Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

Associations between COVID-19 perceptions, anxiety, and depressive symptoms among adults living in the United States

BACKGROUND

Associations among illness perceptions of viruses, anxiety and depression symptoms, and self-management decisions, such as mask-wearing, are critical to informing public health practices to mitigate the short- and long-term consequences of the SARS-CoV-2 viral pandemic.

PURPOSE

Guided by the common-sense model of self-regulation, this observational study examined associations among illness perceptions of COVID-19, anxiety, and depression symptoms among community-dwelling adults.

METHOD

Data were collected from 1380 adults living in the United States early in the pandemic (03-23-2020 to 06-02-2020). Participants completed online surveys. Analyses were conducted using descriptive statistics and correlations.

FINDINGS

While increased anxiety symptoms were associated with less perceived personal control, greater concern, and higher emotional responsiveness, increased depression symptoms were related to lower concern as well as greater emotional responsiveness and perceived consequences of the pandemic.

DISCUSSION

Associations among illness perceptions, anxiety, and depression symptoms may impact viral spread mitigation behavior adoption.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

Perception of Hair Loss and Education Increases the Treatment Willingness in Patients With Androgenetic Alopecica: A Population-Based Study

Background

Androgenetic alopecia (AGA) has a negative impact on self-image and decrease in quality of life. However, relatively few men have sought treatment for AGA. Improvement in treatment willingness is important for maintaining long-term management in patients with AGA.

Objectives

We aimed to identify the prevalence of patients' perception of hair loss and evaluate various factors that affect the treatment willingness in patients with AGA.

Methods

We conducted a population-based cross-sectional survey of 503 patients with AGA (329 men, 174 women). We collected the various demographic data, family history of AGA, history of past treatment, self-perception of hair loss and treatment willingness using structured questionnaires. Then, we provided the knowledge about AGA to the half of subjects and compared the treatment willingness between educated group and nond-educated group.

Results

Two-hundred and forty-seven out of 503 patients (49.1%) did not have illness perception and 262 out of 503 patients (52.1%) did not have treatment willingness in future. The patients with perception of hair loss, accurate information on hair loss and severe hair loss showed 1.745-fold, 1.700-fold, and 2.078-fold higher tendency of receiving treatment in future.

Conclusion

Our findings imply that patients with perception and greater understanding of AGA tend to pursue treatment for AGA. Thus, these elements should be taken into account when treating patients. In addition, emphasis on education is needed to increase public awareness of the AGA.

Management of Chronic Stable Angina

Chronic stable angina (CSA) is a symptomatic problem that is precipitated by ischemic heart disease. CSA is diagnosed when symptoms are present for at least 2 months without changes in severity, character, or triggering circumstances. This article is a summary of current treatment strategies aimed to prevent progression of atherosclerosis, and medication therapies to control angina symptoms and improve quality of life for the individual.

Poor Illness Perceptions Are a Risk Factor for Depressive and Anxious Symptomatology in Fibromyalgia Syndrome: A Longitudinal Cohort Study

BACKGROUND

Patients with widespread pain, such as in fibromyalgia, are vulnerable for depression and anxiety, which composes a relevant public health problem. Identifying risk factors for the onset of depression and anxiety is therefore warranted. Objective of this study was to determine whether severe pain, maladaptive coping, and poor illness perceptions are associated with depressive and anxious symptomatology in fibromyalgia.

METHOD

Consecutive patients referred to an outpatient clinic completed sets of physical and psychological questionnaires at baseline and at 18-month follow-up. A total of 452 patients with fibromyalgia syndrome (FMS) were eligible for inclusion, and subsequently, 280 patients returned the baseline questionnaire. Depressive and anxious symptomatology was measured with the Hospital Anxiety and Depression Scale. To measure pain severity, coping style, and illness perceptions, the Fibromyalgia Impact Questionnaire, Pain Coping Inventory, and the Illness Perception Questionnaire-Revised (IPQ-R) were used, respectively. Multivariable logistic regression analyses, bootstrapping and calibration, were performed to examine the association of pain severity, pain coping, and illness perception with depressive and anxiety symptoms at follow-up, adjusted for sociodemographic variables. Initial level of depressive and anxiety symptoms was selected as covariates.

RESULTS

Mean age was 42.6 years and 95.4% were female. At 18-month follow-up, 68 (of the 195) patients were depressed and 80 (of the 197) were anxious. Only the IPQ-R subscale "emotional representations" showed a significant positive association with depressive symptoms at follow-up (OR = 1.10), next to the initial level of depressive symptoms (OR = 1.30). In case of anxiety, only the IPQ-R subscale "treatment control" showed a significant negative association with anxiety symptoms at follow-up (OR = 0.87), next to the initial level of anxiety symptoms (OR = 1.45).

