Illness acceptance, hospitalization stress and subjective health in a sample of chronic patients admitted to hospital

Psychological state and predictors of psychiatric morbidity in COVID-19 patients six weeks after discharge

To be able to detect possible psychological distress and long-term deterioration caused by COVID-19, following the patient, who has recovered, is crucial. Therefore, this study (i); aims to examine the ongoing fear-loss of control, the rate of anxiety, depression, and post-traumatic stress disorder levels following the 6th week after discharge; (ii) to examine the effect of post-traumatic stress disorder on anxiety, and depression and (iii) within the same context to reveal the developmental markers of psychiatric morbidity and the risk group. The study includes 180 patients who were hospitalized with COVID-19 diagnosis. Sociodemographic Data Form, the Hospital Anxiety Depression Scale and the Impact of Event Scale-Revised were used in the current study. High rates of symptoms of anxiety, depression, and PTSD were reported by the inpatients, as more than one-third scored above the anxiety and depression cut-off scores of borderline abnormal and abnormal. Also, 37.22 % of the participants reported the likely presence of PTSD symptoms. Anxiety and depression were significantly positively related to the symptoms of PTSD. The results suggest that there is psychiatric morbidity in anxiety, depression, and post-traumatic stress disorder and that especially posttraumatic stress poses a risk for other psychopathologies.

Sexual Well-Being in Individuals with Schizophrenia: A Pilot Study on the Role of Self-Esteem and Acceptance of Illness

Schizophrenia is one of the most severe chronic mental illnesses. It drastically changes an individual's life and well-being. Sexual well-being in schizophrenia is often sidelined, even though it is one of the main areas for maintaining quality of life. Based on the conservation of resources theory (COR) and empirical data, we assume that self-esteem and acceptance of illness help in coping with schizophrenia and maintaining sexual well-being. This pilot study aimed to determine the relationship between self-esteem, acceptance of illness, and sexual well-being in Polish individuals with schizophrenia. The results of 60 individuals were included in this study. In the present study, the Self-Esteem Scale (SES), Acceptance of Illness Scale (AIS), and Short Sexual Well-Being Scale (SSWBS) were used. The study showed a significant association between self-esteem, acceptance of illness, and sexual well-being. Self-esteem (β = 0.62) and acceptance of illness (β = 0.55) acted as positive and significant predictors of sexual well-being in individuals with schizophrenia. Acceptance of illness was also found to play a mediating role between self-esteem and sexual well-being in people with schizophrenia (indirect effect: β = 0.34; LLCI = 0.063; ULCI = 0.839). The current pilot study demonstrates the relationship between self-esteem, acceptance of illness, and sexual well-being. Our findings highlight the significant role of acceptance of illness in maintaining sexual well-being among individuals with schizophrenia.

In-hospital stress and patient outcomes: A systematic review and meta-analysis

BACKGROUND

Hospital inpatients are exposed to high levels of stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (known as post-hospital syndrome). However, the existing evidence base has not been reviewed and the magnitude of this relationship remains unknown. Therefore, the aim of the current systematic review and meta-analysis was to: 1) synthesise existing evidence and to determine the strength of the relationship between in-hospital stress and patient outcomes, and 2) determine if this relationship differs between (i) in-hospital vs post-hospital outcomes, and (ii) subjective vs objective outcome measures.

METHODS

A systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, and Web of Science from inception to February 2023 was conducted. Included studies reported a measure of perceived and appraised stress while in hospital, and at least one patient outcome. A random-effects model was generated to pool correlations (Pearson's r), followed by sub-group and sensitivity analyses. The study protocol was preregistered on PROSPERO (CRD42021237017).

RESULTS

A total of 10 studies, comprising 16 effects and 1,832 patients, satisfied the eligibility criteria and were included. A small-to-medium association was found: as in-hospital stress increased, patient outcomes deteriorated (r = 0.19; 95% CI: 0.12-0.26; I2 = 63.6; p < 0.001). This association was significantly stronger for (i) in-hospital versus post-hospital outcomes, and (ii) subjective versus objective outcome measures. Sensitivity analyses indicated that our findings were robust.

