Appraisal Of Illness Research Articles

Quality of life of women with recurrent breast cancer and their family members.

Little information is available about the effects of recurrent breast cancer on the quality of life of women and their family members. The present study assessed patients' and family members' quality of life within 1 month after recurrence, and effects of multiple factors on quality-of-life scores. Patient/family member dyads (N = 189) participated in this study. A stress-appraisal model guided selection of person factors, social/family factors, illness-related factors, appraisal factors, and quality of life, measured with psychometrically sound instruments. Quality of life was measured with both generic (Medical Outcomes Study SF-36) and cancer-specific (Functional Assessment of Cancer Therapy) scales. Patients reported significant impairments in physical, functional, and emotional well-being. Family members reported significant impairments in their own emotional well-being. Structural equation modeling revealed that self-efficacy, social support, and family hardiness had positive effects on quality of life, whereas symptom distress, concerns, hopelessness, and negative appraisal of illness or caregiving had detrimental effects. Study variables accounted for a sizable amount of variance in patients' and family members' physical and mental dimensions of quality of life (72% to 81%). Contrary to findings observed in studies of newly diagnosed breast cancer patients and spouses, little relationship was found between recurrent patients' and family members' quality of life. Women with recurrent breast cancer are in need of programs to assist them with the severe effects of the disease on their quality of life. Programs need to include family members to help counteract the negative effects of the recurrent disease on their mental health, and to enable them to continue as effective caregivers.

Adjustment to chronic illness among HIV-infected women.

To identify factors that influence adjustment to chronic illness among HIV-infected women, using the cognitive appraisal model of stress and coping. Cross-sectional descriptive survey of 101 HIV-infected women living in the Northeastern United States, from December 1996 to December 1997. During face-to-face interviews, the Meaning of Illness Questionnaire, Duke UNC Functional Social Support Questionnaire, HIV Symptom Experience Inventory and Medical Outcomes Study (MOS) Short Form Survey were used to measure appraisal of illness, social support, HIV symptom severity and adjustment to chronic illness. Hierarchical linear regression, path analysis, and procedures to test for mediation were performed. The model variables explained 70% of the variance in adjustment to chronic illness. Symptom experience accounted for the greatest percentage of variance in adjustment (28%). Two of the three predicted relationships were supported as hypothesized: adjustment to chronic illness was directly influenced by appraisal of illness and by HIV-symptom experience. Social support was not found to have a direct effect on adjustment. Instead, appraisal of illness mediated the effect of social support on adjustment and symptom experience. HIV illness stage was not a significant predictor of adjustment. The cognitive appraisal model of stress and coping was useful for building knowledge on adjustment to chronic illness among HIV infected women. Interventions aimed at reframing negative appraisals have the potential to affect adjustment.

The Reliability and Validity of the Impact on Lifestyle Questionnaire in Patients with Acromegaly

Objectives Treatments for acromegaly, a growth hormone disorder, can be burdensome to patients, often requiring multiple self-administered injections daily. We developed the Impact on Lifestyle Questionnaire (ILQ) to measure the impact on patient's lifestyle imposed by the burden of injectable treatments for acromegaly. The primary objective of this study was to establish the reliability and validity of the ILQ. Methods The ILQ consists of the SF-12 and 30 additional questions. Thirty-four patients, from two sites, completed the ILQ and scales measuring related concepts. Fourteen patients also completed a retest survey 4 weeks later. Survey sample data were combined with ILQ data from another 56 patients with acromegaly for a factor analysis. Reliability was assessed with Cronbach's α and test-retest. Zero-order correlations were examined between ILQ subscales and symptoms, depression, SF-12 mental and physical components, a measure of self-care burden, appraisal of illness, and single-item measures of quality of life and satisfaction. Results The preconceived subscale structure was supported by factor analysis. These factors were internally consistent and stable over time. Good convergent validity was demonstrated between the Burden and Disruption scales with other measures of the burden of treatment. Patients indicated that they were generally compliant with therapy, and that treatment was not particularly burdensome or disruptive. Results based on the ILQ were consistent with other scales and qualitative responses. Conclusion The ILQ has three subscales, Burden, Lifestyle Disruption, and Compliance, that are reliable and demonstrate preliminary evidence of construct validity.

The quality of life of African American women with breast cancer.

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.

Couples' patterns of adjustment to colon cancer

The objectives for this longitudinal study were to: (a) compare colon cancer patients’ and their spouses’ appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients’ and spouses’ adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients’ and spouses’ adjustment scores over time. The strongest predictors of patients’ role adjustment problems were hopelessness and spouses’ role problems. The strongest predictors of spouses’ role problems were spouses’ own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.

