The self-regulatory model in women with rheumatoid arthritis: Relationships between illness representations, coping strategies, and illness outcome

How I see is how I feel. Identification of illness perception schema and its association with adaptation outcomes in multiple sclerosis - a 5-year prospective study

The aim of the study was to assess the role of illness perception in adaptation to chronic disease among patients with relapsing-remitting multiple sclerosis (RRMS). The differences between the obtained configurations of the illness perception components during four measurements and the model of predictions of the values of adaptation indicators, i.e. depression, anxiety and quality of life during subsequent measurements, were analyzed. Illness representation was assessed at baseline via the Illness Representation Questionnaire–Revised. The adaptation indicators–anxiety, depression (measured by HADS) and quality of life (measured by MSIS-29) were measured at baseline and three more times over a five-year period. The k-means cluster analysis (with two-way and repeated measures ANOVA) was conducted in a group of 90 patients (48.89% women and 51.11% men). Subsequently, the mean values of depression, anxiety, physical and psychological quality of life were compared between the clusters using the Kruskall-Wallis test. Finally, a cross-lagged panel modeled for HADS and MSIS-29 subscales in each measurement occasion (T1-T4). Three different illness perception clusters (Anxious, Realistic and Fatalistic Illness Perception named AIP, RIP and FIP) were composed which differentiated the depression, anxiety, quality of life level and age. FIP showed the lowest adaptation outcomes with small differences between AIP and RIP. It was also significantly characterized by the highest age. The positive adaptation indicators were related to the RIP cluster. The model presented rather satisfactory fit (χ²(48) = 81.05; CFI = .968; TLI = .925; SRMR = .050) with slightly inflated RMSEA = .087 (90%CI .053-.120). Based on initial measurements of individual characteristics, it was possible to predict the functioning of patients after several years. For patients with AIP, the covariance of anxiety and depression was significant, for patients with RIP–depression and anxiety, and for patients with FIP–depression. In addition, each of the variables was a predictor of subsequent measurements in particular time intervals, illustrating the dynamics of changes. Results highlight that illness perceptions formed at the beginning of RRMS are important for the process of adaptation to the disease. Moreover, they showed the differences between the adaptation outcomes supporting the idea that a cognitive representation might be important for the level of psychological functioning.

HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu's arteritis

INTRODUCTION/OBJECTIVES

The aim of this study was to evaluate the relationships among the disease activity, illness perception, daily life performance, anxiety and depression status as potential mediators in Takayasu's arteritis (TAK) patients.

METHOD

In this cross-sectional study, 77 TAK patients were included. Data were collected by a clinical examination and a structured questionnaire regarding patient reported outcome measures (PROMs). Indian Takayasu's Arteritis Activity Score2010 (ITAS2010) was used to assess the disease activity (0: inactive vs ≥ 1: active). Illness Perception Questionnaire-Revise (IPQ-R), Work Productivity and Activity Impairment (WPAI) and Hospital Anxiety and Depression Scale (HADS) as PROMs were used to understand for the patient' perspective. After preliminary analysis, complex relationships among these variables were evaluated by mediation analyses in the study.

RESULTS

WPAI-Daily impairment score, HADS-A and HADS-D scores as well as IPQ-R Consequence score were found be high in active TAK patients (p = 0.008; p = 0.001; p = 0.031; p = 0.001). HADS-D score was also correlated with WPAI-Daily impairment score and IPQ-R Consequence score (p < 0.05). In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity (ITAS2010) (p = 0.0173) and indirectly mediated through HADS-D score (p = 0.0003). Similarly, HADS-D score was associated with poor WPAI-Daily impairment score in the mediation analysis in the indirect path (p = 0.0069). Disease activity (ITAS2010) also increased WPAI-Daily impairment score in direct path (p = 0.043).

CONCLUSIONS

Active TAK patients perceived their illness more seriously and experienced more impairment in their daily life. Depression status as the mediator influenced them poorly. These interactions could give clues to improve PROMs in the clinical practice. Key Points •IIness perception, disease activity, mental status and daily life performance, assessed as patient-reported outcome measures, have a complex relationship in Takayasu's arteritis. •IPQ-R Consequence score, WPAI-Daily impairment score, HADS-Depression and HADS-Anxiety scores were found be high in active TAK patients. •In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity and indirectly mediated through HADS-D score. Similarly, disease activity increased WPAI-Daily impairment score in direct and HADS-D in indirect paths.