CONCLUSIONS

Higher levels of psychological stress experienced by hospital inpatients are associated with poorer patient outcomes. However, more high-quality, larger scale studies are required to better understand the association between in-hospital stressors and adverse outcomes.

The impact of logo-therapy on disease acceptance and self-awareness of patients undergoing hemodialysis; a pre-test-post-test research

BACKGROUND

Acceptance is considered a key variable in chronic diseases such as chronic renal failure. To achieve adaptation and acceptance, people face obstacles, and identifying these obstacles primarily requires self-awareness. logo-therapy can help a person achieve this goal. To this end, this study aimed to investigate the effect of logo-therapy on disease acceptance and self-awareness of patients undergoing hemodialysis referred to a medical centers supervised by Kerman medical science university in 2021.

METHODS

This quasi-experimental study was conducted with a pre-test-post-test research design on 80 patients with chronic renal failure undergoing hemodialysis in Kerman. The patients who met the inclusion criteria were selected using convenience sampling and were then randomly assigned to intervention and control groups (40 patients in each group). The logo-therapy training program was performed for the participants in the intervention group during 4 sessions of 45-60 min, individually and three times a week. The instruments used for data collection were a demographic information questionnaire, the Acceptance of Illness Scale (AIS), and the Self-Awareness Outcomes Questionnaire (SAOQ). The collected data were analyzed using SPSS software (version 22).

RESULTS

The analysis didn't show a significant difference in the acceptance of illness scores in the intervention group before and after the intervention (P > 0.05). Besides, a statistically significant difference was observed between the intervention and control groups in terms of self-awareness, indicating that the intervention improved the dialysis patients' self-awareness (P < 0.05). Also, the patients' age, marriage length, and the number of children had statistically significant correlations with self-awareness and acceptance (P < 0.05).

CONCLUSION

The results of this study showed that meaning therapy intervention can positively affect disease acceptance and self-awareness of patients undergoing hemodialysis. Since logo-therapy has been effective in other patients and the patients in this study, health officials and managers are recommended to use this intervention method to promote disease acceptance and self-awareness in these patients.

Level of Acceptance of Illness and Its Association with Quality of Life among Patients with Epilepsy in North Shewa, Ethiopia

Acceptance of illness is regarded as an indicator of functioning and predictor of quality of life. However, quality of life of patients with epilepsy in sub-Saharan countries worsen because of low medication adherence, increased morbidity and mortality, and the stigmatization associated with the disease. This research is aimed at assessing the level of acceptance of illness of patients with epilepsy and associated quality of life in North-East Ethiopia. Methods. A cross-sectional study was conducted from January to June 2021 at the Debre Berhan Referral Hospital, North-East Ethiopia. A total of 78 patients with epilepsy aged more than 18 years were randomly selected and assessed using Quality of Life in Epilepsy Inventory 31 and acceptance of illness scale. In addition, authors owned questionnaire were used to evaluate the sociodemographic and clinical characteristics of the patients. P value < 0.05 at 95% confidence level was considered to be statistically significant in all the analysis. Result. The study participants' age varied between 18 and 67 years with the mean age of 28.9 years. Phenobarbital was the most used (73.9%) antiepileptic drug, and 68.7% (n = 66) of the patients seizure was controlled. 72.9% (n = 70) of the patients had medium acceptance of illness (scored 20-30), while 17.7% (n = 17) had low illness acceptance level (scored 8-19), and 9.4% (n = 9) had high acceptance of illness (scored 31-40). The mean of overall acceptance of illness among epileptic patients was 21.04 ± 7.21. The overall score of QOLIE-31 was 79.14 ± 25.46, and the highest mean score was for cognitive (83.5 ± 27.1), while the lowest mean score was that of medication effect (72.7 ± 28.7). Five of the seven QOLIE-31 components correlated significantly with level of acceptance of illness. Cognitive domain (r = 0.498, p < 0.001) demonstrated the highest correlation followed by overall quality of life (r = 0.489, p < 0.001), seizure worry (r = 0.433, p < 0.001), energy/fatigue (r = 0.342, p < 0.001), and emotional well-being (r = 0.278, p < 0.001). Conclusion. Patients with epilepsy in the study area had medium acceptance of illness, and nearly half of them had mean and more than the mean quality of life. The patients' acceptance of illness was significantly associated with overall quality of life, seizure worry, emotional well-being, and cognitive domain of the patients.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus: A cross-sectional study

Objectives

To explore the relationship between acceptance of illness and quality of life (QOL), and factors associated with acceptance of illness among men who have sex with men (MSM) living with human immunodeficiency virus (HIV).

