Differences In Illness Behaviour Research Articles

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.

Why does Scotland have a higher suicide rate than England? An area-level investigation of health and social factors

BackgroundUp until the mid–late 2000s, the national suicide rate in Scotland was the highest among all the UK countries, but the reasons for this phenomenon are poorly understood.MethodsIn a multilevel...

Analysis of Illness Behavior in Patients After “Failed” Antireflux Surgery

Patients complaining of problems after antireflux surgery may have differences in illness behavior that could influence the decision to perform a revision procedure or its outcome. A prospective comparative questionnaire survey of consecutive series of patients. University teaching hospital. Those undergoing esophageal pH and manometric studies from July 1, 2001, through July 1, 2004, for investigation of new or recurrent symptoms after previous antireflux surgery. There were 52 eligible patients, of whom 4 were excluded because of refusal to enter the study (n = 1) or communication difficulties (n = 3). Of the remaining 48 patients, 22 underwent revision surgery and 26 did not. These 2 groups were compared with 167 patients with primary gastroesophageal reflux disease investigated during the same period. Self-administered, validated illness behavior questionnaire completed after informed consent was obtained. Illness behavior categories derived from the questionnaire answers: general hypochondriasis, disease conviction, psychological vs somatic illness perception, affective inhibition, affective disturbance, denial, irritability, Whiteley index of hypochondriasis, affective state, and disease affirmation. There were no significant differences in illness behavior category scores between the 2 groups with postoperative problems and patients with primary gastroesophageal reflux disease. Patients with problems after antireflux surgery have an illness behavior profile similar to that in patients with primary gastroesophageal reflux disease irrespective of whether there is objective evidence of recurrent reflux disease.

Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress

Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour. Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services. Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.

Communication between general practitioners and patients. An observational study with specific attention for the perceptions of general practitioners

This study was designed to compare health and Just World Beliefs, coping style preferences and the mental health of a group of patients that utilize complementary medicine (CM), a group that exclusively use orthodox medicine (OM) and a mixed group who use both. Each participant filled out a questionnaire consisting of four sections: a measure of health beliefs which attributed certain factors to the state of their current health and to their capacity to become healthier in the future; a measure of the extent of their Belief in a Just World; a measure of coping style preference when faced with a threatening situation; and a measure of mental health. The results, co-varying out demographic factors, showed differences between the group yielded significant differences on the beliefs about future health, with the CM group scoring higher than the OM group. There were no differences in coping styles, Just World Beliefs or mental health between the three groups. The results were discussed in relation to explanations for differences in illness behaviour, specifically the reasons for choosing complementary therapies against orthodox therapies for the treatment of illness.

Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice?

Our aim was to assess international differences in illness behaviour and clinical outcome for patients in Europe with an episode of acute tonsillitis. The subjects were 2423 patients from seven countries whose acute tonsillitis was treated with antibiotics. Each country selected at least 10 GPs who filled in a questionnaire for each episode of acute tonsillitis treated during a 3-month period, November 1989-May 1990. The outcome measure was the number of days of illness. Backwards multiple regression analysis with predictors (age, sex, country, initial temperature, days prior to illness) was performed. The number of days of illness of patients with an episode of acute tonsillitis varied between the European countries, from 3 to 10 days. Country was the most important predictor, whereas disease-specific and patients' characteristics were not important predictors. Duration of illness was primarily influenced by country. The countries in Eastern Europe especially were characterized by a longer duration of illness. Transcultural differences may influence the duration of illness and need more attention in daily practice.

Gender differences in medical treatment: The case of physician-prescribed activity restrictions