Gaining Longitudinal Accounts of Carers' Experiences Using IPA and Photograph Elicitation

Fluctuations in positive and negative caregiving experiences remain only partially explained as the significant variability over time of potential predictive factors themselves is understudied. The current study aims to gain considerable insight into caregiving experiences and perceptions over time by using photovoice methodology to support semi-structured interviews. A case study, longitudinal design is taken with three female caregivers who provide detailed insight into their caregivers' experiences over a 12 month period. The interview transcripts were analyzed using IPA- Interpretative Phenomenological Analysis. This innovative combination of methods resulted in the emergence of three related themes which included consuming the role, feeling consumed by the role, and letting go of the role. The idiographic approach taken allowed both within case differences to be examined over time, and also between carer differences to be highlighted. Implications of illness type and its characteristics, and of attachment and relationship quality with the care recipient were seen in terms of how and when the caregivers moved between the themes identified. The use of others' support or respite care is examined vis-a vis caregiver's own beliefs, emotions, relationship attachment and motivations to care. Caregivers self-efficacy beliefs also shifted over time and were influential in caregiver experience as the care recipient condition or needs changed. No previous studies have found that negative caregiving consequences are, in part, under volitional control and yet our data on the underlying reasons for consuming caregiving or allowing themselves to consume, would suggest this may in part be true. This is important because it suggests that interventions to support caregivers should address relational and motivational factors more fully.

Perception of Multiple Sclerosis Impact and Treatment Efficacy Beliefs: Mediating Effect of Patient's Illness and Self-Appraisals

CONTEXT

Patients with multiple sclerosis (MS) experience many negative, seriously aggravating disease symptoms, and hence, research studies are utmost required to improve their coping with symptoms. Our research is an attempt to show ways to increase participation of patients with MS in the treatment and treatment planning process, as well as in managing the symptoms of the disease.

OBJECTIVES

To examine the relationship between perception of MS impact and treatment efficacy beliefs in patients with MS and the extent to which self and illness appraisals can be regarded as mediator variables in this relationship.

METHODS

The cross-sectional study included 278 MS patients who completed the Treatment Beliefs Scale, Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and Brief Illness Perception Questionnaire. Demographic and clinical characteristics of the participants were collected with a self-report survey.

RESULTS

Illness perception and general self-efficacy mediated the relationship between perception of MS impact and treatment efficacy beliefs under the control of age and time from diagnosis. The standardized indirect effects for illness perception and general self-efficacy were -0.131 95% CI [-0.2029, -0.0739] and -0.086 95% CI [-0.1663, -0.0165], respectively.

CONCLUSION

Our results indicate that worse perception of physical condition in patients with MS is associated with more negative treatment efficacy beliefs, and that this association is mediated by self-efficacy and illness perception. To inhibit the increase of negative treatment efficacy beliefs, health care specialists can work on improving self-efficacy and illness appraisals.

Mental Health and Rheumatoid Arthritis: Toward Understanding the Emotional Status of People with Chronic Disease

Introduction

Rheumatoid arthritis (RA) is a long-term disorder significantly impairing the somatic, emotional, and psychological functioning of its sufferers. Previous research has shown that affected individuals are characterized by an increased level of anxiety and depression. Currently, there are two main treatment schemes for RA; the first uses anti-inflammatory drugs, and the second utilizes biologic agents. This begs the question whether sufferers differ in intensities of pain, anxiety, and depression depending on the type of treatment and what the determinants of these affective states in patients treated using different methods are.

Methods

The study comprised 85 patients affected by RA (including 57 receiving biologically inactive medication). Research participants filled out a set of questionnaires measuring levels of anxiety and depression, intensity of experienced pain, strategies of coping with pain, and ego resiliency.

Results

The collected data was analyzed through intergroup comparisons, calculating simple correlation coefficients, developing and solving regression equations. The results imply that the choice of treatment differentiates the intensity of pain experienced by patients. Those receiving biologic agents reported lower levels of pain compared to those taking anti-inflammatory medication. It has also been noted that there are distinct configurations of conditions conducive to anxiety and depression in both anti-inflammatory and biologic agent groups.

Discussion

The observed constellation of dependencies between variables indicates that the choice of treatment scheme differentiates pain levels. This confirms the assumption that pain intensity, coping strategies, and ego resiliency depend on the severity of anxiety and depression.

A cross-sectional study on self-reported physical and mental health-related quality of life in rheumatoid arthritis and the role of illness perception

BACKGROUND

Psychosocial models including illness perception might explain individual differences in health-related quality of life (HRQoL) and daily functioning in chronically ill patients. The aim of this study was to assess the association of illness perception among rheumatoid arthritis (RA) patients with physical and mental HRQoL, adjusted for demographic variables, clinical variables and social support.

METHODS

A cross-sectional study conducted at a Viennese rheumatology outpatient clinic on 120 RA patients. Participants completed questionnaires on demographic and clinical characteristics, HRQoL (SF-36 Questionnaire), illness beliefs (Brief Illness Perception Questionnaire) and social support (Social Support Scale-8). Analyses were performed with multivariate linear regression.

