Aspects Of Illness Behaviour Research Articles

The Heterogeneity of Illness Behaviors in Patients with Medically Unexplained Physical Symptoms.

To investigate the heterogeneity of illness behavior in patients with medically unexplained physical symptoms (MUPS), we clustered patients in regard to their degree of engaging in different aspects of illness behavior and identified related variables with these behaviors. A sample of N = 224 patients attending treatment in primary care with a history of MUPS (at least two symptoms) was investigated by analyzing different aspects of illness behavior with the self-reported number of doctor visits during the last 6months and the Scale for the Assessment of Illness Behavior (SAIB; e.g., expression of symptoms). Two distinct clusters were identified by cluster analysis: a low (n = 106) and a high (n = 118) illness behavior clusters. The high illness behavior cluster exhibited a significantly higher rate of health anxiety than the low illness behavior cluster. Regression analysis revealed a particular effect of sex in the high illness behavior cluster: whereas being male was associated with increased illness behavior as measured by the SAIB, being female was linked to a higher number of doctor visits. Increased health anxiety was associated with the SAIB illness behavior in both clusters. Depression and anxiety did not show incremental associations with all aspects of illness behavior. Knowledge of the pattern of illness behavior in patients with MUPS enables us to improve psychological treatments that directly address specific aspects of illness behavior or health anxiety. Differences between sexes in illness behaviors require more differentiated consideration in future research.

Including illness behavior in the assessment of endocrine patients.

The concept of illness behavior was introduced by Mechanic and Volkart in the 1960s and refers to the ways in which individuals experience, perceive, evaluate and respond to their own health status (1). Accordingly, behavioral responses to the same illness or the same physical symptom may vary widely among subjects and greatly affect the disease course and outcome. In past decades, important lines of research have been concerned with illness perception, coping, risk behavior, attendance at medical facilities, treatment-seeking behavior, and treatment adherence. They have, however, mostly investigated single aspects separately. We have recently suggested that the concept of illness behavior may provide a unifying framework to observations and findings that would otherwise remain scattered and unrelated in the medical literature (1). Aspects of illness behavior that have important clinical implications have been investigated in the setting of diabetes but have been otherwise understudied in endocrine disorders. Some issues are worth considering to improve effectiveness in the longitudinal management of endocrine patients. Delayed diagnosis is a challenging matter in clinical endocrinology. Early recognition of many endocrine disorders may be impaired by symptoms that are initially subtle and nonspecific as well as by the presence of psychiatric symptoms. Stern et al (2) found that 19.9% of patients with Graves’ disease received an accurate diagnosis more than 6 months after they had sought medical care. Indeed, several psychiatric symptoms such as irritability, anxiety, and sleep difficulties were found to be presenting manifestations of this condition (2). These symptoms are likely to be considered by the physician an expression of psychological disturbance and make the differential diagnosis difficult. Similarly, a patient’s interpretation of symptoms may also contribute to a delay in the diagnosis. In the same study (2), 35.1% of patients with Graves’ disease took more than 6 months to seek medical care after they had experienced their initial symptoms because they were interpreting them as a sign of psychological distress and were therefore reluctant to seek help. Once a subject receives a diagnosis of an endocrine disease, he/she is usually required to undergo regular follow-up visits. According to some preliminary findings, nonattendance at outpatient visits is an important phenomenon in endocrinology. In a large patient population at the Taiwan University Hospital where this issue was examined over a period of 6 months in endocrinology and metabolism outpatient clinics, booked visits were not attended at a rate of 73% (3). In the same study, nonattendance was predicted by features concerning both the patient (eg, younger age) and the physician (eg, teaching status) as well as some appointment characteristics (eg, first-time visit) (3). However, the role of psychosocial variables (eg, patients’ illness attitudes) as potential predictors of nonattendance was not explored. In some instances, decreased motivation by the patient to attend follow-up visits may be determined by a lack of perceived symptoms. In a study by Kasuki et al (4), 17.6% of acromegalic patients were not attending follow-up visits at their reference centers for more than 1 year. Many of them stopped attending the acromegalic outpatient clinic because they were not experiencing symptoms and were not feeling sick, even though they were found to still have active acromegaly. There were no significant differences between