An appraisal of Albert Einstein's chronic illness

For the last 39 of his 76 years of life, physicist Albert Einstein (1879–1955) suffered from chronic illness. His health problems were primarily related to multiple complications of digestive system disorders; liver ailment, stomach ulcer, inflammation of gall bladder, jaundice and intestinal pains. Based on the published autobiographical records and biographies written by his secretary Helen Dukas and collaborators such as Philipp Frank and Banesh Hoffmann, this paper appraises the chronic illness of Einstein. Reasons for the insufficient attention to Einstein's medical history are also postulated. These possibly include, 1) his dislike of divulging personal details to analysts, interviewers and reporters; and 2) scattering of his medical records due to a peripatetic life lived in 4 countries, Germany, Switzerland, Czechoslovakia and USA.

Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes.

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes.

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Perception of Control and Appraisal of Illness in Chronic Low Back Pain

People who experience chronic low back pain face significant changes in their lives, and it is unclear why some people adapt to the pain situation better than others. Using a cognitive appraisal model, outcomes of the pain situation were examined in 40 chronic low back pain patients using situational control and appraisal of illness as predicted mediating factors. This article presents background of the problem and the results of the study.

A critical appraisal of X-linked bipolar illness. Evidence for the assumed mode of inheritance is lacking.

The major assumption underlying all X-linkage studies of bipolar disorder has been that a subgroup of manic-depressive illness follows an X-linked dominant mode of inheritance. An evaluation of the segregation patterns in the pedigrees that have been analysed for X-linkage over the past 20 years does not support this assumption, because the formal genetic criteria for an X-linked dominant mode of inheritance are virtually absent. Not a single pedigree has been ascertained in which the segregation pattern is suggestive of the assumed mode of inheritance. This is mainly because segregation ratios characteristic for X-linked dominant inheritance cannot be observed among the offspring of affected males.

Self-care burden, stress appraisal, and mood among persons receiving radiotherapy

This study was undertaken to describe the self-care burden (SCB) of persons receiving radiation as outpatients, to identify factors contributing to SCB, and to test a model of the effects of SCB, symptom distress, and appraisal of illness on mood. The subjects were 72 adults with cancer who had been in treatment an average of 4 weeks. Fatigue was reported to be the most distressing symptom. Among health deviation self-care tasks, coming for treatment was the most demanding, and self-treatment, such as administering medications, was the most difficult. Universal self-care activities most disrupted by treatment were social and recreational activities. Path analysis revealed that dependency was the primary predictor of health deviation SCB, while symptom distress was the best predictor of universal SCB. Universal SCB and family hardiness were the best predictors of appraisal scores. Symptom distress and somatic mood were highly correlated, suggesting collinearity between these factors. Four variables--appraisal, symptom distress, family hardiness, and health deviation SCB--explained 55% of the variance in affective mood scores. Theoretical and clinical implications are discussed.

Appraisal of life change, depression, and illness in hardy and nonhardy women.

A survey study of adult women was conducted to examine whether psychological hardiness buffers people against stressful life change through the appraisal and interpretation of life experiences. Hardy and nonhardy participants reported life events for the previous year, physical illness for the previous 6 months, and current levels of depression and rated each reported event in terms of its desirability. Results indicate that, although hardiness is not associated with the likelihood of reporting any specific life event, nonhardy subjects appraise a significantly higher proportion of their life experiences as undesirable than do hardy subjects and report that each negative event requires greater adjustment. Discussion focuses on nonhardiness as a correlate of the trait of negative affectivity rather than hardiness as a reflection of special resiliency to stress.

Appraisal of life change, depression, and illness in hardy and nonhardy women.

A survey study of adult women was conducted to examine whether psychological hardiness buffers people against stressful life change through the appraisal and interpretation of life experiences. Hardy and nonhardy participants reported life events for the previous year, physical illness for the previous 6 months, and current levels of depression and rated each reported event in terms of its desirability. Results indicate that, although hardiness is not associated with the likelihood of reporting any specific life event, nonhardy subjects appraise a significantly higher proportion of their life experiences as undesirable than do hardy subjects and report that each negative event requires greater adjustment. Discussion focuses on nonhardiness as a correlate of the trait of negative affectivity rather than hardiness as a reflection of special resiliency to stress.

Somatopsychics and Attribution

Physical states can influence attributional process and, reciprocally, attributional inference affects health relevant outcomes. Indeed appraisal of illness or health itself depends, to a great extent, on perceptual, causal inferences. The paper describes the way this attribution process works in affecting health-relevant states and behavior, and indicates possible sources of attributional bias or error that could have significant consequences for evaluating one's physical state and its impact on other behaviors.