RESULTS

The mean physical was lower (38.38) than the mean mental SF-36 summary score (46.94). In univariate analysis, all domains of illness perception except belief in a chronic disease course were associated with physical and mental HRQoL. In multivariate analyses, illness perception accounted for 51% of variance in physical HRQoL. A stronger belief in the consequences of RA (consequences, β = - 0.33) and a stronger belief in repeated disease recurrence (timeline cyclical, β = - 0 .31) were significantly associated with physical HRQoL in the fully adjusted model. Illness perception accounted for 45% of variance in mental HRQoL. Emotional representation (β = - 0 .27) and fatigue (β = - 0 .36) were significantly associated with mental HRQoL in the fully adjusted model.

CONCLUSION

This study highlights the importance of RA patients' beliefs about their illness and symptoms in relation to HRQoL. Identification of patients' perception of RA may be a way to positively influence disease outcomes such as quality of life as illness perception is amenable to intervention.

Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations

OBJECTIVES

Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

DESIGN AND MAIN OUTCOME MEASURES

This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

METHODS

To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

RESULTS

On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

CONCLUSION

IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.

Exploring Symptom Severity, Illness Perceptions, Coping Styles, and Well-Being in Gastroparesis Patients Using the Common Sense Model

AIMS

This study aimed to examine the relationships between gastroparesis symptom severity, illness perceptions, coping styles, quality of life (QoL), and psychological distress in patients with gastroparesis, guided by the common sense model.

METHODS

One hundred and seventy-nine adults with gastroparesis (165 females, 14 males; mean age 41.82 years) completed an online questionnaire. The Gastroparesis Cardinal Symptom Index was used to measure gastroparesis symptom severity, QoL was explored using the PAGI-QOL, illness perceptions were measured using the Brief Illness Perception Questionnaire, the Carver Brief COPE scale assessed coping styles, and psychological distress was investigated using the DASS21.

RESULTS

Structural equation modeling resulted in a final model with excellent fit. Gastroparesis symptom severity directly influenced illness perceptions (β = .52, p < .001) and QoL (β = .30, p < .001). Illness perceptions directly influenced maladaptive coping (β = - .64, p < .001), psychological distress (β = - .32, p < .001), and QoL (β = .30, p = .01). Maladaptive coping directly influenced psychological distress (β = .62, p < .001), which in turn had a direct influence on QoL (β = - .38, p < .001).

CONCLUSIONS

The final model showed that the influence of gastroparesis symptom severity on psychological distress was fully mediated by illness perceptions, while the influence on QoL was partially mediated by illness perceptions. The study provides guidance for the development of psychological interventions targeted toward improving mediating psychological factors.

Applying the Common Sense Model to predicting quality of life in alopecia areata: The role of illness perceptions and coping strategies

Applying the Common Sense Model, this cross-sectional study examines associations between illness perceptions and quality of life and the mediating role of coping in 243 adults with alopecia areata, a chronic dermatological condition. At least some QoL impairment was reported by 84 percent of participants, with 31 percent reporting very to extremely large impairment. Stronger perceptions of consequences, emotional representations, identity, and lower attribution to chance were related to more impairment, with avoidant coping acting as (partial) mediator. Illness perceptions and avoidant coping seem to play an important role in QoL and are relevant intervention targets in alopecia areata.

Are Illness Perceptions Associated With Disease Activity or Psychological Well-Being in Rheumatoid Arthritis? A Study With the Evidence of Confirmatory Factor Analysis

Objectives

This study aims to assess the factor structure of the Turkish Revised Illness Perception Questionnaire (IPQ-R) in patients with rheumatoid arthritis (RA) and the relationship of illness perceptions with disease activity and psychological well-being.

Patients and methods

One hundred and fifty RA patients (8 males, 142 females; mean age 51.1±12.7 years; range 21 to 81 years) were included in the study. Confirmatory factor analysis was used to test the factor structure of the IPQ-R. Pain was assessed by visual analog scale, disease activity by Disease Activity Score 28, depression by Beck Depression Inventory, global life satisfaction by the Satisfaction with Life Scale, and illness perception by the IPQ-R.

Results

Three items (items 12, 18, 19) were deleted because of poor factor loadings. The modified 35-item model showed good reliability and discriminant validity. Beck Depression Inventory scores were correlated with identity, consequences, and emotional representations subscales positively (p<0.001); and with illness coherence subscale negatively (p<0.05). There were positive correlations between Satisfaction with Life Scale scores, and treatment control and illness coherence subscales (p<0.05). Satisfaction with Life Scale scores were negatively correlated with identity, emotional representation, and timeline acute/chronic subscales (p<0.05), and consequences subscale (p<0.001). Disease Activity Score 28 was not correlated with IPQ-R domains (p>0.05).

Conclusion

The Turkish IPQ-R appears to be a useful clinical assessment tool to evaluate RA-related illness perceptions. RA healthcare should include psychological intervention to strengthen patients' beliefs about their RA regardless of disease activity.

Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients

PURPOSE

We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual's illness perceptions as well as what coping strategies they engage in.

DESIGN

Descriptive, cross-sectional questionnaire-based study.

SUBJECTS AND SETTING

One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

METHODS

Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

RESULTS

Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

CONCLUSIONS

Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis

This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.

The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review

AIM

This systematic review examines how specific coping strategies are associated with psychological and physical outcomes in rheumatoid arthritis.

BACKGROUND AND METHODS

Rheumatoid arthritis is a long-term condition that people cope with but it is unclear whether specific coping strategies have an effect on mood and function. Therefore a systematic review was undertaken of the coping with arthritis literature and 174 studies were initially included. Further examination determined that 31 studies (11 longitudinal and 20 cross sectional) were finally included in the review. The 31 studies were clinically and methodologically diverse; therefore the analysis of results was a qualitative synthesis. Coping strategies that contributed to the prediction of outcomes were allocated to a new structure for the classification of coping.

RESULTS

The results demonstrated there was not sufficient, consistent evidence to support the overall view that individual coping strategies contributed to longitudinal outcomes in rheumatoid arthritis. However, major differences in the design of included studies may have hindered the comparison of results. There was some evidence from longitudinal studies that patients who used resting, inactivity, etc. (helplessness category) experienced negative outcomes. Avoidance (escape) was the most common overall category associated with predominantly negative outcomes in both cross-sectional and longitudinal studies.

CONCLUSIONS

There was generally limited evidence to suggest an association between coping strategies and outcomes but the design of studies and the lack of clarity about coping strategies were identified as problems. This study used a new framework for the conceptualisation of coping strategies, thus contributing to further examining the utility of coping strategies and contributing to their redefinition.

RELEVANCE TO CLINICAL PRACTICE

The use of helplessness (inactivity and passive coping) and escape/avoidant coping strategies, including denial and wishful thinking, could be identified and addressed by nurses and other health professionals to reduce the associated negative outcomes.

Erfassung von Achtsamkeit mit der deutschen Version des Five Facet Mindfulness Questionnaires (FFMQ-D)

Zusammenfassung. Achtsamkeit hat für die Gesundheitspsychologie eine immer stärkere Bedeutung, da achtsamkeitsbasierte Interventionen in der Prävention und Rehabilitation das körperliche Wohlbefinden und die Lebensqualität steigern können. Wie valide lässt sich selbstberichtete Achtsamkeit mit der deutschen Übersetzung des „Five Facet Mindfulness Questionnaire“ (FFMQ) erfassen? Der 39 Items umfassende FFMQ wurde ins Deutsche übersetzt. An einer Stichprobe von 550 studentischen Versuchspersonen wurde die dimensionale Struktur, Reliabilität und Validität der fünf Skalen bestimmt. Die Ergebnisse zeigen eine hohe Übereinstimmung mit den Validierungsstudien zur englischsprachigen Originalfassung des FFMQ. Die fünf-faktorielle Struktur konnte weitestgehend repliziert werden. Hypothesenkonform fanden sich korrelative Zusammenhänge zur psychopathologischen Symptombelastung und zu Indikatoren der psychischen Gesundheit. Mit der deutschen Version des FFMQ liegt ein valides Instrument vor, das die Erfassung der von Baer beschriebenen fünf Facetten selbstberichteter Achtsamkeit ermöglicht.

Effects of an in-hospital nursing intervention on changing illness perceptions in patients with injury

AIM

The aim of this study was to evaluate the effectiveness of a nursing intervention in changing the illness perceptions of injured patients.

BACKGROUND

Illness perceptions have been found to be among the important patient outcomes after an injury. Research has suggested that a designed intervention might be an effective means of shaping injured patients' illness perceptions.

DESIGN

An experimental study design was employed.

METHODS

A total of 82 injured patients completed this study, with 42 in the experimental group and 40 in the control group. Data were collected from 2011-2013. A trained nurse practitioner delivered an in-hospital nursing intervention according to self-regulatory theory. The outcome measure was the change in illness perceptions of injury among the patients as measured by the Chinese Illness Perception Questionnaire Revised-Trauma (the Chinese IPQ-R-Trauma), which comprises eight subscales. The experimental and control groups were followed up via telephone survey 3 months after discharge. The generalized estimating equations were used to analyse the data.

RESULTS

The results showed statistically significant differences on two subscales of the Chinese IPQ-R-Trauma, Identity and Controllability, before and after the intervention. Results for the remaining six subscales did not change significantly. The findings indicate that the intervention resulted in a decrease in injury-related physical symptoms and in increases in positive perceptions among patients about controlling their postinjury condition.

CONCLUSIONS

This nursing intervention led to changes in patients' illness perceptions and potentially improved the patients' self-regulation after their injuries. Future research can be conducted to enhance the effectiveness of the intervention protocol.

