Illness perceptions in patients with systemic lupus erythematosus and proliferative lupus nephritis

[Current patient care of systematic lupus erythematosus in Rhineland-Palatinate and Saarland]

BACKGROUND

Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease that is associated with great suffering for those affected, as well as high socioeconomic costs. Early diagnosis and adequate medical care are essential for a mild course of the disease. However, there is a lack of current figures and data on the care situation of patients in the area.

METHODOLOGY

A total of 1546 general practitioners, rheumatologists, neurologists, nephrologists and dermatologists in Rhineland-Palatinate and Saarland were interviewed by fax or mail using a questionnaire regarding epidemiology, symptoms, therapy and therapy success. In addition, there was the possibility of making suggestions for improvement.

RESULTS

Five out of six of the 635 reported SLE patients were female. The most common main symptoms were arthralgia, fatigue, myalgia, and skin changes. Of the patients, 68% received antimalarials (AMs), whereas 46% were treated with glucocorticoids (GCs) and 50% with an immunosuppressant (IS), mainly methotrexate. In terms of comorbidities, patients suffered mainly from cardiovascular disease, fibromyalgia syndrome and depression. Rheumatologists also frequently described anaemia, diabetes mellitus and osteoporosis.

DISCUSSION

Compared with guideline recommendations, the low rate of AMs in therapy was particularly striking in patients not treated by rheumatologists (35% on average compared with 81% for rheumatologists). Additionally, (sustained) high doses of GCs are not in line with literature recommendations. In the free text field, the main requests were for more rheumatologists in private practice and faster appointment scheduling, as well as better communication and networking. In addition, the desire for more training and education was frequently expressed..

Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease

Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.

Effects of illness perceptions on health-related quality of life in patients with rheumatoid arthritis in China

Objectives

For patients with rheumatoid arthritis (RA) in China, little is known of how their illness perceptions affect their health-related quality of life (HRQoL). The present study investigated associations between specific illness perceptions due to RA and HRQoL features.

Methods

For 191 patients with RA, illness perceptions were measured using the Brief Illness Perceptions Questionnaire (BIPQ) comprising 8 domains. HRQoL was determined with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Multivariate linear regression analyses were performed.

Results

The overall BIPQ of patients with RA was 49.09 ± 11.06. The highest and lowest scores were for concern (9.15 ± 1.81) and personal control (4.30 ± 2.52), respectively. Multivariate stepwise regression analyses showed that the overall BIPQ was significantly negatively associated with each HRQoL feature, and HRQoL total score (β = − 0.343, P < 0.001, 95% CI − 7.080 to − 4.077). Positive associations between BIPQ features and HRQoL included personal control (β = 0.119, P = 0.004, 95% CI 2.857–14.194) and treatment control (β = 0.084, P = 0.029, 95% CI 0.640–12.391). Negative associations with HRQoL were identity (β = − 0.105, P = 0.034, 95% CI − 13.159 to − 0.430) and emotional response (β = − 0.207, P < 0.001, 95% CI − 18.334 to − 6.811).

Conclusions

Patients with RA in China perceive their illness in ways that affect their HRQoL. These results suggest that strategies that target these perceptions may improve the quality of life of these patients.

Associations between brain drawings following mild traumatic brain injury and negative illness perceptions and post-concussion symptoms at 4 years

Characteristics of patient's drawings have been linked to short-term health-related outcomes across a range of health conditions. This study examined associations between brain drawings at 1 month and illness perceptions and post-concussion symptoms at 4 years in 92 adults following mild traumatic brain injury. Greater damage depicted at 1 month was correlated with perceived greater impact on life, duration of injury, symptoms of brain injury, emotional consequences and late-onset post-concussion symptoms. Results indicate that brain drawings shortly after traumatic brain injury offer a simple and insightful tool that may help to identify those who need additional support to improve long-term outcomes.

Does illness perception associate with disease symptoms in Behçet's disease?

