Illness Attributions Research Articles

Relatives' expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis

It has been well-demonstrated that Expressed Emotion (EE) in caregivers of schizophrenia patients is related to their illness attributions, but little is known about relatives' cognitive and emotional appraisals at early stages of psychosis. This study examined differences on the relationships of EE with distress and illness attributions in 78 relatives of At-Risk Mental States (ARMS) and First-Episode of Psychosis (FEP) patients, and which of those variables better predicted EE. Criticism and Emotional Over-Involvement (EOI) were associated with distress and with several illness attributions in both groups. Anxiety was more strongly associated with criticism in ARMS than in FEP-relatives, and it was associated with EOI in the ARMS but not in the FEP-group. No differences on the relationships of EE with depression or attributions were found. Furthermore, distress and attributions of blame toward the patients predicted criticism. Attributions of control by the patient and emotional negative representation about the disorder predicted EOI. Findings highlight the need to focus on early family interventions that provide proper information and psychological support in accordance with the illness stage, to help relatives improve their understanding of the disorder, handle difficult thoughts and emotions, reduce negative appraisals, and prevent high-EE over the psychotic process.

Perceived control of patients with diabetes in Taiwan: Exploring the relationships among illness attributions, illness representations, and self-care behavior

Perceived control of patients with diabetes in Taiwan: Exploring the relationships among illness attributions, illness representations, and self-care behavior

Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients.

We researched associations between somatic symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]-15), depression (PHQ-9), anxiety (General Anxiety Disorder [GAD]-7), health anxiety (Whiteley-7 [WI-7]), illness perception (Brief-Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire-Revised [IPQ-R]), and sense of coherence (Sense of Coherence [SOC]-9). Logistic regression was applied to identify the strongest correlates with SSS. Our sample of high (PHQ-15≥10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r=0.339, P<.001), symptom-related disability (Karnofsky Index) (r=0.182, P<.001), depression (r=0.556, P<.001), anxiety (r=0.433, P<.001), health anxiety (r=0.400, P<.001), illness perception (r=0.349, P<.001), psychological illness attributions (r=0.217, P<.01), and sense of coherence (r=-0.254, P<.001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI-7, B=0.388, P=.002), higher depression (PHQ-9, B=0.158, P<.001), younger age (B=-0.042, P=.048), higher impairment in daily life (B=1.098, P=.010), and longer symptom duration (Wald=18.487, P=.001) showed a significant association with high SSS; the model explained 55.1% of the variance. High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.

Does calling alcoholism an illness make a difference? The public image of alcoholism in Italy

AimsUsing data from a population survey in two communities in the region of Sardinia, Italy, we examined the association between illness definition and attribution of personal characteristics to people with alcoholism. MethodsQuota samples, stratified by gender and age, were drawn from the general population (males: 48%; mean age 48±18; range: 15–90). A fully-structured interview was conducted face-to-face with 404 respondents. The assessment of the public view of ‘alcoholics’ was measured by their reactions to stimulus words rated on bipolar scales, and defined with adjectives with opposite meanings at each end. Results322 participants (80%) rated the ‘alcoholic’ as ‘ill’. The definition of the ‘alcoholic’ as being ill showed a statistically higher odd of stigma across all the dimensions of personal attributes. ConclusionsThe expectation that people adopting the illness model would tend to blame less those afflicted for their condition and, consequently, stigmatize them less, was not confirmed.

Stigma towards psychiatric disorders in a sample of depressed females in two different communities

IntroductionStigma and discrimination experienced by persons suffering from mental illness, unlike other medical conditions, recognized as a barrier in countries rich and poor, and in countries with well-developed mental health services and those with limited services. It was hypothesized that depression may affect patients’ attitude towards mental illness “public stigma” as well as self-stigmatization and that there will be a difference between Egyptians and Germans.AimsThis study sets out to identify and compare public–and self-stigma among depressed women in two different communities.ObjectivesTo test findings from transcultural comparative study of two patient groups of depressed women from two different communities. Participants were 50 adult females diagnosed with depression from Egypt and Germany.MethodParticipants completed after clinical interviewing and diagnosis with depression two questionnaires: the inventory of attitude towards mental illness (Shokeer, 2002) and the explanatory model interview catalogue EMIC (Weis et al., 2001).ResultsAnalysis indicates that positive attitudes towards mental illness were more for the German respondents than for the Egyptians. There were significant differences between the two groups in the causal attributions of mental illness. Psychotherapy was widely accepted in the two groups as a helpful method for treatment of mental illness.ConclusionIt was concluded that the traditional beliefs affect the understanding of illness causality and that the subjective experience of depression may affect attitude towards mental illness and mentally ill people. The effect of the social desirability is discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital

Objective To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors. Methods This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score Results The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P Conclusions Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.