Coping strategies for health and daily-life stressors in patients with rheumatoid arthritis, ankylosing spondylitis, and gout: STROBE-compliant article

This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease. We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy. We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and reappraisal strategies were predominant when patients cope with health stressors; emotional/negative and evasive strategies predominated when coping with daily-life stressors. There was a significant association between the evasive pattern and the low short-form health survey (SF-36) scores and health stressors across the 3 diseases. Besides some differences between diagnoses, the most important finding was the predominance of the evasive strategy and its association with low SF-36 score and high level of pain in patients with gout. Patients with rheumatic diseases cope in different ways when confronted with health and daily-life stressors. The strategy of coping differs across diagnoses; emotional/negative and evasive strategies are associated with poor health-related quality of life. The identification of the coping strategies could result in the design of psychosocial interventions to improve self-management.

The Common Sense Model in early adolescents with asthma: longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping

OBJECTIVE

The present study examined the longitudinal relations between illness perceptions and asthma control and emotional problems (i.e., anxiety, depression, stress), respectively, in adolescents with asthma. Furthermore, the mediating effects of asthma-specific coping strategies on these relations were examined, as specified in the Common Sense Model (CSM).

METHODS

In 2011, 2012, and 2013, adolescents (aged 10-15) with asthma were visited at home (N=253) and completed questionnaires about their illness perceptions, asthma-specific coping strategies, asthma control, symptoms of anxiety and depression, and perceived stress. Path analyses were used to examine the direct relations of illness perceptions with asthma control and emotional problems and the mediating effects of coping strategies cross-sectionally and longitudinally.

RESULTS

Perceptions of less perceived control and attributing more complaints to asthma were associated with better asthma control. Perceptions of more concern, less coherence, and increased influence of asthma on emotional well-being were associated with more emotional problems. Longitudinally, perceptions of more treatment control and fewer concerns predicted less emotional problems over time. More worrying mediated the cross-sectional relation between perceiving more concern about asthma and less asthma control and the longitudinal relation between perceiving more concern about asthma and more emotional problems.

CONCLUSION

Illness perceptions were associated with asthma control and emotional problems; however, over time, illness perceptions only predicted changes in emotional problems. Most coping strategies did not mediate the relation between illness perceptions and outcomes. Interventions aimed to change illness perceptions in adolescents with asthma could decrease emotional problems.

Exploring caregiving experiences: caregiver coping and making sense of illness

OBJECTIVES

The current research explores how family caregivers (1) make sense of caregiving and (2) cope with their circumstance.

METHOD

We analysed semistructured interviews of 13 caregivers of people with either stroke (n = 5) or dementia (n = 8) and used photographs that caregivers took exemplifying their caregiving experiences to elicit their description of how they made sense of caregiving. This enabled greater insight into caregivers' perspective of caregiving complementing our use of Interpretative Phenomenological Analysis (IPA) to analyse verbatim transcripts.

RESULTS

Emerging themes included (1) making sense of illness including the implications of receiving a diagnosis, caregiving motivations and receiving support, and (2) coping with caregiving, with variance in coping depending on, in part, individual differences in sense making. Caregivers adopted active and information seeking techniques to deal with current problems and to increase their sense of control, but avoidant techniques when considering future logistics of caregiving and when feeling helpless due to the burden they faced. At times caregivers looked on the bright side and made downward comparisons.

CONCLUSION

The combination of elicitation techniques and analysis using IPA established patterns across caregivers and individual differences between caregivers in the meaning they assigned to their caregiving experience. Differences in sense making were based on the context of the caregiving stressor, which in turn influenced the variability in caregiver's coping techniques adopted. The analysis detailed within this article provides evidence that information and service provision must be tailored to individual caregiver experiences.

Impact of psychological factors on subjective disease activity assessments in patients with severe rheumatoid arthritis

OBJECTIVE

The Disease Activity Score in 28 joints (DAS28), used to assess disease activity in rheumatoid arthritis (RA), is a composite score comprising clinical, biochemical, and patient self-report measures. We hypothesized that psychological factors (cognitions and mood) would be more strongly associated with patient-reported components of the DAS28 than clinical or biochemical components.

METHODS

A cross-sectional, observational study of 322 RA patients with active disease (mean DAS28 6.0) awaiting therapy with a biologic agent was undertaken. Patients' illness beliefs, treatment beliefs, and mood were measured using the Brief Illness Perception Questionnaire (IPQ), the Beliefs about Medicines Questionnaire (BMQ), and the Hospital Anxiety and Depression Scale (HADS), respectively. Relationships between psychological factors and 1) total DAS28 and 2) individual components of the DAS28 were analyzed using linear regression.

