the course of illness on support needs depends on the type of self-management activities.

CONCLUSION

How chronically ill patients perceive the course of illness and actual changes in self-rated health are predictive for their need for support for self-management activities. Illness duration is not.

PRACTICE IMPLICATIONS

Helping patients to self-manage should not be confined to the first years after diagnosis. Healthcare providers should be alert to patients' own perceptions of their course of illness and health status.

Quality of life and acceptance of illness among patients with chronic respiratory diseases

The purpose of this study was to determine quality of life (QoL) and acceptance of illness in patients with chronic respiratory diseases. The study involved 315 adult patients of the mean age of 63.9±15.7 years. The World Health Organization Quality of Life Instrument Short Form and the Acceptance of Illness Scale were used. The mean score for QoL was 2.0±1.3. The highest scores were obtained in the Social Relationship Domain (13.9±2.7) and the lowest in the Environmental Domain (10.5±2.2). The strongest correlations within QoL domains were noted between Physical and Psychological Domains: r=0.611 (p<0.001), Psychological and Social Domains: r=0.605 (p<0.001). The overall degree of illness acceptance was low (26.0±7.8). The strongest correlations were observed between illness acceptance and Physical: r=0.591 (p<0.001) and Psychological Domains: r=0.450 (p<0.001). We conclude that illness acceptance can be augmented by improving the patient's clinical state and by the provision of psychological support and QoL by improving the Psychological and Environmental Domains.

Group therapy for patients with mild cognitive impairment and their significant others: results of a waiting-list controlled trial

BACKGROUND

Patients with mild cognitive impairment (MCI) have to deal with an uncertain prognosis and also face a multitude of memory-related problems and psychosocial consequences. A newly developed group programme proved to be feasible, however, it needed confirmation by a controlled study.

AIM

This controlled study evaluates this group therapy for MCI patients aimed to help them accept and manage the memory problems and the psychosocial consequences. The programme combines elements from psychoeducation, cognitive rehabilitation and cognitive-behavioural therapy.

PATIENTS AND METHODS

Ninety-three MCI patients received treatment, with 30 patients being first assigned to a waiting list, thus serving as their own control group. Pre- and post-treatment acceptance and helplessness were assessed using subscales of the Illness Cognition Questionnaire, while distress and general well-being were gauged with the Geriatric Depression Scale and subscales of the RAND-36.

RESULTS

Linear mixed model analyses showed that, relative to the controls, acceptance had increased more in the intervention group compared to the waiting-list period (p = 0.034). Distress and general well-being showed no changes. Treatment responders demonstrating a clinically significant effect on acceptance and two of three secondary outcome measures had higher baseline levels of helplessness and fewer self-reported memory complaints in daily life than patients who did not improve.

CONCLUSION

The intervention helped the patients deal better with their uncertain future in that they were overall better able to accept their condition, with especially the female patients showing a decrease in helplessness cognitions, although the effects were relatively small.

Work factors related to psychological and health-related distress among employees with chronic illnesses

OBJECTIVE

This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses.

METHODS

The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires.

RESULTS

Both low psychological well-being and high health-related distress were associated with an increase in work limitations (beta=0.20, SE=.03; and beta=0.19, SE=.01, respectively), poorer management of illness symptoms at work (beta=-0.17, SE=.12; and beta=-0.13, SE=.02), high presentieesm (beta=0.19, SE=.25; and beta=0.14, SE=.05) and low workplace support (beta=-0.05, SE=.22; and beta=-0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (beta=0.18, SE=.08) and long-term sickness absence (beta=0.10, SE=.06).

CONCLUSIONS

To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.

Health-related quality of life and mental health problems after a disaster: are chronically ill survivors more vulnerable to health problems?

Studies have shown that the chronically ill are at higher risk for reduced health-related quality of life (HRQL) and for mental health problems. A combination with traumatic events might increase this risk. This longitudinal study among 1216 survivors of a disaster examines whether chronically ill survivors had a different course of HRQL and mental health problems compared to survivors without chronic diseases. HRQL and mental health problems were measured 3 weeks, 18 months and 4 years post-disaster. Data on pre-disaster chronic diseases was obtained from the electronic medical records of general practitioners. Random coefficient analyses showed significant interaction effects for social functioning, bodily pain and emotional role limitations at T2 only. Chronically ill survivors did not consistently have a different course of general health, physical role limitations, and mental health problems. In conclusion, chronic diseases were not an important risk factor for impaired HRQL and mental health problems among survivors.

Chronic disease and mental disorder

The aim of this study was to achieve a better understanding of the relationship between chronic medical illness and mental distress. Therefore, the association between chronic medical illness and mental distress was analysed, taking into account the modifying effects of generic disease characteristics (concerning course, control and possible stressful consequences), physical quality of life indicators and social and relationship problems. Panel data from the Dutch national Panel of Patients with a Chronic Disease (PPCZ) were used. Data from 1788 chronically medical ill patients (nine disease categories) concerning their mental and physical health have been used in a cross-sectional, multivariate analysis. Somatic disease, generic disease characteristics and physical quality of life were assessed by medical doctors. Mental distress and social/ relationship problems were assessed by questionnaire (respectively, GHQ-12 and Biopro). Members of the panel had more mental distress than a random community sample. However, there were no differences between specific somatic diseases. Relationship, job-related and financial problems increased the probability of mental disorder considerably. Relationship problems may be considered a generic characteristic of chronically ill patients, causing an increased risk of mental disorder. Poor physical health condition contributed to a higher probability of mental disorder as well. General practitioners, home care providers and medical specialists should be aware that people with chronic diseases are in general more at risk of mental disorder. For many chronically ill people, this risk is further exacerbated by social/relationship problems, and a poor level of perceived health.