Methods

Three hundred and one MSM were recruited from an HIV clinic between August and December 2018. The battery of measurements consisted of the Acceptance of Illness Scale, World Health Organization Quality of Life Questionnaire for HIV brief version, HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information. Pearson correlation test was used to examine the relationship between acceptance of illness and QOL. Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data (demographic and HIV-related clinical data) and HIV cognitive appraisal were associated with acceptance of illness levels.

Results

Descriptive analysis showed the acceptance level among MSM living with HIV was moderate (Mean = 26.29, SD = 5.28). Those with a better acceptance of illness had a better QOL (r = 0.69, P < 0.01). In the multivariate ordinal logistic regression model, education level, threat appraisals (OR:1.09; 95%CI [1.06–1.13]), and controllability appraisals (OR: 0.82; 95%CI [0.71–0.94]) were significantly associated with acceptance of illness.

Conclusions

Results showed acceptance level was moderate and had a positive correlation with QOL. High level of education, low threat appraisals and high controllability appraisals were related to high illness acceptance. This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Psychosocial Adaptation to Chronic Illness and Disability: An Updated and Expanded Conceptual Framework

The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.

Psychological outcomes after hospitalization for COVID-19: data from a multidisciplinary follow-up screening program for recovered patients

Patients who are hospitalized for coronavirus disease 2019 (COVID-19) face an extremely stressful experience that might challenge their mental health. The study aims to describe the psychological condition of recovered patients, focusing on anxiety and depression symptoms, as well as post-traumatic stress. All the recovered COVID-19 patients who accessed to a multidisciplinary follow-up screening program scheduled within two months after their hospital discharge were included. As far as the psychological assessment, patients completed the Hospital Anxiety and Depression Scale and the Impact of Event Scale- Revised for post-traumatic stress. Socio-demographic and clinical data (days of hospitalization, intensity of received care, and number of supportive sessions with the hospital psychologist after the hospitalization) were collected. Descriptive, correlation and regression analyses were conducted. The sample includes 261 patients (68.2% men), aged between 23 and 90 (mean=58.9 st. dev=13.3). High numbers of patients reported anxiety (28%) and depression symptoms (17%), as well as post-traumatic stress (36.4%). Impaired outcomes were associated with female gender, while patient's age was found to be negatively correlated with anxiety symptoms. 13.8% of patients underwent a psychological visit and 6.1% of them were taken in charge for psychological support. Few months after hospital discharge, individuals recovered by COVID-19 reported negative consequences on their mental health. Understanding the impact that COVID-19 and hospitalization have on recovered patients may provide insights about how to develop an effective psychological intervention to help them deal with such psychological distress and prevent further psychopathological effects.

Couples coping with sensory loss: A dyadic study of the roles of self- and perceived partner acceptance

OBJECTIVES

Hearing-, vision-, and dual-sensory loss have been linked to relational and psychological distress among adults with sensory loss (AWSLs) and their spouses. Regardless, research on factors associated with couples' adjustment is lacking. This study examined the stability and strength of associations between self-acceptance of sensory loss, perceived partner acceptance of sensory loss, and relationship satisfaction and psychological distress among AWSLs and their spouses over time.

DESIGN

A total of 122 AWSLs and their spouses completed an online survey at two time points over a 6-month period.

METHODS

A multigroup (i.e., time 1 and time 2) actor-partner interdependence model assessed the stability and strength of actor and partner effects of self-acceptance and perceived partner acceptance on each partner's relationship satisfaction and psychological distress over time.