CONCLUSION

Our data suggest that not pain severity or maladaptive coping, but poor illness perceptions are important in elevated depressive and anxious symptomatology. Patients with fibromyalgia who think their illness negatively affects their mental well-being are at increased risk for more depressive symptoms, and those who think treatment of their illness will not be effective are at increased risk for more anxiety symptoms. Strengthening illness beliefs and reducing catastrophic thinking, therefore, seem crucial factors in the treatment of patients with FMS.

Cross-cultural adaptation and psychometric properties of an Arabic language version of the Brief Illness Perception Questionnaire in Lebanon

BACKGROUND

Patients' positive illness perceptions (IPs) significantly contribute to treatment success. The Brief Illness Perception Questionnaire (Brief IPQ) is widely used in various diseases for assessing IPs. It was developed in English-speaking countries and studies on it in Arab countries are scarce.

OBJECTIVES, SETTING AND DESIGN

This observational cross-sectional study aimed to cross-culturally adapt the Brief IPQ English version into a modern Arabic language version and determine its psychometric properties in a sample of Lebanese cardiac disease patients. This study was approved by the Institutional Review Board of Saint Joseph University of Beirut, Lebanon.

PARTICIPANTS

A convenience sample of 30 patients with cardiac disease were recruited during routine visits to cardiologists' offices in Beirut, Lebanon. Inclusion criteria were at least one cardiac disease for at least 6 months with no acute episode or exacerbation of the disease during the 6 preceding months, age ≥ 18 years, and the ability to read and comprehend Arabic. The pre-final version of the Brief IPQ Arabic version was tested for face and content validity. The meaning, comprehensibility, and acceptability were studied by individual interviews. For discriminant validity and internal consistency of the Brief IPQ Arabic version (Brief IPQ-Ar), 100 patients were recruited in a similar manner using the same inclusion criteria. To assess reproducibility, 30 patients, selected randomly from the 100 patients, filled the questionnaire a second time, 3-4 weeks after its first administration and under the same conditions.

MAIN OUTCOME MEASURES

Psychometric properties of the Brief IPQ-Ar among Lebanese patients suffering from cardiac diseases.

RESULTS

Semantic equivalence between the Brief IPQ-Ar questions and patients' descriptions was 100%. Cronbach's alpha was 0.717, which shows good internal consistency. Reproducibility was satisfactory (ICC values>0.776). Moreover, the Brief IPQ-Ar discriminated participants according to the type of cardiac disease and treatment-related characteristics.

CONCLUSIONS

We confirm that the Brief IPQ-Ar is appropriate for exploring IPs in cardiac disease patients whose first language is Arabic. Further research should be conducted to test this Arabic version in other types of diseases.

The impact of illness perceptions and disease severity on quality of life in congenital heart disease

BACKGROUND

Despite an increasing prevalence of adults living with a CHD, little is known about the psychosocial impact of CHD. We sought to investigate the relative impact of disease severity and patients' perceptions about their condition on depression, anxiety, and quality of life over a period of a year.

METHODS

A total of 110 patients aged over 16 years completed an initial questionnaire containing measures for anxiety, depression, quality of life, and illness perceptions when they attended the Adult Congenital Heart Disease Clinic. Cardiologists rated the patients' disease severity and illness course. A year later, patients were invited to complete the same measures. Regression analyses were performed to determine the relative impact of illness perceptions and disease severity on psychological outcomes a year later.

RESULTS

At baseline, 23% of the study population had depressive symptoms and 30% had elevated trait anxiety. After controlling for associations with disease-related variables, illness perceptions explained 28% of the variance in depression, 40% anxiety, and 27% overall quality of life at baseline. Baseline illness perceptions bivariately predicted quality of life, cardiac anxiety, and depression 1 year later, and regression analyses controlling for other factors showed that they were significant predictors of outcomes 1 year later.

CONCLUSION

Symptoms of depression and anxiety are common among adults with CHD. Patients' illness perceptions are related to psychological outcomes, especially cross-sectionally. Future research could investigate whether an intervention to discuss patients' perceptions about their CHD can improve mental health and quality of life.