This study aims to assess the relationship between illness perception and disease course and symptoms in Behçet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 ± 9.88 years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 ± 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised version of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than the others (6.77 ± 2.91 vs. 5.08 ± 3.3, respectively, p = 0.007). The consequences score for musculoskeletal involvement (19.52 ± 7.03) and timeline (acute/chronic) score for eye involvement (26.67 ± 4.32) are also higher compared to patients without them (16.37 ± 5.82 and 22.09 ± 8.68) (p = 0.011 and p = 0.038), reflecting negative beliefs about the illness. The score of psychological attribution is higher in patients with psoriasis than BD (p = 0.039), whereas the other subgroup scores are lower in patients with psoriasis compared to those of BD (p < 0.05). This study provides a patient's perspective in the disease management process of BD using the IPQ-R questionnaire. A patient's own personal beliefs and emotional responses to their symptoms might affect the outcome measures, especially with musculoskeletal symptoms and eye involvement in BD. However, psychological attribution is found to be a prominent issue in psoriasis.

Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners

INTRODUCTION

A description is given of the quality of life (QOL) of women who were treated with peripartum embolization or hysterectomy for major obstetric hemorrhage (MOH).

METHODS

Questionnaires assessing QOL, combined with questionnaires and drawings assessing illness perceptions, were used to compare women with MOH to reference groups provided by the questionnaires.

RESULTS

Women who experienced MOH have similar scores on QOL questionnaires compared to reference groups. Women treated with arterial embolization scored better than women treated with hysterectomy. Partners of women with MOH scored better on QOL questionnaires than reference groups. Drawings reflect the major emotional impact of MOH.

DISCUSSION

MOH does not seem to have a negative effect on QOL 6-8 years after the event, although drawings and verbalizations indicate major emotional impact. More extensive follow-up is advised for early recognition of the need for psychological help. Women after embolization seem to have better QOL compared to women after hysterectomy.

Illness perception is significantly determined by depression and anxiety in systemic lupus erythematosus

Objectives Illness perception is a cognitive representation influencing physical and psychological functioning and adherence in patients with rheumatic disease. Studies exploring illness perception in systemic lupus erythematosus (SLE) are still scarce and none of them have investigated factors determining illness perception. We aimed to assess illness perception and to identify psychological, clinical and sociodemographic factors that might influence illness perception in SLE. Methods The study involved 80 patients with SLE (87.5% women, mean age 41.56 years). The Brief Illness Perception Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Visual Analogue Scale-Pain and Fatigue Severity Scale were used. Clinical and sociodemographic data were collected via structured interview and medical files review. Results Illness perception was significantly positively correlated with anxiety, depression, sleep quality, fatigue and pain while it was not related to age, education, steroid treatment, disease duration and activity (SLEDAI) or organ damage (SLICC/ACR). Regression analysis revealed that state anxiety and depression explained 43% of illness perception variance. Cluster analysis identified three patient groups among which the middle-aged group had the most negative illness perception, the highest levels of anxiety, depression, pain and fatigue, and the poorest sleep quality. Conclusions The study has proved a significant relationship between negative illness perception and anxiety and depression. Patients reporting fatigue, poor sleep and pain might have special needs in terms of psychological intervention focused on negative illness perception and distress symptoms. Multidisciplinary care in managing SLE seems to be of great importance.

Adaptation to inflammatory rheumatic disease: Do illness representations predict patients' physical functioning over time? A complex relationship

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N = 54) or systemic lupus erythematosus (N = 58) participated in the two phases of the study, 1 year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1 year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness.

Illness perceptions of leprosy-cured individuals in Surinam with residual disfigurements - "I am cured, but still I am ill"

Objective Leprosy has rarely been the subject of health psychology research despite its substantial impact. Our aim was to explore illness perceptions in patients and their health care providers in Surinam. The Common Sense Model (CSM) was the guiding theoretical model. Design Patients with biomedically cured leprosy and their health care providers completed the B-IPQ and took part in semi-structured interviews. The literature on illness perceptions in patients with leprosy was reviewed. Main outcome measures Patients' B-IPQ scores were compared with samples of patients with other (chronic) illnesses, and with health care providers completing the questionnaire as if they were visibly disfigured patients. Quotations from the semi-structured interviews were used to contextualise the illness perceptions. Results Patients' B-IPQ scores reflected the chronic nature of leprosy and were comparable with those with other chronic illnesses. Health care providers perceived leprosy to have a greater negative impact than did the patients. Perceived understanding of causes differed considerably between patients and health care providers. Conclusion Leprosy continues to be experienced as an illness with major psychological and social consequences such as stigmatisation, even after biomedical cure. Interventions that target patients, health care providers, and society at large may help reduce perceived shame and stigma. The CSM is a helpful theoretical model in studying this population.