Exploring Diverse Mental Illness Attributions in a Multinational Sample: A Mixed-Methods Survey of Scholars in International Psychology

Attributions, or beliefs about the causes of mental illness, have been associated with thoughts, emotions, and actions related to mental health problems and treatment. Research has shown that people hold a wide variety of beliefs about the causes of mental illness, including components that are social, genetic, spiritual, fatalistic, or simply a result of chance. The current study surveyed 158 English-speaking scholars in psychology from 65 different countries, who reported beliefs they had observed among members of the public related to attributions of mental illness. Following the research design of Landrine and Klonoff (1994) , questionnaires included free-form qualitative questions and a list of quantitative ratings of the importance of various attributions in a specific country. The scholars’ responses supported models developed with more geographically homogeneous samples, with supernatural causes, social stress, and lifestyle among the most common attributions of illness in a variety of nations. A multivariate analysis of variance (MANOVA) of the 7 derived factors revealed significant differences in attributions among regions of the world, and particularly with respect to attributions to supernatural causes, social/stress, physical health, and substance use. Although further validation of the model is recommended, an international attribution framework may lead to valuable research examining help seeking for mental health concerns, mental illness stigma, and other variables in diverse geographical and cultural contexts.

Inequality in Health for Women, Infants, and Children: An Alarming Public Health Concern.

Inequality in Health for Women, Infants, and Children: An Alarming Public Health Concern.

Апробация методик локуса контроля причин болезни и лечения и самоэффективности в отношении лечения

Illness and treatment representation in the broad sense is considered as one of the key factors of self-regulation in the situation of the illness in psychosomatics and health psychology. This work is devoted to the application of locus of control constructs (internality / externality of attribution of events) and self-efficacy (confidence of the person in her ability to realize her plans) to health and illness. According to the results of the theoretical review, it is important to assess the locus of control and self-efficacy in the specific situation – like situation of illness and treatment. We assume that the structure of the locus of control can be distinguished to not only internal, external and impersonal locus of control – but also that the locus of control of illness reasons and of treatment have different functions. On the basis of these assumptions we developed illness- and treatment-related locus of control scale and treatment-related selfefficacy scale and validated them on a sample of 517 respondents. Consistency of scales in different samples was 0,63-0,82 (with the exception of external locus of control subscale for illness reasons, 0,53-0,58), test-retest reliability - 0,58-0,81. Factor analysis confirms the 6-factor structure of the illness- and treatment-related locus of control scale, and single-factor of treatment-related self-efficacy scale. Correlation with general locus of control questionnaire and general self-efficacy scale is in favor of their convergent validity. Typical profile of internal, external and impersonal locus of control regarding the illness reasons and treatment was revealed. Treatment self-efficacy is related to the majority of indicators of both physical and psychological subjective well-being, while external and impersonal LC regarding illness reasons and impersonal LC of treatment are associated with worse quality of life (in domains of health, emotions), and in some cases - with symptoms of anxiety and depression. The role of internal LC and external LC of treatment is less clear. The scales could be used in studies of the attribution of illness and treatment and confidence in the treatment.

Supplemental Material for Exploring Diverse Mental Illness Attributions in a Multinational Sample: A Mixed-Methods Survey of Scholars in International Psychology

Supplemental Material for Exploring Diverse Mental Illness Attributions in a Multinational Sample: A Mixed-Methods Survey of Scholars in International Psychology

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.

Ethnicity and pathways to care during first episode psychosis: the role of cultural illness attributions.

BackgroundStudies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, however, that have statistically examined the influence of culturally mediated illness attributions on these variations.MethodsWe conducted an observational study of 123 (45 White; 35 Black; 43 Asian) patients recruited over a two-year period from an Early Intervention Service (EIS) in Birmingham, UK. Sociodemographic factors (age; sex; education; country of birth; religious practice; marital status; living alone), duration of untreated psychosis (DUP), service contacts (general practitioner; emergency services; faith-based; compulsory detention; criminal justice) and illness attributions (“individual;” “natural;” “social;” “supernatural;” “no attribution”) were assessed.ResultsEthnic groups did not differ in DUP (p = 0.86). Asian patients were more likely to report supernatural illness attributions in comparison to White (Odds Ratio: 4.02; 95 % Confidence Intervals: 1.52, 10.62) and Black (OR: 3.48; 95 % CI: 1.25, 9.67) patients. In logistic regressions controlling for confounders and illness attributions, Black (OR: 14.00; 95 % CI: 1.30, 151.11) and Asian (OR: 13.29; 95 % CI: 1.26, 140.47) patients were more likely to consult faith-based institutions than White patients. Black patients were more likely to be compulsorily detained than White patients (OR: 4.56; 95 % CI: 1.40, 14.85).ConclusionIllness attributions and sociodemographic confounders do not fully explain the ethnic tendency to seek out faith-based institutions. While Asian and Black patients are more likely to seek help from faith-based organisations, this does not appear to lead to a delay in contact with mental health services.