Gender Differences in Illness Behavior After Cardiac Surgery

Differences in the ways male and female patients confront their illness after cardiac surgery may contribute to previously observed gender differences in the outcomes of cardiac rehabilitation. The aim of this cross-sectional study was to verify whether there are gender-related differences in illness behavior (IB) soon after cardiac surgery and before entering cardiac rehabilitation. Patients (N = 1323) completed the IB Questionnaire and Hospital Anxiety and Depression Scale (HADS) 9 ± 5 (mean ± SD) days after cardiac surgery. The scores were tested for gender differences in score distributions (Mann-Whitney U test) and in prevalence of clinically relevant scores (the Pearson χ² test). Multivariate regression analyses were made with IB Questionnaire and HADS scores as independent variables, and gender, age, education, marital status, and type of surgery as predictors. Denial was significantly (P < .01) prevalent among the men (3.6 ± 1.4) versus women (3.2 ± 1.6), whereas disease conviction (men = 2.1 ± 1.5, women = 2.5 ± 1.6), dysphoria (men = 1.5 ± 1.5, women = 2.0 ± 1.6), anxiety (men = 6.0 ± 3.6, women = 6.9 ± 3.9), and depression (men = 5.3 ± 3.8, women = 6.5 ± 4.0) were significantly more prevalent among women. The prevalences of clinically relevant scores for disease conviction, anxiety, and depression were also significantly higher in women. Multivariate analysis showed that gender predicted these scores even after the removal of confounders. Gender differences exist in denial, disease conviction, and dysphoria, probably depending on the culturally assigned roles of men and women. As these aspects of IB may compromise treatment compliance and the quality of life, the efficacy of cardiac rehabilitation programs might be improved taking into account the different prevalences in men and women.

Specific Effects of Depression, Panic, and Somatic Symptoms on Illness Behavior

In terms of restricted financial resources, the contribution of mental disorders to health care use and illness behavior is highly relevant. However, the specific contributions of panic disorder, depression, and somatic complaints to illness behavior in unselected samples is unclear. A representative sample of 2507 inhabitants of Germany was selected and grouped into people with panic disorder (30), somatic syndrome (102), major depression (24), depressive syndrome (77), and controls (2269). Assessment instruments were the complete version of the Patient Health Questionnaire (PHQ), the Scale for the Assessment of Illness Behavior (SAIB) as well as measures of health care use. Although all clinical groups showed increased illness behavior, their impact was independent and specific. Subjects fulfilling the criteria of panic disorder showed the highest scores for illness behavior and health care use. People with mental disorders showed a greater increase in visits to general practitioners and medical specialists than to psychiatrists or psychologists. Regression analysis revealed that somatic complaints and depression have independent associations with illness behavior and health care use. Different mental and psychosomatic disorders contribute independently to health care use and other aspects of illness behavior.

The role of workplace low-level mechanical trauma, posture and environment in the onset of chronic widespread pain.

We have recently demonstrated that individual psychosocial factors are important predictors of the onset of chronic widespread pain. It has been hypothesized that excessive mechanical exposure may also be associated with symptom onset, although this has not been formally examined. We therefore determined the relative contributions of individual psychosocial and work-related mechanical, posture and environment factors in symptom onset. We conducted a population-based prospective survey and identified 1658 adults aged 18-65 yr who were symptom-free. At baseline, detailed information was obtained on work-related mechanical and environment factors using validated instruments. Individual psychosocial features were also measured. Subjects free of chronic widespread pain at baseline were followed up at 12 and 36 months to identify those reporting the onset of new symptoms. In all, 1445 (91%) returned the questionnaire at 12 months and 978 (89%) at 36 months. Of these, 81 and 92 respectively reported new chronic widespread pain. Symptom onset was predicted by workplace factors [pushing/pulling heavy weights [relative risk (RR) = 1.8, 95% confidence interval (CI) 1.1, 3.0]; repetitive movements of the wrists (RR = 1.8, 95% CI 1.2, 2.7); kneeling (RR = 2.2, 95% CI 1.2, 4.1)] and individual factors [aspects of illness behaviour (RR = 2.9, 95% CI 1.6, 5.3); somatic symptoms (RR = 1.9 95% CI 1.1, 3.3); fatigue (RR = 1.9, 95% CI 1.2, 3.1); baseline pain symptoms (RR = 2.5, 95% CI 1.6, 3.9)]. In multivariate analysis, pushing/pulling heavy weights, repetitive wrist movements, kneeling and other pain at baseline were associated with new-onset chronic widespread pain. However, the strongest predictor was a high score on the illness behaviour scale. This study provides only limited support for the hypothesis that low-level mechanical injury may be a risk factor for developing chronic widespread pain. The onset of chronic widespread pain appears to be multifactorial and is strongly predicted by individual psychosocial factors.