A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and female patients has been among the documented concerns. Yet, little is known about the extent to which differential treatment of male and female patients reflects the influence of social bias or of more acceptable factors, such as different patient preferences or different anticipated outcomes of care. This paper attempts to ascertain the underlying basis for an observed differential in physicians' tendency to advise activity restrictions for male and female patients. We explore the extent to which the gender-based treatment differential is attributable to: (1) patients' health profile, (2) patients' role responsibilities, (3) patients' illness behaviors, and (4) physician characteristics. These four categories of variables correspond to four prominent social science hypotheses concerning gender differences in health and health care utilization (i.e. biological basis hypothesis, fixed role hypothesis, socialization hypothesis, physician bias hypothesis). Data are drawn from the Medical Outcomes Study (MOS), a longitudinal observational study of 1546 patients of 349 physicians practicing in three U.S. cities. Multivariate logistic regression is used to evaluate the likelihood of physician-prescribed activity restrictions for male and female patients, and to explore the absolute and relative influence of patient and physician factors on the observed treatment differential. Results reveal that the odds of prescribed activity restrictions are 3.6 times higher for female patients than for males with equivalent characteristics. The observed differential is not explained by differences in male and female patients' health or role responsibilities. Gender differences in illness behavior and physician gender biases both appear to contribute to the observed differential. Female patients exhibit more illness behavior than males, and these behaviors increase physicians' tendency to prescribe activity restrictions. After accounting for illness behavior differences and all other factors, the odds of prescribed activity restrictions among female patients of male physicians is four times that of equivalent male patients of those physicians. Medical practice, education, and research must strive to identify and remove the likely unconscious role of social bias in medical decision making.

Erratum to “Non-organic symptom reporting in patients with chronic nonmalignant pain” [Pain 68 (1996) 329-342

Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physical disease. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale (Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.

Non-organic symptom reporting in patients with chronic non-malignant pain

Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physi. Paper presented at the 3rd International Symposium on Childrenss Pain, Philadelphia, PA, 1994cal disease. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale ( Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.

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.

Differences in patient perception of appropriate level of care

Objectives: The principle of achieving the most cost-effective level of care in relation to needs is an essential aim for all health care systems. However, it is not certain that the corresponding knowledge and attitudes with respect to the appropriate level of care for different symptoms can be found in the general population. There may be age-related differences in illness behaviour that manifest in ‘overutilisation’ of the system. We studied illness behaviour with regard to attitudes and inclination to seek care for different symptoms at various levels in the health care system.Methods: The study group consisted of a random selection of 296 persons, born in the 1940s, ′50s and ′60s, and living in a defined region in Sweden. In a questionnaire they had to choose between different levels of care for twelve symptom descriptions with varying degrees of severity. The answers were scored according to the level of care, adequacy and overutilisation.Results: The vast majority of participants chose an adequate ...

The development of a method for measuring anticipated illness behaviour in three common injuries.

This note outlines the rationale, development and validation of three injury scenarios as objective measures of anticipated illness behaviour. The measures were originally developed to consider differences in illness behaviour with distance from medical services in rural and remote areas of Queensland, Australia. However, the measures have a more universal applicability than the purpose for which they were developed. Unlike other measures of illness behaviour, the scenarios each incorporate a number of progressively worsening stages which permit the mapping of changes in individual or group behaviour. By working through conditions stage by stage, the likelihood of individual variations in interpretation of condition severity is greatly reduced and so a better understanding of people's responses to these conditions is obtained. In a survey of 800 rural households, each scenario met the proposed criteria of: (i) increasing urgency of action with increasing condition severity; and (ii) increasing agreement about urgency of action with increasing severity. The fractured limb scenario was perceived by respondents (in terms of urgency and agreement about type of action) as the most serious condition. There was little difference in perceived seriousness for the other two conditions.

Health, just world beliefs and coping style preferences in patients of complementary and orthodox medicine.

This study was designed to compare health and Just World Beliefs, coping style preferences and the mental health of a group of patients that utilize complementary medicine (CM), a group that exclusively use orthodox medicine (OM) and a mixed group who use both. Each participant filled out a questionnaire consisting of four sections: a measure of health beliefs which attributed certain factors to the state of their current health and to their capacity to become healthier in the future; a measure of the extent of their Belief in a Just World; a measure of coping style preference when faced with a threatening situation; and a measure of mental health. The results, co-varying out demographic factors, showed differences between the group yielded significant differences on the beliefs about future health, with the CM group scoring higher than the OM group. There were no differences in coping styles, Just World Beliefs or mental health between the three groups. The results were discussed in relation to explanations for differences in illness behaviour, specifically the reasons for choosing complementary therapies against orthodox therapies for the treatment of illness.

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.