Time valuation of historical outbreak attribution data.

Human illness attribution is recognized as an important metric for prioritizing and informing food-safety decisions and for monitoring progress towards long-term food-safety goals. Inferences regarding the proportion of illnesses attributed to a specific commodity class are often based on analyses of datasets describing the number of outbreaks in a given year or combination of years. In many countries, the total number of pathogen-related outbreaks reported nationwide for an implicated food source is often fewer than 50 instances in a given year and the number of years for which data are available can be fewer than 10. Therefore, a high degree of uncertainty is associated with the estimated fraction of pathogen-related outbreaks attributed to a general food commodity. Although it is possible to make inferences using only data from the most recent year, this type of estimation strategy ignores the data collected in previous years. Thus, a strong argument exists for an estimator that could 'borrow strength' from data collected in the previous years by combining the current data with the data from previous years. While many estimators exist for combining multiple years of data, most either require more data than is currently available or lack an objective and biologically plausible theoretical basis. This study introduces an estimation strategy that progressively reduces the influence of data collected in past years in accordance with the degree of departure from a Poisson process. The methodology is applied to the estimation of the attribution fraction for Salmonella and Escherichia coli O157:H7 for common food commodities and the estimates are compared against two alternative estimators.

Attribution of mental illness to work: a Delphi study.

Clinicians may be asked whether mental ill-health has been caused by work but there is no guidance on how this judgement should be made. To seek a consensus on the factors that should be considered and how they should be sought when attributing mental ill-health to work. A three-round Delphi study involving expert academics, occupational physicians, psychiatrists and psychologists. We deemed consensus had been reached when 66% or more of the experts were in agreement. Of 54 invited experts, 35 (65%) took part in the first round, 30 of these 35 (86%) in the second and 29 of these 30 (97%) in the final round. Consensus was reached for 11 workplace stressors: high job strain; effort-reward imbalance; major trauma; interpersonal conflict; inadequate support; role ambiguity; person-job mismatch; organizational injustice; organizational culture; work scheduling and threats to job security. Seven personal factors were identified as being important: previous mental illness; personality traits of neuroticism; adverse life events or social circumstances; resilience; a family history of mental illness and secondary gain. The worker, manager and co-workers were thought to be the most useful sources of workplace information. Consensus was reached for a definition of occupational mental illness but not for a threshold of work-relatedness. The attribution of mental ill-health to work is complex and involves the consideration of both workplace stressors and personal factors of vulnerability. Clinical consultation with an occupational physician who is familiar with the workplace is central to the process.

Lay Theories on the Role of Biomedicalization in the Exclusion of Depressed People

This study examined lay theories about the relationship between biomedicalization and the exclusion of depressed people. More precisely, lay theories were examined under the two dominant models which predict that attribution of mental illness to biomedical causes should reduce perceived responsibility and either decrease (attribution theory) or increase (medical model) perceived exclusion of depressed people. The goal was also to assess the impact of three factors most often disregarded from both models, namely, type of responsibility (mental state vs. behaviors), life domain (family vs. occupational environment) and familiarity (contact vs. personal experience). Analysis of data from a representative survey conducted in the Nord Pas de Calais French region (n = 12,533) showed that contact and personal experience have opposite effects on perceived exclusion and that lay theories differed as a function of type of responsibility. The role of ascribed responsibility for behaviors did not depend on life domain and was consistent with the medical model. On the contrary, the role of responsibility for mental state was limited to exclusion from family and in line with attribution theory. Future research should examine more thoroughly the role of the different kinds of biomedical explanations in relation with both types of responsibility.

Systematic review of expert elicitation methods as a tool for source attribution of enteric illness.