RESULTS

No moderation by time was identified, indicating stability in associations over the 6-month period. Overall, both actor and partner effects were evident. Specifically, self-acceptance among AWSLs was inversely associated with own psychological distress and the relationship satisfaction of spouses. Self-acceptance by spouses was inversely associated with the psychological distress of AWSLs and spouses. Perception of spouse acceptance by AWSLs was positively associated with own and spouse relationship satisfaction.

CONCLUSIONS

Interventions targeting acceptance that incorporate a family systems perspective may be beneficial in alleviating psychological and relational distress among couples coping with sensory loss. Statement of contribution What is already known on this subject? The experience of hearing and/or vision loss has been linked to heightened distress both psychologically and within intimate relationships. Prior research has demonstrated a link between an individual's ability to accept their sensory loss and healthier well-being. What does this study add? This is the first dyadic study of sensory loss acceptance and its link to relationship satisfaction and distress. Acceptance operates interpersonally protecting against distress for those with sensory loss and their spouses. Perceiving that one's spouse accepts the sensory loss is important for both partner's relationship satisfaction.

'What does that mean?': a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK

OBJECTIVES

To explore the clinical care experiences of young people with continence problems.

DESIGN

In-depth semistructured qualitative interviews were conducted by Skype and telephone, with the addition of art-based participatory research techniques. Transcripts were analysed using inductive thematic analysis.

SETTING

Primary and secondary care in the UK.

PARTICIPANTS

We interviewed 20 participants (9 females, 11 males) aged 11-20 years. There were six participants with bedwetting alone, five with daytime wetting alone, five with combined (day and night) wetting and four with soiling.

RESULTS

We identified four themes: appointment experiences, treatment experiences, engagement with treatment and internalisation and externalisation of the continence problem. Patient-focused appointments using age-appropriate language were highly desirable. Continuity of care was highlighted as an important aspect of positive clinical experiences; however, this was found to be rare with many participants seeing a different person on each visit. Participants had tried a wide range of treatments for their continence problems with varying degrees of success. Relapse and treatment failure were common. Experiencing relapse was distressing and diminished participants' belief in the success of future treatments and undermined adherence. Participants would be seen to adopt two opposing coping strategies for dealing with their continence problem- internalisation and externalisation.

CONCLUSION

Incontinence in young people is challenging to manage. Young people may need to try a range of treatments before their symptoms improve. Due to challenges in treatment, there is an increased risk of poor adherence. During patient-focused appointments, clinicians should work to build rapport with patients and use age-appropriate language. Involving young people in their own care decisions is important. The way in which young people understand their continence problem can influence their coping strategies and adherence to treatment regimes.

Adaptation to illness in relation to pain perceived by patients after surgery

Background

Pain is one of the factors that decrease quality of life. Undergoing surgery is inevitably associated with the sensation of pain, which can affect a patient’s level of acceptance of an illness. The aim of the study was to evaluate the level of acceptance of illness in patients undergoing surgical treatment with relation to the pain perceived by them during surgical treatment and to determine other factors that affect adaptation to illness among patients subjected to invasive treatment.

Material and methods

The study was conducted on a group of 100 patients with mean age of 51.27 (SD=18.98) hospitalized in surgery departments in the Provincial Specialist Hospital in Wrocław, Poland, in April 2016. The Acceptance of Illness Scale (AIS) and the Visual Analog Scale (VAS) for pain were used.

Results

The mean score of VAS was 3.86 (SD =2.02). The mean score of AIS was 24.42 (SD =7.35). The level of acceptance of illness was significantly negatively correlated with the intensity of pain (p<0.001; r=−0.498), the number of coexisting diseases (p=0.002; r=−0.31), age (p<0.001; r=−0.391), and the period of time since the operation (p=0.007; r=−0.266). Patients taking analgesics showed a significantly lower acceptance of illness than those who did not (p=0.009). A patient’s place of living, education, and sex had no significant impact on their acceptance of illness.