A new approach to assess illness behaviour

Objective: The aim of this study was to develop a scale to assess the different aspects of illness behaviour and to evaluate the measure in depressive and somatising patients. Methods: The psychometric properties of the scale were assessed in the following diagnostic groups: patients with major depression ( n=36), major depressives with an additional somatisation syndrome ( n=40), patients with somatisation syndrome ( n=37), and a control group ( n=37). After multiple test construction procedures and factor analysis, we developed the Scale for the Assessment of Illness Behaviour (SAIB). Results: The scale included 26 items (originally 58 items) and comprised five factors: (1) verification of diagnoses, (2) expression of symptoms, (3) medication, (4) consequences of illness, and (5) scanning. The intercorrelations between these factors were low confirming the multidimensional structure of illness behaviour. Physicians' rating partially confirmed the factors. All patient groups had elevated scores for illness behaviour. Correlational analyses demonstrated that illness behaviour was closely related to anxiety (such as health worries and phobic anxiety), even after controlling for other factors. Somatisation had medium associations with some aspects of illness behaviour. Symptom Checklist (SCL) results revealed that illness behaviour is not associated with the distress of single symptoms, but with the general number of symptoms. Conclusion: A suitable instrument to assess illness behaviour has been developed and should be further analysed in subsequent studies.

Use of keyboards and symptoms in the neck and arm: evidence from a national survey.

The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey. A questionnaire was mailed to 21,201 subjects aged 16-64 years, selected at random from the registers of 34 British general practices. Information was collected on occupation and on regular use of keyboards (for >4 h in an average working day), pain in the upper limbs and neck, numbness or tingling in the upper limbs, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, with the resultant odds ratios converted into prevalence ratios (PRs). Among 12,262 respondents, 4899 held non-manual occupations. These included 1871 regular users of keyboards (e.g. computer operators, data processors, clerks, administrators, secretaries and typists). Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30 and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. After adjustment for these factors, regular keyboard use was significantly associated with pain in the past week in the shoulders (PRs 1.2-1.4) and the wrists or hands (PR 1.4), but not with elbow pain or sensory symptoms over the same period, or with neck or upper limb pain that prevented normal activities in the past year. Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers. We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or hand, but risk estimates were lower than generally reported in workplace surveys. Previous estimates of risk in the occupational setting may have been biased by shared expectations, concerns, or other aspects of illness behaviour.

Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study

Objective: To determine the aetiology of forearm pain. In particular to determine the relative contribution of (a) psychological factors, features of somatisation, and health anxiety and behaviour, (b) work related...

The clientel of a psychotherapeutic polyclinic in the light of a documentation base

A documentation system for use during the diagnostical process with psychotherapy outpatients is outlined, and sociodemographic, medical and psychosocial data of newly admitted patients of a university psychotherapy outpatient department are presented. The population structure is described on the basis of data collected during the first 18 months of the implementation of the assessment system. Data are compared with those of other psychotherapeutical institutions that differ with regard to setting (outpatient vs. inpatient), health care sector (acute care vs rehabilitation) and geographic region. Sociodemographic and medical data are given. Patients' mean age is 33.5 years. Two-thirds of the patients are female. The majority is single and has higher formal education. Slightly more than half of the patients are working. Modes of admittance, somatic and psychological complaints and aspects of illness behaviour are described. Pertaining to diagnostical classification, affective disorders (34%), somatoform disorders (15%) and anxiety disorders (11%) are most frequent. Mean duration of symptoms is 6 years. However, only few patients had prior psychological treatment. Treatments most frequently selected at the time of assessment were psychodynamic psychotherapy (41%), behavioural therapy (24%), and group therapy (10%). When comparing the study population with those of other institutions, differences showed up especially in contrast to rehabilitation clinics, where older, male, and working persons as well as those with somatoform disorders and longer durations of illness are more frequent.

Dental anxiety and illness behaviour.

To analyse the relationship between dental anxiety and illness behaviour. Dental anxiety was assessed in 165 patients from private practice using the Dental Anxiety Scale (DAS), aspects of illness behaviour were evaluated by the Illness Attitude Scale (IAS), and aspects of general anxiety were analysed by the State Trait Anxiety Inventory (STAI). Dental status was documented using the DMFS index and Bleeding-on-Probing index (BOP). Multiple regression analysis (explained proportion of variance = 32%) showed that dental anxiety was significantly correlated with female gender (t = 3.109, p < 0.002) and IAS health habits (t = -2.210, p < 0.03). In addition, a correlation trend was found between dental anxiety and BOP index (t = -1.789, p < 0.08). Dental anxiety appears to be a gender-specific phenomenon. Results indicate a tendency towards abnormal illness behaviour (i.e. denial of dental anxiety) in a considerable proportion of subjects and as a consequence display of poor health habits (i.e. counterphobic behaviour). The latter may lead to an increased tendency to develop gingivitis as indicated by the correlation trend between dental anxiety and BOP index.