RESULTS

Total DAS28 produced significant but weak associations with 2 of the Brief IPQ items, but no associations with BMQ or HADS scores. There were larger significant associations between the patient-reported visual analog scale (VAS) with 5 items of the Brief IPQ and with HADS depression. Low illness coherence was associated with higher tender joint count. Three Brief IPQ items and HADS anxiety scores were significantly associated with C-reactive protein level or erythrocyte sedimentation rate. No psychological factors were associated with the swollen joint count.

CONCLUSION

One of the subjective components of the DAS28, patient VAS, was highly correlated with cognitive factors and depression in those with severe RA. By reporting individual DAS28 components, clinicians may be better able to assess the impact of therapies on each component, adjusting approaches according to patients' needs.

The mediating role of dysfunctional coping in the relationship between beliefs about the disease and the level of depression in patients with rheumatoid arthritis

Aim. Rheumatoid arthritis is one of the most severe chronic diseases. In many cases it leads to disability and results in a decreased quality of life and increased levels of anxiety and depression. The problem that needs to be addressed is the following: which mental processes lead to increased levels of depression in patients with rheumatoid arthritis? Methods. 210 patients with rheumatoid arthritis hospitalized in rheumatology wards took part in the research. They filled in illness perception questionnaires (IPQ-R) and questionnaires for testing strategies of handling stress (Mini-COPE) and the level of depression (CES-D). Results. The observed correlation coefficients indicate that several elements of the perception of one's disease moderately contribute to a high level of depression. Moreover, frequent use of dysfunctional coping strategies contributed to high levels of depression. Dysfunctional coping was moderately linked to depression. Conclusion. The conducted analyses confirmed the links between the beliefs about the disease and levels of depression and showed that the use of dysfunctional coping strategies mediates the relationship between the following elements of the representation of the disease: illness coherence, emotional representation, psychological attribution, risk factors, and the level of depression.

Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients

BACKGROUND AND AIMS

Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

METHODS

Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

CONCLUSIONS

The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

Factores psicosociales predictores de la calidad de vida en personas en situación de discapacidad física

El presente estudio correlacional descriptivo se propuso evaluar los factores que determinan la calidad de vida (CV) relacionada con la salud en 78 personas con discapacidad física que vivían en Bogotá, y hacían parte de un proyecto de inclusión laboral dirigido por una ONG. Se evaluó la calidad de vida relacionada con la salud (Cuestionario de Salud SF36 y visita domiciliaria), al igual que las condiciones asociadas a la discapacidad y algunos factores psicológicos (Escala de Autoeficacia Generalizada, Prueba de Imagen Corporal, Inventario de Estilos de Afrontamiento, Prueba de optimismo disposicional, Inventario de Depresión de Beck y Escala de Ansiedad de Zung). Se utilizó un modelo de ecuaciones estructurales para encontrar el poder predictivo de las variables en la calidad de vida. El modelo obtenido predecía un 39% de la varianza, incluyendo en orden de peso relativo aportando variables como condiciones de enfermedad, depresión, afrontamiento centrado en la fantasía, trascendencia, pesimismo, ansiedad y autoeficacia. Se discuten los hallazgos y las limitaciones del estudio.

Applying Leventhal’s self-regulatory model to pregnancy: Evidence that pregnancy-related beliefs and emotional responses are associated with maternal health outcomes

This study explored whether women’s beliefs about, and emotional responses to, pregnancy could account for variations in maternal mental and physical health outcomes, using the self-regulatory model as a theoretical framework. Women in the last trimester of pregnancy ( N = 408) completed an online survey including measures of representations of pregnancy, coping, and physical and mental health. Results revealed that representations of pregnancy accounted for up to 30 and 39 per cent of the variance in indicators of physical and mental health, respectively. Findings suggest that beliefs about pregnancy may have important implications for maternal health.

Negative and positive illness representations of rheumatoid arthritis: a latent profile analysis

This study extends previous work to consider whether individuals with rheumatoid arthritis (RA) can be categorised into groups with similar illness representations. Data from 227 RA patients attending outpatient clinics were collected prospectively at two time points, 6 months apart. The optimal number of illness representation groups at the baseline assessment was identified using latent profile analysis. Two groups of individuals sharing similar illness perception profiles were identified. The smaller group (43%), characterised by a negative representation of their illness, attributed more symptoms to their condition and reported stronger perceptions of the consequences, chronicity and cyclicality of their condition, and lower control compared to the positive representation group (57%). Cross-sectionally, membership of the negative representation group was associated with higher levels of pain and functional disability and, longitudinally, with increases in levels of pain, functional disability and distress. These data highlight the central role of illness perceptions in RA and suggest that individuals with RA can be categorised into groups with similar illness representations.