Perceptions of Multiple Sclerosis in Hispanic Americans: Need for Targeted Messaging

BACKGROUND

Illness perceptions have been reported to be important determinants of multiple sclerosis (MS)-related well-being. Hispanic culture is defined by strong cultural beliefs in which illness is often perceived to arise from strong emotions. Understanding the perceptions of MS in Hispanic Americans may provide a better understanding of cultural barriers that may exist. The purpose of this study was to describe Hispanic American perceptions of MS.

METHODS

We gathered information from semistructured interviews, focus groups, and participant responses from the University of Southern California Hispanic MS Registry. This information was then stratified into a matrix of environmental, biological, and sociocultural determinants. Differences were examined by place of birth, treatment preference, and ambulatory difficulty. Logistic regression was used to investigate the relationship between sociocultural perceptions, place of birth, and ambulation.

RESULTS

Most participants were female (n = 64, 61%), US born (n = 64, 61%), and receiving treatment for MS. Participants cited environmental and sociocultural perceptions, with significant differences noted by place of birth. Sociocultural factors such as strong emotions were almost four times more commonly perceived in immigrants compared with US-born participants (adjusted odds ratio, 3.66; 95% confidence interval, 1.12-11.90; P = .03). Male, low-education, and low-income participants were also more likely to perceive MS to be a result of strong emotions, but these differences were not statistically significant.

CONCLUSIONS

Hispanic American perceptions of MS differ by place of birth, with reports of cultural idioms more common among immigrants, which could affect disease management. These findings may be useful in designing educational interventions to improve MS-related well-being in Hispanic populations.

Neuropsychiatric symptoms in systemic lupus erythematosus: impact on quality of life

Objective

Assess quality of life in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric symptoms (neuropsychiatric SLE, NPSLE).

Methods

Quality of life was assessed using the Short-Form 36 item Health Survey (SF-36) in patients visiting the Leiden NPSLE clinic at baseline and at follow-up. SF-36 subscales and summary scores were calculated and compared with quality of life of the general Dutch population and patients with other chronic diseases.

Results

At baseline, quality of life was assessed in 248 SLE patients, of whom 98 had NPSLE (39.7%). Follow-up data were available for 104 patients (42%), of whom 64 had NPSLE (61.5%). SLE patients presenting neuropsychiatric symptoms showed a significantly reduced quality of life in all subscales of the SF-36. Quality of life at follow-up showed a significant improvement in physical functioning role (p = 0.001), social functioning (p = 0.007), vitality (p = 0.023), mental health (p = 0.014) and mental component score (p = 0.042) in patients with neuropsychiatric symptoms not attributed to SLE, but no significant improvement was seen in patients with NPSLE.

Conclusion

Quality of life is significantly reduced in patients with SLE presenting neuropsychiatric symptoms compared with the general population and patients with other chronic diseases. Quality of life remains considerably impaired at follow-up. Our results illustrate the need for biopsychosocial care in patients with SLE and neuropsychiatric symptoms.

Using drawings to explore patients' perceptions of their illness: a scoping review

Background

An emerging approach for investigating patient perspectives of their illness is the use of drawings.

Objective

This scoping review consolidates findings from current literature regarding the use of drawings to explore patients’ perceptions and experiences of their illness and treatment.

Methods

Electronic databases (Medline, PubMed, Embase, PsychINFO, Cinahl, Art Index and Scopus) and reference lists were searched to identify published English language studies using participant-generated drawings to explore adults’ perceptions and experiences of their illness and treatment. Using the scoping methodological framework, data were analyzed with respect to each study’s design, key findings and implications.