A regressional analysis of maladaptive rumination, illness perception and negative emotional outcomes in Asian patients suffering from depressive disorder

Although illness perception has been shown to be associated with illness outcomes in various chronic physical diseases, the association of illness perception and rumination are not well elucidated in mental disorders. This study aims to investigate the mediational effects of adaptive and maladaptive rumination in the relationship between illness perception and negative emotions (depression, anxiety and stress) in male and female patients (N=110) suffering from depressive disorders. The results showed that maladaptive rumination mediated the relationship between illness perception and negative emotions in both male and female depressive patients. However, no mediating effects of adaptive rumination were found in the relationship between illness perception and negative emotion. Maladaptive rumination mediated the relationship between perceived identity, chronicity of illness, consequences of illness and emotional representation of illness and negative emotions in males. It also mediated the relationship between perceived identity and emotional representation of illness and negative emotions in females. The results, possible clinical implications and limitations of this study are also discussed.

The contribution of illness perception to psychological distress in heart failure patients

BACKGROUND

The influences on the psychological well-being of heart failure (HF) patients have received limited attention. Illness perceptions are a specific set of cognitive representations that have been shown to predict health-related outcomes in other patient groups. This study sought to explore the role of illness perceptions in the psychological well-being of HF patients by creating a profile of illness perceptions in HF and examining their relations with anxiety and depression.

METHODS

Participants were 95 consecutive outpatients. Indices of psychological well-being were depression and anxiety, measured using the Hospital Anxiety and Depression Scale (HADS). Illness perceptions were measured using the Illness Perception Questionnaire - Revised (IPQ-R). Functional status was also determined using the New York Heart Association (NYHA) classification.

RESULTS

Illness perceptions were associated with indices of psychological well-being. Regression analyses showed that illness perceptions accounted for a significant proportion of the variance in both depression and anxiety. The contribution of illness perceptions was greater than that made by traditional covariates (socio-demographic variables and functional status).

CONCLUSIONS

Results highlight dynamic interrelations between perceptions of illness and mental health indices. They also suggest that in considering the role of illness perceptions in psychological well-being, the primary focus should be on the overall dynamic of an individual's illness experience rather than on specific illness dimensions. Findings highlight the potential role of illness perceptions in depression and anxiety in HF. This has implications for interventions to maximise psychological well-being in this patient group.

Validation and comparison of EuroQoL-5 dimension (EQ-5D) and Short Form-6 dimension (SF-6D) among stable angina patients

OBJECTIVES

Several preference-based health-related quality of life (HRQoL) instruments have been published and widely used in different populations. However no consensus has emerged regarding the most appropriate instrument in therapeutic area of stable angina. This study compared and validated the psychometric properties of two generic preference-based instruments, the EQ-5D and SF-6D, among Chinese stable angina patients.

METHODS

Convergent validity of the EQ-5D and SF-6D was examined with eight a priori hypotheses from stable angina patients in conjunction with Seattle Angina Questionnaire (SAQ). Responsiveness was compared using the effect size (ES), relative efficiency (RE) and receiver operating characteristic (ROC) curves. Agreement between the EQ-5D and SF-6D was tested using intra-class correlation coefficient (ICC) and Bland-Altman plot. Factors affecting utility difference were explored with multiple linear regression analysis.

RESULTS

In 411 patients (mean age 68.08 ± 11.35), mean utility scores (SD) were 0.78 (0.15) for the EQ-5D and 0.68 (0.12) for the SF-6D. Validity was demonstrated by the moderate to strong correlation coefficients (Range: 0.368-0.594, P< 0.001) for five of the eight hypotheses in both the EQ-5D and SF-6D. There were no serious floor effects for the EQ-5D and SF-6D, but ceiling effects for the EQ-5D were large. The areas under ROC of them all exceeded 0.5 (0.660-0.814, P< 0.001). The SF-6D showed a better discriminative capacity (ES: 0.573 to 1.179) between groups with different stable-angina-specific health status than the EQ-5D (ES: 0.426 to 1.126). RE suggested that the SF-6D (RE: 44.8 to 177.8%) was more efficient than the EQ-5D except for physical function. Poor agreement between them was observed with ICC (0.448, P< 0.001) and Bland-Altman plot analysis. Multiple liner regression showed that clinical variables significantly (P< 0.05) influenced differences in utility scores between the EQ-5D and SF-6D.

CONCLUSIONS

Both EQ-5D and SF-6D are valid and sensitive preference-based HRQoL instruments in Chinese stable angina patients. The SF-6D may be a more effective tool with lower ceiling effect and greater sensitivity. Further study is needed to compare other properties, such as reliability and longitudinal response.

Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction?