Conclusion

A higher level of pain translates into a lower adaptation to illness despite the use of analgesics, which may indicate that inadequate pain control leads to a decrease in the acceptance of illness. Further research on monitoring postoperative pain, as well as the development of postoperative prevention programs, is required.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature

BACKGROUND

Increased life expectancy has led to an increase in diagnoses of chronic illness in people with an intellectual disability; despite this increase, research about the psychological impact is rare. This review explored the psychosocial experiences of chronic illness in adults with an intellectual disability, revealing potential predictors and moderators of these experiences.

METHODS

Online databases were systematically searched to identify relevant literature, using predefined inclusion criteria. Of the 25,058 titles initially identified, 4 were included, that is, those collecting data on people with an intellectual disability and diagnosed with cancer (n = 2), chronic pain (n = 1) and diabetes (n = 1).

RESULTS

Narrative synthesis of the data identified six themes, namely, (1) delayed diagnosis, (2) information, communication and understanding, (3) negative psychological consequences, (4) negative physical consequences, (5) social perception and (6) social support.

CONCLUSIONS

There are unmet needs within this population, including a lack of assistance in understanding their illness. A substantial gap in the literature should be addressed through further empirical work.

The potential of psychological interventions to improve quality of life and mood in muscle disorders

Quality of life (QoL) and mood are reduced in many patients with muscle disorders. Psychological variables appear to be contributors to both QoL and mood, suggesting that psychological interventions could improve these outcomes, yet research in this area is sparse. We review the roles of psychological variables, plus context and disease severity, in explaining QoL. A cognitive-behavioral model of disease self-management, with acceptance as the central component, is discussed. This model is then used to describe how psychological interventions derived from cognitive behavioral therapy (CBT), in particular Acceptance and Commitment Therapy (ACT), might be applied to address the issues of distress, nonadherence to treatments, pain, and fatigue in people with muscle disorders.

Determinants of patients' attitudes toward patient-centered care: a cross-sectional study in Greece

OBJECTIVE

The aim of this study was to investigate - for the first time in Greece - patients' attitudes toward patient-centered care, by identifying the impact of socio-demographic factors, health condition, social support and religious beliefs.

METHODS

454 Hospitalized patients were interviewed on the first day of their scheduled admission, answering demographic questions and the following questionnaires: Patient-Practitioner Orientation Scale (PPOS), Autonomy Preference Index (API), Short Form SF-12v2 Health Survey, God Locus of Health Control (GLHC) and Perceived Available Support (PAS).

RESULTS

Mean PPOS and API scores were: PPOS Sharing 3.4 (sd=0.69), Caring 3.99 (sd=0.76), API Information-Seeking 88.32 (sd=9.35) and Decision-Making 51.19 (sd=9.27). Higher desire for information was associated with younger age, more years of education, weaker spiritual faith in healing and worse subjective health status. Higher expectations for caring physicians were correlated with older age, more years of education, higher perceived social support and weaker spiritual faith in healing.

CONCLUSION

Age, years of education, health status, social support and religious beliefs are determinants of patient-centered attitudes.

PRACTICE IMPLICATIONS

Patients expect to be informed, although they do not equally want to be involved in decision-making. Religious faith and perceived social support should be taken into consideration to further understand patients' needs.

Assessing the stages of the grieving process in chronic obstructive pulmonary disease (COPD): validation of the Acceptance of Disease and Impairments Questionnaire (ADIQ)

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) encounter many (gradual) losses due to their disease, which trigger a grieving process. This process is characterized by stages of denial, resistance, sorrow, and acceptance.

PURPOSE

This study examined whether these stages are conceptually distinct and whether the Acceptance of Disease and Impairments Questionnaire (ADIQ) can validly and reliably measure these stages in three samples of patients with COPD in the Netherlands.

METHODS

Exploratory factor analysis (EFA) was performed on 145 outpatients with moderate to severe COPD. Confirmatory factor analyses were performed on 303 outpatients with mild to very severe COPD and 127 patients entering an inpatient pulmonary rehabilitation program. Furthermore, internal reliability, construct validity, sensitivity to change, and floor and ceiling effects were examined.

RESULTS

EFA yielded a four-factor solution that explained 73.2 % of variance. Confirmatory factor analyses showed a good fit of the four-factor structure in all study samples. Cronbach's alpha reliability coefficients were .79 or higher. Subscales showed to be sensitive to change.