Results

Thirty-two studies were identified and these reflected diversities in both health conditions and methods of data collection and analysis. Participants’ drawings revealed new, insightful knowledge about patients’ perceptions, beliefs and experiences of their condition and were associated with clinical and psychological markers of health. Drawing was a powerful adjunct to traditional data collection approaches, and demonstrated potential benefits for participants. This review provides detailed insights and guidance on the use of drawings in research and clinical practice.

Conclusion

Drawing is a novel and potentially valuable technique for exploring patients’ perceptions and experiences about their illness and treatment. Advancing the methodology and applicability of drawings in this area will assist in the future development of this technique, with benefits for the patient, researcher and health care professional alike.

Drawings of Blood Cells Reveal People's Perception of Their Blood Disorder: A Pilot Study

CONTEXT

Sickle cell disease (SCD) and thalassemia are rare but chronic blood disorders. Recent literature showed impaired quality of life (QOL) in people with these blood disorders. Assessing one of the determinants of QOL (i.e. illness perceptions) therefore, is an important next research area.

OBJECTIVE

We aimed to explore illness perceptions of people with a blood disorder with drawings in addition to the Brief Illness Perception Questionnaire (Brief IPQ). Drawings are a novel method to assess illness perceptions and the free-range answers drawings offer can add additional insight into how people perceive their illness.

METHOD

We conducted a cross-sectional study including 17 participants with a blood disorder. Participants' illness perceptions were assessed by the Brief IPQ and drawings. Brief IPQ scores were compared with reference groups from the literature (i.e. people with asthma or lupus erythematosus).

RESULTS

Participants with SCD or thalassemia perceived their blood disorder as being more chronic and reported more severe symptoms than people with either asthma or lupus erythematosus. In the drawings of these participants with a blood disorder, a greater number of blood cells drawn was negatively correlated with perceived personal control (P<0.05), indicating that a greater quantity in the drawing is associated with more negative or distressing beliefs.

CONCLUSION

Participants with a blood disorder perceive their disease as fairly threatening compared with people with other chronic illnesses. Drawings can add additional insight into how people perceive their illness by offering free-range answers.

Choroidal Thickness in Patients with Systemic Lupus Erythematosus Analyzed by Spectral-domain Optical Coherence Tomography

PURPOSE

The aim of this study is to investigate the effect of systemic lupus erythematosus (SLE) on choroidal thickness (CT) in the subfoveal and perifoveal area as measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with SLE.

MATERIALS AND METHODS

Fifty-eight patients with SLE (study group) and 58 healthy individuals (control group) were enrolled in the study. The subfoveal and perifoveal CT were measured by EDI-OCT.

RESULTS

The mean CT (μm) subfoveal, nasal, and temporal was 231.2 ± 57.6, 190.56 ± 30.64, and 222.65 ± 37.45 in the study group and 297.5 ± 45.1, 248.34 ± 39.67, and 286.54 ± 49.65 in the control group, respectively (p < 0.001, for all).

CONCLUSION

The mean subfoveal, nasal, and temporal CT values were statistically significantly lower in patients with SLE when compared with healthy controls.

A picture paints a thousand words: Heart drawings reflect acute distress and illness perception and predict posttraumatic stress symptoms after acute myocardial infarction

The aim of this study was to examine whether heart drawings of patients with acute myocardial infarction reflect acute distress symptoms and negative illness beliefs and predict posttraumatic stress symptoms 3 months post-myocardial infarction. In total, 84 patients aged over 18 years drew pictures of their heart. The larger the area drawn as damaged, the greater were the levels of acute distress (r = 0.36; p < 0.05), negative illness perceptions (r = 0.42, p < 0.05), and posttraumatic stress symptoms (r = 0.54, p < 0.01). Pain drawings may offer a tool to identify maladaptive cognitions and thus patients at risk of posttraumatic stress disorder.