Sex differences in factors associated with use of medical care and alternative illness behaviors

In many previous investigations of illness behavior the dependent variable has been restricted to use or nonuse of physicians' services. The purpose of this study was to determine how males and females differ in the tendency to respond to their symptoms when self-treatment and lay consultation as well as medical care are considered. The sample consisted of all white, married individuals ( n = 532) participating in a household survey who reported at least one symptom episode during a 4-week recall period. An important feature of this survey data set is that there were no proxy respondents. Similar distributions of behavioral responses to symptom episodes were found for men and women. Multinomial logit analysis was used to identify the factors associated with specific illness behaviors. The independent variables were: (1) characteristics of the individual and family such as number of children. social class and employment status; (2) characteristics and perceptions of the symptom episode including discomfort, disability and belief that a physician could do something to relieve it; and (3) access to, and attitudes toward medical care. Belief that a physician could do something to relieve the symptoms, number of days of disability and number of component symptoms in the complex were positively related to use of medical care and duration of the symptom episode was negatively related to use of medical care for both men and women. Several of the independent variables affected only one sex group or had differential effects on males and females. Sex differences were most pronounced with respect to use of lay consultants. Among men, higher social class was associated with use of medical care, whereas, among women, those in higher social classes were more likely to use lay consultants. Other things being equal, women who rated their symptom complexes high on discomfort and seriousness visited a physician, those worried about their symptoms sought lay consultation. An unexpected finding was that the presence of children in the home had a significant effect on men but not women. Employment status, number of children and age of the youngest child did not have significant effects on illness behaviors of men or women These findings should not be generalized beyond similar groups of white, primarily working class adults living in nuclear families in the early seventies. However, this data set provided an opportunity to explore gender differences in the factors associated with alternative illness behaviors including self-treatment and lay consultation in addition to use of medical care. In this sample sex differences in illness behavior were most pronounced with respect to the factors associated with use of the lay network to cope with illness. Further study is warranted.

Physician gender and the physician-patient relationship: Recent evidence and relevant questions

Despite criticisms of the quality of health care for women and considerable research on sex differences in illness behavior and utilization of health services, little research has addressed the potential impact of physician gender on the physician-patient relationship and its outcomes. With the entry of more women into the medical profession, opportunities to investigate effects of physician gender will increase. A theoretical rationale for expecting physician gender to affect the key dimensions of the interactive physician-patient relationship (communication of information, affective tone, negotiative quality) and its outcomes (satisfaction, compliance, health status) is presented. Physician gender might impact on the relationship through three mechanisms: sex differences among physicians, particularly with respect to sex-role attitudes; patients' different expectations of male and female physicians; or increased status congruence between physician and patient in same-sex, as compared to opposite-sex, physician-patient dyads. Recent research related to these topics is discussed and found to support the plausibility of these mechanisms of potential gender effects. Some methodological suggestions for future research are presented, including the suggestion that future research identify specific conditions under which physician gender effects might be more salient.

Teetering on the horns of a dilemma: Professor gove's latest paper on sex differences in illness behavior

Teetering on the horns of a dilemma: Professor gove's latest paper on sex differences in illness behavior

Age and Sex Differences in Patients' Reactions to Illness

To test hypotheses derived from theories regarding sex differences in illness behavior, health care received, and psychological development across the life span, patients' descriptions of their current' life situations were content analyzed using nine scales that measure patterns of anxiety, depression, anger, helplessness, competence, sociability and positive feelings. Patients had chronic diseases or were awaiting surgery. Two-way analyses of variance were used to compare the responses of 261 males and 318 females offour age groups: young adult (18 to 30 years), adult (31 to 45), middle-aged (46 to 60), and elderly (61 to 85). Women expressed greater separation anxiety and sociability than men. Elderly patients experienced less anxiety, fewer feelings of competence and of helplessness, and fewer positive feelings than did young adults. Older patients reported as many social interactions, but these were more likely to be solidarity interactions in which they were reactors. Results seem best interpreted in terms of developmental theories regarding women's greater affiliation needs and abilities.

Sex Differences in Illness Behavior: Care Seeking Among Cancer Patients

Sex Differences in Illness Behavior: Care Seeking Among Cancer Patients

Marital status, health, illness andservice use

Substantial differences are shown to exist between marital groups in their mortality rates, illness experience and use of health services. Evidence is presented which suggests that only a small part of the observed variations can be attributed to the selective effects of marriage and remarriage. The main factor appears to be that of the effects of the occupancy of different marital states, with this being associated with differences in stress, life styles and social support, as well with possible differences in illness behaviour and what is perceived as their relative needs for care from the official services.