CONCLUSIONS

Four distinct stages of grief are recognized in COPD. The ADIQ is a valid and reliable instrument to measure these stages: denial, resistance, sorrow, and acceptance. Measuring the stages of grieving is important for disease management: addressing patients with a specific therapeutic approach for the stage they are in could help to motivate patients to engage in self-management and change their lifestyle.

[Development of a measurement of stress for hospitalized schizophrenic patient]

PURPOSE

This study was done to develop a measurement for stress experienced by patients with schizophrenia during hospitalization.

METHODS

The preliminary tool was developed through in-depth interviews and a validity verification test of content. For data collection, 15 inpatients with schizophrenia were selected as participants for in-depth interviews and 195 patients admitted to one of eight psychiatric hospitals in four provinces were recruited as participants to test reliability and validity of the preliminary tool.

RESULTS

The questionnaire was developed as a four-point Likert-type scale in a self-report form with 28 items. Factor analysis showed 28 items in six factors. Factors were named 'Unjust human rights infringement', 'Futureless life', 'Alienation from other family members', 'Infringement of basic needs', 'Infringement of personal preference' and 'Inconvenience of shared living'. The six factors explained 63.5% of the total variance. Cronbach's alpha for the total items was .93 and for the factors ranged from .65 to .87.

CONCLUSION

A tool to measure stress in patients hospitalized with schizophrenic was developed based on identified hospitalization stress experiences. Study results indicate that this tool can be used to evaluate hospitalization stress in these patients and will contribute to establishing nursing interventions for relief of hospitalization stress.

The mental health of asbestos-exposed subjects with pleural abnormalities

PURPOSE

To examine the effect of knowledge of radiographic abnormalities on the mental health of asbestos-exposed people with and without pleural abnormalities.

METHODS

Subjects were former asbestos mine and mill workers and residents of the mining town who had participated in an annual health review program. Pleural abnormalities (pleural plaques, diffuse pleural thickening and asbestosis) were determined from plain chest X-rays. All Participants completed a questionnaire on mental health status (SF-12) and locus of control (LOC).

RESULTS

There were no significant differences between asbestos-exposed people with and without radiographic abnormalities for either the SF-12 mental health score or LOC. However, the asbestos-exposed cohorts had lower mental health scores compared with a random sample of the local population.

CONCLUSION

The presence of pleural abnormalities did not further affect the mental health of asbestos-exposed people beyond a decrement associated with exposure per se.

Negative life events and migraine: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data

Background

Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

Methods

ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity.

Results

We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19 – 1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47 – 1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25 – 1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09 – 1.75) in full-adjusted model.

Conclusions

The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.

Self-esteem and illness self-concept in emerging adults with Type 1 diabetes: Long-term associations with problem areas in diabetes

This long-term prospective study examined whether illness self-concept (or the degree to which chronic illness becomes integrated in the self) mediated the pathway from self-esteem to problem areas in diabetes in emerging adults with Type 1 diabetes. Having a central illness self-concept (i.e. feeling overwhelmed by diabetes) was found to relate to lower self-esteem, and more treatment, food, emotional, and social support problems. Furthermore, path analyses indicated that self-esteem was negatively related to both levels and relative changes in these problem areas in diabetes over a period of 5 years. Illness self-concept fully mediated these associations.

Development and validity of the Patient-centred COPD Questionnaire (PCQ)

OBJECTIVE

COPD-guidelines recommend regular evaluation of both the degree of airway obstruction and health-status to provide adequate treatment. Numerous health-status questionnaires have been developed of which the 'Clinical-COPD-Questionnaire' and the 'COPD-Assessment-Test' are best known; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the 'Patient-centred-COPD-Questionnaire' (PCQ).

METHODS

Six focus groups with COPD patients and (lung) health care providers from primary, secondary and tertiary (rehabilitation) care were formed to discuss aspects of COPD most relevant to patients' daily lives. Eighty candidate items were derived for explorative factor analyses (EFA) to test their psychometric properties (study I, n=541). These resulted in an 18-item scale that was further explored by confirmatory factor analyses (CFA) and construct and concurrent validity assessment (study II, n=412).