The role of body image integrity and posttraumatic growth in kidney transplantation: A 3-year longitudinal study

The aim of this study was to explore the role of body image, posttraumatic growth, and emotional state in recovery after transplantation. A total of 53 kidney transplant patients were assessed using our Self-Test and Organ Drawing Test, the Spielberger Anxiety Inventory, the Beck Depression Inventory, and the Posttraumatic Growth Inventory in a 3-year follow-up. Logistic regression analysis showed that lower levels of integrity of the body image and posttraumatic growth, and higher pre-discharge serum creatinine levels were significant predictors of graft rejection. Our results suggest that the integrity of the body image and posttraumatic growth might contribute to better health outcomes in organ transplantation.

Persistent negative illness perceptions despite long-term biochemical control of acromegaly: novel application of the drawing test

CONTEXT AND OBJECTIVE

Patients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly.

DESIGN

A cross-sectional study was conducted to evaluate the utility of the drawing test.

METHODS

A total of 50 patients after long-term remission (mean±s.e.m., 16±1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL.

RESULTS

Patients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P<0.05), a higher score on emotional representations (P<0.05), and more perceived symptoms that were attributed to acromegaly (P<0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P<0.05).

CONCLUSION

There are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.

Patient drawings of their melanoma: a novel approach to understanding symptom perception and appraisal prior to health care

OBJECTIVE

This pilot study investigated the use of patient drawings to explore patient experiences of symptoms of melanoma prior to health care use.

DESIGN

Patients (n = 63) with melanoma were interviewed within 10 weeks of diagnosis. Participants were asked to draw what their melanoma had looked like when they first noticed it, and to make additional drawings to depict changes as it developed.

MAIN OUTCOME MEASURE

The size and features of the drawings were compared between participants and with clinical data (thickness of the melanoma; histological diameter; clinical photographs).

RESULTS

Eighty-four percent of participants were able to produce at least one drawing. This facilitated discussion of their lesion and recall of events on the pathway to diagnosis. Common features of the drawings related to the view, presence of shading, inclusion of sections and the shape and border of the lesion. There was potential for disparity between the details in awareness resources and the perceptions of patients. The drawings resembled the clinical photographs and the size of the drawings was positively associated with the histological diameter, but did not differ according to tumour thickness.

CONCLUSION

Asking patients to make drawings of their melanoma appears to be an acceptable, inclusive, feasible and insightful methodological tool.

Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire

The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with chronic conditions (58.7% women) completed the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. The internal consistency of the Polish Brief Illness Perception Questionnaire measured with Cronbach's alpha was satisfactory (α = 0.74). Structural validity was demonstrated by significant inter-correlations between the Brief Illness Perception Questionnaire components. Discriminant validity was supported by the fact that the Brief Illness Perception Questionnaire enables patients with various conditions to be differentiated. Significant correlations were found between Brief Illness Perception Questionnaire and depression and anxiety levels. The Polish Brief Illness Perception Questionnaire thus evaluated is a reliable and valid tool.

Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate

The aim of the study was to identify the determinants of adherence to medication among Egyptian patients with SLE. A single-center cross-sectional study was conducted among Egyptian patients with SLE. Adherence to medication was measured via The Compliance Questionnaire for Rheumatology-19, and the patients were classified as non-adherers if they were taking <80% of their medication correctly. Predictors of adherence to SLE medication were determined by multiple logistic regressions. The mean age of participants was 30.9 ± 11.7 years. Females constituted 95% of all participants. Thirty-eight (%) were taking <80% of their medication correctly. On logistic regression analysis, the significant independent predictors of medication non-adherence were lower educational level (OR 5.6, 95% CI 2.1-7.3, P < 0.001), very low and low socioeconomic status (OR 2.6, 95% CI 1.6-4.3, P < 0.04), rural residency (OR 3.4, 95% CI 1.4-5, P < 0.01), more number of medications (OR 3.2, 95% CI 2.3-6.9, P < 0.01), and higher depressive symptoms (OR 3.7, 95% CI 1.4-10.2, P < 0.001). The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load, minimizing depressive symptoms, and ensuring an uninterrupted access to free services regimen for patients with low socioeconomic status is strongly recommended. More attention should be given to SLE patients who live in rural regions.