INTRODUCTION

Myocardial infarction (MI) as a life-threatening event, carrying high risk of recurrence and chronic disabling complications, increases the risk of developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or both. The aim of this study was to investigate the relationship between illness perceptions and having ASD, PTSD, or both in patients after MI.

METHOD

Seventy-six patients diagnosed with acute MI were enrolled into our prospective study. We evaluated patients during the first week and six months after MI. Patients were assessed by using the Clinician Administered PTSD Scale (CAPS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Brief Illness Perception Questionnaire (BIPQ), and a semi-structured interview for socio-demographic characteristics during both the first and second evaluations.

RESULTS

Acute stress disorder (ASD) developed in 9.2% of patients and PTSD developed in 11.9% of patients with MI. Illness perception factors of 'consequences, identity and concern' predicted the occurrence of both ASD and PTSD, whereas 'emotion' predicted only PTSD.

CONCLUSION

The factors of illness perceptions predicted the induction of ASD and PTSD in patients who had acute MI.

Chronic stable angina is associated with lower health-related quality of life: evidence from Chinese patients

Objectives

To compare health-related quality of life (HRQoL) between patients with stable angina and the general population in China and to examine factors associated with HRQoL among patients with stable angina.

Methods

A cross-sectional HRQoL survey of stable angina patients recruited from 4 hospitals (n = 411) and the general population recruited from 3 Physical Examination Centers (n = 549) was conducted from July to December, 2011 in two large cities, Tianjin and Chengdu. HRQoL was assessed using the EQ-5D, EQ-VAS, and SF-6D instruments. The health status specific to patients with stable angina was assessed using the Seattle Angina Questionnaire (SAQ). Information on socio-demographic, clinical, and lifestyle factors were also collected. Nested regressions were performed to explore how these factors were associated with HRQoL in patients with stable angina.

Results

Compared with the general population (44.2±10 years, 49.9% females), stable angina patients (68.1±12 years, 50.4% females) had significantly lower HRQoL scores in EQ-5D utility index (0.75±0.19 vs. 0.90±0.20, p<0.05), SF-6D utility index (0.68±0.12 vs. 0.85±0.11, p<0.05), and EQ-VAS (71.2±12.3 vs. 83.9±10.9, p<0.05). The differences remained (−0.05 for EQ-5D, −9.27 for EQ-VAS and −0.13 for SF-6D) after controlling for socio-economic characteristics. SAQ scores showed that stable angina patients experienced impaired disease-specific health status, especially in angina stability (40.5±34.6). Nested regressions indicated stable angina-specific health status explained most of the variation in HRQoL, among which disease perception, physical limitation, and angina stability were the strongest predictors. More physical exercise and better sleep were positively related with HRQoL.

Conclusions

Compared to the general population, stable angina patients were associated with lower HRQoL and lower health utility scores, which were largely impacted by clinical symptoms. Further studies are needed to characterize the influence of geographic and cultural factors on the variations of health-related utility in stable angina patients.

Health related quality of life and mental distress after PCI: restoring a state of equilibrium

BACKGROUND

Patient self reported measures for Health Related Quality of Life (HRQOL) and mental distress are frequently used to evaluate outcome of therapeutic strategies in cardiac patients.Our study aims to describe changes in HRQOL and mental distress after percutaneous coronary intervention (PCI) focusing on temporal pattern of change and interdependences between both outcome measures.

METHOD

163 PCI patients recruited at 7 cardiovascular care units in Austria answered MacNew Health Related Quality of Life and Hospital Anxiety and Depression Scale (HADS) questionnaires during hospital stay after intervention and at 1, 6, 12 and 24 months.

RESULTS

Improvement of MacNew HRQOL was found up to 6 month after PCI. Mental distress declined during the first month of the follow-up period. MacNew HRQOL is negatively correlated to mental distress. The relationship could be well described by a linear regression with MacNew HRQOL as dependent and HADS Total score as independent variable. The explained variance (R2) of the regression equation increases drastically from 45% at the baseline to a level between 67% and 77% in the follow up.

CONCLUSION

Our data suggest that the regression equation describing the relation between MacNew HRQOL and HADS-Total score six month after PCI defines a state of equilibrium: In absence of actual symptoms of coronary artery disease (CAD) both measures reflect the general health status and the general attitude underlying the self-assessment of health. At the baseline this equilibrium is imbalanced because the symptoms of CAD have a more pronounced impact on the disease specific MacNew HRQOL measure than on the non-disease specific HADS measure for mental distress. In order to use the MacNew questionnaire as a monitoring and/or prognostic tool it seems promising to refer to the state of equilibrium to define expectancy values for successful treatment.