RESULTS

EFA in study I suggested a reliable three component solution ('shortness of breath', 'acceptance of COPD' and 'confidence in care'). In study II this model was confirmed with CFA, and significant and clinically relevant correlations were found between the PCQ subscales, and other COPD specific and general health questionnaires. Furthermore, multivariate analyses of covariance revealed that more severely ill patients reported more impairment.

CONCLUSIONS

The PCQ is a questionnaire with three dimensions to assess the impact of COPD on daily life that is easy to complete. For the first time, a dimension referring to 'confidence in care' is included in a tool that assesses COPD-related impairment.

The psychological well-being of couples experiencing a chronic illness: A matter of personal and partner illness cognitions and the role of marital quality

This study aimed to examine the effects of 75 cardiac patients’ and their spouses’ illness cognitions of acceptance and helplessness on their own and their partner’s psychological symptoms, as well as the impact of marital quality. Dyadic responses were examined with the Actor–Partner Interdependence Model, while PROCESS was used to examine possible conditional indirect effects. Patients’ and spouses’ cognitions were related to their partners’ symptoms through the partners’ cognitions. These relationships were not statistically significant at the higher levels of marital quality. Thus, there seems to be a flow of information between partners, while marital quality may impact self-regulation processes.

Gender differences in perception of quality of life in adults with and without chronic health conditions: the role of depressive symptoms

Previous studies have shown that chronic conditions have a negative impact on quality of life. Furthermore, this impact appears to be different in males and females, but it is not yet clear what factors may mediate this relationship. Females with chronic health conditions had poorer quality of life in the physical and psychological domains as compared to males with chronic health conditions. The difference between male and female patients in the psychological domain disappeared when the analysis was adjusted for confounding factors such as age, presence of a chronic health condition, socioeconomic status, and depressive symptoms.

Mood symptoms and personality dimensions as determinants of health-related quality of life in patients with coronary artery disease

This study examined the effects of personality dimensions in relation to the symptoms of depression and anxiety on health-related quality of life in coronary artery disease patients (N = 514). A linear regression analysis showed that symptoms of depression and anxiety as well as personality trait of emotional stability have independent significant effect on the health-related quality of life in patients with coronary artery disease. Psychological interventions in coronary artery disease patients should not only be limited to the treatment of symptoms of depression and anxiety but should also be extended to the management of personality traits.

Assessing nonacceptance of the facial appearance in adult patients after complete treatment of their rare facial cleft

BACKGROUND

Treatment of patients with severe congenital facial disfigurements is aimed at restoring an aesthetic and functional balance. Besides an adequate level of satisfaction, an individual's acceptance of facial appearance is important to achieve because nonacceptance is thought to lead to daily psychological struggles. This study objectified the prevalence of nonacceptance among adult patients treated for their severe facial clefts, evaluated risk factors, and developed a screening tool.

METHODS

The study included 59 adults with completed treatment for their severe facial cleft. All the patients underwent a semistructured in-depth interview and filled out the Body Cathexis Scale.

RESULTS

Nonacceptance of facial appearance was experienced by 44% of the patients. Of the nonaccepting patients, 72% experienced difficulties in everyday activities related to their appearance versus 35% of the accepting patients. Acceptance did not correlate with objective severity or bullying in the past. Risk factors for nonacceptance were high self-perceived visibility, a troublesome puberty period, and an emotion-focused coping strategy. Also, the presence of functional problems was shown to be highly associated.

CONCLUSIONS

The objective severity of the residual deformity did not correlate with the patients' acceptance of their facial appearance, but the self-perceived visibility did correlate. The process of nonacceptance resembles the process seen in patients with body dysmorphic disorders. Surgical treatment is no guarantee for an improvement in acceptance and is therefore discouraged for patients who match the risk factors for nonacceptance unless it solves a functional problem. The authors therefore recommend screening patients for nonacceptance and considering psychological treatment before surgery is performed.

LEVEL OF EVIDENCE III

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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.