Wolf-living with SLE in a novel

Living with SLE is a major task for the patients and their social environment. In modern health care, quality of life is increasingly incorporated as an important outcome. Studying novels about illness is a new method of exploring quality of life in patients with an illness. In this paper, we use the novel A tribe of women by Hervé Bazin as data to explore how a patient with SLE gives meaning to her illness and how her social environment reacts toward the illness and its treatment. We find that the novel-probably the only one where SLE is a major subject-offers a rich set of data on "living with SLE". Our findings may be instrumental in encouraging health care providers to explore quality of life in patients with SLE, incorporating self-management in order to improve their quality of life, and in teaching medical students about "medical humanities".

Resilience and treatment adhesion in patients with systemic lupus erythematosus

BACKGROUND

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune, rheumatic inflammatory disease that can cause significant morbidity with evident psychological impacts and obvious harm to quality-of-life that require the patient to adapt treatment.

OBJECTIVE

Assessment of resilience and the self-reported treatment adhesion behaviors of patients with SLE, investigating which of these factors are associated to resilience.

METHOD

Cross-sectional study of 40 women with SLE. A questionnaire with social demographic data, health history and the Wagnild Young Resilience Scale were used.

RESULTS

62.5% followed the medical treatment properly but 55% found it difficult. 27.5% of the patients presented low resilience, 57.5% medium and 15% high resilience. Resilience was associated in the chi-square test (p-value < 0.05) with the variables work, understanding SLE, trying to find out about SLE, following the treatment correctly, difficulty in following the treatment and stopping some activity because of the disease. In the correlation analysis, resilience was associated with age (-0.3960), number of working hours (0.5533), specialized treatment duration (-0.8103) and disease duration from diagnosis (-0.8014).

CONCLUSION

Patients with high resilience tended to follow treatment correctly, tried to understand the disease and adhered more to the treatment to avoid risks and promote protection factors. Therefore knowledge of resilience in patients with SLE is necessary. It is important that the state takes necessary actions to facilitate access to treatment, to educational programs and to medical support. Awareness and counselling sessions must be initiated to develop and promote individual capacities to learn how to tackle with the disease for which psychological support of family and doctors can play a significant role.

Drawings reflect a new dimension of the psychological impact of long-term remission of Cushing's syndrome

CONTEXT AND OBJECTIVE

Drawings can be used to assess perceptions of patients about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions, quality of life (QoL), and clinical disease severity in patients after long-term remission of Cushing's syndrome.

DESIGN AND SUBJECTS

We conducted a cross-sectional study including 47 patients with long-term remission of Cushing's syndrome. Patients completed the drawing test, the Illness Perception Questionnaire-Revised, the Short-Form 36, the EuroQoL-5D, and the Cushing QoL. The Cushing's syndrome severity index was scored based on medical records.

RESULTS

Characteristics of the drawings were strongly associated with the Cushing's syndrome severity index and severity ratings of health professionals (all P < 0.02). In addition, patients perceived a dramatic change in body size during the active state of the disease compared to the healthy state before disease. Patients reported that their body does not completely return to the original size (i.e. before disease) after treatment. There were no clear associations between characteristics of the drawings and QoL or illness perceptions. This indicates that drawings and QoL or illness perceptions do not share multiple common properties and measure different aspects/dimensions of the disease process.

CONCLUSION

Drawings reflect a new dimension of the psychological impact of long-term remission of Cushing's syndrome because drawings do not share common properties with parameters of QoL or illness perceptions, but do represent the clinical severity of the disease. The assessment of drawings may enable doctors to appreciate the perceptions of patients with long-term remission of Cushing's syndrome and will lead the way in dispelling idiosyncratic beliefs.

Locus of control and lupus: patients' beliefs, perspectives, and disease activity

Patients with lupus often experience a high degree of psychological symptoms such as anxiety, depression, and mood disorders that can influence their beliefs and perceptions of their illness. The purpose of the study was to examine how a patient's self-reported psychosocial needs (depression and anxiety) and beliefs about how much control they have over their health (health locus of control) influences their perception of disease chronicity and acuity. The study findings were based on a survey of 378 patients self-diagnosed with lupus.