Illness behavior and somatization in general practice

In the primary care setting, the early recognition that a patient has psychological problems is frequently hindered by the deceptive mode of presentation known as somatization. In a cross-sectional survey of patients attending suburban General Practitioners in a large metropolitan city, the General Health Questionnaire-30 (GHQ-30) and the Illness Behavior Questionnaire (IBQ) were completed by 201 patients. A comparison was made between somatizing and nonsomatizing patients with new inceptions of illness in terms of the risk of the presence of a mild nonpsychotic psychiatric illness and aspects of illness behavior. For the group as a whole, somatizing patients were more likely to be older and female. Male somatizers differed from male nonsomatizers by showing greater disease conviction and affective disturbance and more readiness to acknowledge difficulties in their lives other than health problems. No differences were found between female somatizing and nonsomatizing patients. We conclude that, while male patients who somatize psychological distress may be distinguished from male nonsomatizers early in their illness, in terms of their illness behavior, these differences are not seen as early distinguishing characteristics in female patients who present to their General Practitioners with physical problems for which no organic cause can be established.

Illness Behaviour and the Measurement of Class Differentials in Morbidity

SUMMARY Summary measures of morbidity are necessary for research and health policy purposes but those used at present may provide unreliable estimates of the magnitude of social class differences in health. Class differences in illness behaviour will affect self-reported health measures independently of any differences in health. The aspects of illness behaviour which are relevant will vary with the morbidity measure. It may be possible to test for illness behaviour effects during data analysis; if not, the effects need to be considered when results are interpreted. Future studies might develop a battery of standardized instruments to estimate the proportion of a population which is free of serious disease.

Illness behaviour in patients with arthritis.

To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.

The Land As Body: An Essay on the Interpretation of Ritual Among the Manjaks of Guinea‐Bissau

Although neo‐Marxism informed the author's fieldwork on the therapeutic effectiveness of rituals among the Manjaks of northwestern Guinea‐Bissau, the explanatory value of materialist models turned out to be limited. Far from collapsing under the impact of capitalism because of migrant labor to Senegal and France, Manjak society retains an intact symbolic order. Migrants continue to interpret their physical and mental disorders in local terms and to participate in expensive rituals that absorb their capitalist earnings. Thus they submit to the gerontocratic order, restoring their roots in a cosmology in which the orificeless Perfect Body is ultimately the ancestral land itself. Spatio‐temporal belonging, filiation, domestic kinship power, and bodily functions merge, influencing many aspects of illness behavior and its expression in ritual and everyday life. Neo‐Marxism, epistemologically linked to societies under capitalism, scarcely explains this repertoire of symbols, yet helps us to pinpoint its unexpected vitality.

Aspects of illness behavior in patients with facial pain

Results of recent studies have suggested that factors other than clinical signs and symptoms have a significant role in determining whether people seek treatment for perceived facial pain and mandibular dysfunction. The concept of "illness behavior" can be used to investigate this problem. Knowledge of a patient's illness behavior patterns helps enable the dentist to understand who seeks care for symptoms of facial pain and mandibular dysfunction; why the care is sought; the meaning of the symptoms to the patient; and the patient's response to treatment.

Further studies of illness behaviour in long term haemodialysis

Abstract A 34 item self-administered questionnaire designed to measure aspects of illness behaviour was completed by 30 patients undergoing long-term haemodialysis. A principal components analysis of the data yielded 8 factors (together accounting for 75% of the total variance) which were subjected to orthogonal rotation. The patterns of factor loadings suggested meaningful dimensions which were labelled: ‘helpless dependence’, ‘distressing preoccupation’, ‘openness vs concealment’, ‘paranoid non-involvement vs optimistic involvement’, ‘surrender vs fight’, ‘paranoid hostility to the illness as an enemy’, ‘illness as a non-attributable challenge’ and ‘lack of information about illness’. A comparison was made with an earlier study on a smaller group of patients and this revealed some encouraging similarities in the patterns of illness behaviour.