Assessing patients' beliefs about their cancer-related fatigue: validation of an adapted version of the Illness Perception Questionnaire

Cancer-related fatigue (CRF) is a common and distressing side-effect of cancer treatment. The present study developed a brief version of the Illness Perception Questionnaire (IPQ) for assessing patients' representations of CRF. Cancer patients and survivors (n = 155) completed a revised version of the IPQ as well as measures of fatigue severity at two different time-points. Confirmatory factor analysis at both Time 1 and 2 showed that the seven-factor solution based on the Self-Regulation Model fit the data adequately and factorial invariance over the two time-points was supported. The resulting subscales exhibited good internal consistency and test-retest reliability. The adapted version of the IPQ shows promise for the assessment of patient perceptions regarding CRF. The scale may be able to be used clinically to identify if patients have inaccurate or unhelpful representations of CRF and to help tailor interventions for persistent fatigue in cancer survivors.

Juvenile-onset inflammatory arthritis: a study of adolescents' beliefs about underlying cause

OBJECTIVE

Patients' beliefs regarding the cause of illness may influence treatment adherence and long-term outcome. Little is known of adolescents' beliefs regarding the cause of JIA. This study aims to identify adolescents' beliefs about the underlying cause of their arthritis at first presentation to the paediatric rheumatology department.

METHODS

One hundred and twenty-two adolescents aged ≥11 years participating in the larger prospective Childhood Arthritis Prospective Study, an inception cohort of childhood-onset inflammatory arthritis, were asked to complete a questionnaire regarding underlying beliefs about their arthritis. The top-listed causes were identified, and associations between beliefs and characteristics of the adolescents and their arthritis were compared across the different causal beliefs.

RESULTS

The most common causal beliefs were genetics (27.1%), the immune system (21.3%), accident or injury (15.6%) and infection (13.1%). Association between causal beliefs and gender, disease duration, International League Against Rheumatism subtype and source of referral was observed, although small numbers prevented robust statistical comparisons.

CONCLUSION

This first report on adolescents' beliefs about the cause of their juvenile arthritis found the most common causal beliefs to be related to genes or the immune system. Brief assessments of adolescents' beliefs at presentation will enable providers to modify or adapt potentially unhelpful beliefs and provide age-appropriate information regarding arthritis.

Delays in seeking cancer diagnosis in relation to beliefs about the curability of cancer in patients with different disease locations

This study is aimed at investigating factors leading to delayed oncologic examinations versus immediate consultation with a physician in patients with various cancers. We analysed the results of a study of patients (n = 291) reporting for their first oncologic examinations. We conducted structured interviews containing social, demographic and clinical data, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory and Harris and Guten's health appraisal scores. Based on an analysis of decision-making trees, the results indicate that it is possible to predict beliefs regarding the curability of cancer and immediate versus delayed reporting to a physician. Delayed reports may be predicted on the basis of two factors: (1) a belief that cancer is incurable combined with increased state anxiety, 'good' or 'very good' self-appraisal of health and low depression; and (2) a belief that cancer is incurable accompanied by increased anxiety and depression. The characteristics of patients delaying a visit to the oncologist suggest the existence of three independent factors leading to both considerable (longer than nine months) and minor (up to one month) delays in seeking treatment.

Adjusting to recent onset of rheumatoid arthritis: a qualitative study

The purpose of this study was to examine men’s and women’s experiences living with rheumatoid arthritis (RA). Using semi-structured, in-depth telephone interviews, nine women and seven men who were recently diagnosed with RA (disease duration < four years) were interviewed about their experiences adjusting to RA. Line-by-line coding using thematic analysis was used to identify themes. Findings from the qualitative analysis revealed six categories emerging from the data: 1. degree of severity of the impact of the disease, 2. appraisal about what the illness means to me, 3. availability of social support, 4. perception of self-efficacious behaviours, 5. use of coping strategies, and 6. RA’s effect on valued life activities. A number of participants described positive thinking about managing their RA; whereas others described negative thinking. Individuals’ appraisals and perceptions about their illness coupled with how their illness affected their ability to fulfill their role responsibilities were important in their adjustment to RA. Social support was also identified as key in learning to live with RA. For individuals with RA, the impact of the disease on their ability to maintain normal life is important, and as such it is vital that healthcare professionals have a better understanding of the perceptions and experiences that individuals have living with RA.

The association between discrepancy in illness representations on distress in stroke patients and carers

BACKGROUND

To investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke.

METHOD

Forty-two stroke survivors and their carers were assessed at 3 months and 32 couples returned data at 6 months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor-Partner Interdependence Model.

RESULTS

Carers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2.

CONCLUSION

Illness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.

"Striving for a good life" - the management of rheumatoid arthritis as experienced by patients

Aim

To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life.

Method

An explorative design with the grounded theory approach was used by interviewing 16 informants with RA.

Results

The generated theoretical model emerged in a core category- Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients’ different ways of managing RA: mastering, relying, struggling and being resigned.