Expert elicitation is a useful tool to explore sources of uncertainty and to answer questions where data are expensive or difficult to collect. It has been used across a variety of disciplines and represents an important method for estimating source attribution for enteric illness. A systematic review was undertaken to explore published expert elicitation studies, identify key considerations, and to make recommendations for designing an expert elicitation in the context of enteric illness source attribution. Fifty-nine studies were reviewed. Five key themes were identified: the expert panel including composition and recruitment; the pre-elicitation material, which clarifies the research question and provides training in uncertainty and probability; the choice of elicitation tool and method (e.g., questionnaires, surveys, and interviews); research design; and analysis of elicited data. Careful consideration of these themes is critical in designing and implementing an expert elicitation in order to reduce bias and produce the best possible results. While there are various epidemiological and microbiological methods available to explore source attribution of enteric illness, expert elicitation provides an opportunity to identify gaps in our understanding and where such studies are not feasible or available, represents the only possible method for synthesizing knowledge about transmission.

The Relations between Violence Exposure, Posttraumatic Stress Symptoms, Secondary Traumatization, Vicarious Post Traumatic Growth and Illness Attribution among Psychiatric Nurses

This study examined posttraumatic stress disorder symptoms (PTSD), secondary traumatization (ST) and vicarious posttraumatic growth (VG) among Israeli psychiatric nurses (PN) who were compared to community nurses (CN). Furthermore, we examined the contribution of PN perceptions of the etiology of their patients’ mental illness to their PTSD, ST and VG. Results show that PN reported higher levels of both PTSD and ST symptoms, but lower levels of VG, as compare to CN. While ST symptoms were positively related to VG among CN, PTSD and ST symptoms were negatively associated among PN. Finally, exposure to patients' violence, PTSD or ST symptoms, and illness attribution dimensions of 'powerful others', predicted nurses' VG. PN are an at-risk population for work-related stress residues.

Attributions of Mental Illness: An Ethnically Diverse Community Perspective.

Although the prevalence of mental illness is similar across ethnic groups, a large disparity exists in the utilization of services. Mental health attributions, causal beliefs regarding the etiology of mental illness, may contribute to this disparity. To understand mental health attributions across diverse ethnic backgrounds, we conducted focus groups with African American (n = 8; 24 %), Asian American (n = 6; 18 %), Latino/Hispanic (n = 9; 26 %), and White (n = 11; 32 %) participants. We solicited attributions about 19 mental health disorders, each representing major sub-categories of the DSM-IV. Using a grounded theory approach, participant responses were categorized into 12 themes: Biological, Normalization, Personal Characteristic, Personal Choice, Just World, Spiritual, Family, Social Other, Environment, Trauma, Stress, and Diagnosis. Results indicate that ethnic minorities are more likely than Whites to mention spirituality and normalization causes. Understanding ethnic minority mental health attributions is critical to promote treatment-seeking behaviors and inform culturally responsive community-based mental health services.

Healthcare providers' attitudes toward persons with schizophrenia.

This study compared the attitudes of mental health and primary care providers toward persons with schizophrenia at 5 Veterans Affairs (VA) facilities. This study utilized a cross-sectional anonymous survey, including clinical vignettes describing identical patient scenarios for a hypothetical patient with and without schizophrenia, to examine the differences in attitudes of primary care and mental health providers. The survey was distributed in 3 waves from August 2011 to April 2012. Participants included 351 VA providers from 5 VA medical centers, including 205 mental health providers (psychiatrists, psychologists, and mental health nurses) and 146 primary care providers (nurses and physicians). Providers' attitudes were assessed on 3 domains, including social distance, stereotyping, and attribution of mental illness. Primary care providers had significantly more negative attitudes toward the vignette patient with schizophrenia compared with the patient without schizophrenia on 2 of 3 attitude measures (stereotyping and attribution of mental illness); however, this difference was not observed for mental health providers on the 2 measures. Conclusions and Implication for Practice: Primary care providers' negative attitudes toward individuals with schizophrenia represent a potential target for interventions to reduce disparities in care for individuals with schizophrenia.

"Head take you": causal attributions of mental illness in Jamaica.

Causal attributions are a key factor in explanatory models of illness; however, little research on causal attributions of mental illness has been conducted in developing nations in the Caribbean, including Jamaica. Explanatory models of mental illness may be important in understanding illness experience and be a crucial factor in mental health service seeking and utilization. We explored causal attributions of mental illness in Jamaica by conducting 20 focus groups, including 16 community samples, 2 patient samples, and 2 samples of caregivers of patients, with a total of 159 participants. The 5 most commonly endorsed causal attributions of mental illness are discussed: (a) drug-related causes, including ganja (marijuana); (b) biological causes, such as chemical imbalance, familial transmission, and "blood"; (c) psychological causes, including stress and thinking too much; (d) social causes, such as relationship problems and job loss; and (e) spiritual or religious causes, including Obeah.