Discussion

The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients’ need of support were highlighted as aspects that were of importance when managing RA. Patients’ experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients’ self-efficacy and with their experience of support.

Illness beliefs predict disability in rheumatoid arthritis

OBJECTIVE

This study examined the relationships between patients' beliefs about rheumatoid arthritis (using Leventhal's Common Sense Model) and their levels of disability, health-related quality of life, and disease activity. A proposed illness beliefs construct of "seriousness" was also investigated, combining beliefs about illness identity (symptoms), consequences, and timeline.

METHOD

A cross-sectional study evaluated 125 patients with rheumatoid arthritis from two South East London hospitals. Questionnaires assessed their illness beliefs, disability, and quality of life. An objective measure of disease activity was also obtained.

RESULTS

Higher disability scores were associated with beliefs about identity (r=.31, P<.01) and consequences (r=.28, P<.01). Stronger control beliefs were associated with lower disability (r=-.40, P<.01) and better physical (r=.20, P<.05) quality of life. Disease activity scores, although positively related to disability scores (r=.39, P<.01), showed no associations with illness beliefs. Multivariate analysis resulted in models accounting for 45.5%, 27.3%, and 19.3% variance in disability, "physical quality of life" scores, and "mental quality of life" scores, respectively. The hypothesis for a proposed "seriousness" construct was not supported.

CONCLUSION

Patients' beliefs about their rheumatoid arthritis are associated with disability and quality of life and cannot be explained by disease status. Longitudinal research is needed to assess the stability of beliefs.

A review of assessment tools of illness representations: are these adapted for a work disability prevention context?

INTRODUCTION

Musculoskeletal disorders are among the main causes of short- and long-term disability.

AIM

Identify the methods for assessing multidimensional components of illness representations.

METHODS

An electronic literature search (French, English) from 1980 to the present was conducted in medical, paramedical and social science databases using predetermined key words. After screening titles and abstracts based on a specific set of criteria, sixty-four articles were reviewed.

RESULTS

Qualitative approaches for assessing illness representation were found mainly in the fields of anthropology and sociology and were based on the explanatory models of illness. The interviews reviewed were: the Short Explanatory Model Interview, the Explanatory Model of Illness Catalogue and the McGill Illness Narrative Interview. Quantitative approaches were found in the health psychology field and used the following self-administered questionnaires: the Survey of Pain Attitudes, the Pain Beliefs and Perceptions Inventory, the Pain Beliefs Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Implicit Model of Illness Questionnaire, the Illness Perception Questionnaire, including its derivatives, and the Illness Cognition Questionnaire.

CONCLUSION

This review shows the actual use and existence of multiple interviews and questionnaires in assessing multidimensional illness representations. All have been used and/or tested in a medical context but none have been tested in a work disability context. Further research will be needed to determine their suitability for use in a work disability context.

Work ability and return-to-work in cancer patients

The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0–10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted return-to-work at 18 months, after correction for the influence of age and treatment (hazard ratio=1.37, CI 1.27–1.48). We conclude that self-assessed work ability is an important factor in the return-to-work process of cancer patients independent of age and clinical factors.

Psychological well-being across 1 year with rheumatoid arthritis: coping resources as buffers of perceived stress

OBJECTIVES

Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well-being among rheumatoid arthritis (RA) patients.

DESIGN

A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year.

METHODS

Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well-being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for.

RESULTS

Perceived stress had the strongest relationship with psychological well-being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well-being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months.

CONCLUSIONS

Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.

Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health

OBJECTIVES

Using the International Classification of Functioning, Disability and Health as framework, we evaluated modifying effects of illness perceptions and mental health on the association between impairments in body structures and functions due to osteoarthritis (OA) and limitation in activities in the lower extremities.

METHODS

Self-reported limitation in activities was assessed by the Western Ontario and McMaster Universities OA index (WOMAC) function subscale in 316 patients with knee or hip pain or evidence of OA on knee or hip radiographs. Body structures and functions were evaluated during clinical and radiological assessments. Illness perceptions and mental health were assessed with the revised Illness Perception Questionnaire (IPQ-R) and the mental component summary score of the RAND 36-item Health Survey, respectively. For each patient an expected WOMAC function score was calculated, using an equation based on a multivariate model of the association of body structures and functions with limitation in activities.

RESULTS

The median (interquartile) self-reported WOMAC function score was 22.2 (9.6-43.5). Ninety-one patients reported more and 120 patients reported less limitation in activities than expected. Patients with lumbar spine degeneration, physical or exercise therapy and high IPQ-R identity, consequences and chronic timeline scores had an increased risk to report more limitation in activities than the expected range. Low IPQ-R identity, consequences and emotional representation scores and better mental health were associated with reporting less limitation in activities than the expected range.

CONCLUSION

Illness perceptions and mental health modify the association between self-reported limitation in activities and calculated limitation in activities based on impairments in body structures and functions due to OA.