Illness-related Stress Research Articles

Parental information, motivation, and adherence behaviors among children with sickle cell disease

Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD). Participants were parents of 150 children, ages 1-17 years, receiving care in a sickle cell center. Parents completed questionnaires assessing information, motivation, adherence behaviors, and other factors with respect to SCD management. Data regarding health care utilization in the previous 12 months were obtained from parent report and electronic medical records. Stepwise multiple regression analysis was conducted to determine associations between IMB factors and health care use. Parents rated highly in the domains of information, motivation, and adherence behaviors for managing their child's SCD. Children of parents reporting higher satisfaction with social supports had higher odds (OR 1.49, 95% CI 1.03-2.15) of two or more routine hematology visits in the previous 12 months. Neither information nor adherence behavior was associated with urgent or routine care use. Among other variables measured, high parental illness-related stress and child health status reported as fair/poor were the strongest predictors of urgent care use while private insurance type was the strongest predictor of routine care use. Among IMB factors, social support was associated with routine health care utilization. Social support and parental illness-related stress may serve as important, modifiable targets in interventions to allocate needed resources to families and reduce unnecessary medical care.

Using Yoga Interventions to Enhance Clinical Social Work Practices with Young Women with Cancer

It is widely published that physical, psychological, and social stressors adversely affect many individuals who are diagnosed with cancer, influencing their experience of treatment and perhaps, the quality of life after treatment is complete. No one is prepared for this battle, yet most patients are forced to make split-second decisions that are critical to their care. This case study highlights the mindfulness approach taken by one social worker to help a young woman during her journey with cancer. By guiding her through gentle yoga postures, yoga breathing, and meditation this patient learned how to take back some measure of control in her recovery, address her illness-related stress, and possibly enhance the quality of her life during treatment. As more clinicians combine conventional best practices with complementary healing therapies, they may provide tools any patient can use to instill hope and promote wellness during this most challenging time and beyond.

Age-related differences in the quality of life in end-stage renal disease in patients enrolled in hemodialysis or continuous peritoneal dialysis

BackgroundThe aim of the present study was to compare the experience elderly and younger patients in terms of emotional status, disease perception, methods of coping with the end-stage renal disease (ESRD) stress, and health-related quality of life in 2 different settings of renal replacement therapy: hemodialysis (HD) and continuous ambulatory peritoneal dialysis programs (CAPD). Specifically, we hypothesized that younger people will more frequently use goal-oriented strategies to cope with illness-related stress and elderly patients will use more strategies related to the control of emotion.Material/MethodsA total of 69 HD patients, 40 CAPD patients, and 89 healthy volunteers were analyzed. The Situation and Trait Anxiety Inventory, the Profile of Mood States, the Cognitive Stress Appraisal Questionnaire, and the Nottingham Health Profile were used to assess anxiety, long-term emotional status, coping mechanisms, and health-related quality of life. Data were collected on several biochemical and demographic variables.ResultsOur study revealed that younger and elderly people on dialysis faced quite different problems. Younger people in both RRT groups had statistically higher assessment of ESRD as loss or challenge and they more frequently used distractive and emotional preoccupation coping strategies. Depression, confusion, and bewilderment dominate the emotional status of both patient populations, especially in the younger cohort. Both HDyoung and CAPDyoung patients complained more about lack of energy, mobility limitations, and sleep disturbances as compared to their elderly HD and CAPD counterparts.ConclusionsThere are different needs and problems in younger and elderly patients on renal replacement therapy. Younger people required more ESRD-oriented support to relieve their health-related complaints to the level observed in their peers and needed extensive psychological assistance in order to cope with negative emotions related to their disease.

Examining the association between parent illness-related stress and child pain across acupuncture treatments

Examining the association between parent illness-related stress and child pain across acupuncture treatments

Predictors of support provision: A study with couples adapting to incontinence following radical prostatectomy

Four domains of predictors of support provision were tested in couples facing an illness-related stress context. Predictor domains of partners' support provision to patients adapting to incontinence following prostatectomy included stress factors, recipient factors, provider factors, and relationship factors. Data from 109 patients and their female partners were analysed. Couples provided data on five measurement occasions from 2 weeks to 1 year postsurgery. Predictors included patient's incontinence (stress factor), patient's support mobilization, affect and general self-efficacy (recipient factors), partner's affect and general self-efficacy (provider factors), partners' average waking time spent together, both partners' relationship satisfaction and partner's received support from patient (as an indicator of reciprocal support; relationship factors). Provider factors were not reliably associated with support provision, neither was patient negative affect. Stress and relationship factors accounted for outcome variance in the expected directions. Among recipient factors, mobilization of support and patient self-efficacy were positively related with the outcome, whereas patient positive affect was negatively associated with support provision by partners. Findings on predictor domains are in line with other couple studies that used non-illness-related stress contexts. Resemblance of findings points to generalizability of predictions across stress contexts varying in content, controllability, and duration.

Heme Oxygenase 1 Polymorphisms and Plasma Concentrations in Critically Ill Patients

Heme oxygenase 1 (HO-1) is a cytoprotective enzyme upregulated by various critical illness-related stress stimuli. We investigated the association of HO-1 gene polymorphisms and plasma concentrations with the outcome of critically ill patients in a prospective cohort study of 231 critically ill patients admitted to tertiary care medical and medical-surgical intensive care units. Blood samples were collected on days 1, 2, and 3 to 4 in the intensive care unit. The HO-1 plasma concentration was measured in serial samples, and HO-1 single nucleotide polymorphisms, -413A/T and +99G/C, and HO-1 promoter GTn repeat length polymorphism were determined. The +99C and long GTn alleles were in perfect linkage disequilibrium, and the -413T/GT(L)/+99C haplotype had significant independent effect on first-day HO-1 plasma concentrations in linear regression analysis (P = 0.03) and associated with lower HO-1 plasma levels. Furthermore, -413T/GT(L)/+99C haplotype associated with a lower frequency of multiple-organ dysfunction compared with other haplotypes (P = 0.017). The HO-1 plasma concentrations of study patients were significantly higher than the values of healthy controls at all time points (P < 0.001), and the first-day plasma HO-1 levels were independently associated with the Sequential Organ Failure Assessment score (P = 0.001). In conclusion, the HO-1 -413T/GT(L)/+99C haplotype is associated with HO-1 plasma levels and the frequency of multiple-organ dysfunction in critically ill patients. The HO-1 plasma concentrations are significantly increased among critically ill patients and associated with the degree of organ dysfunction.

Testing a Model of Physical and Psychological Recovery After a Cardiac Event

Little is known about the specific sources and types of support that assist patients in alleviating stress and achieving positive recovery outcomes after a cardiac event. The purpose of this study is to examine the effects of illness-related stress, emotional and tangible support from a significant other, and informational support from a health care provider on physical and psychological recovery outcomes in cardiac patients 8 weeks after their cardiac event. The sample consists of 220 cardiac patients. Data analysis uses structural equation modeling. Final fit indices were as follows: χ(2) (df = 110) = 156.169, comparative fit index = .963, Tucker-Lewis index = .949, and root mean square error of approximation = .044 suggesting an acceptable model. Illness-related stress has direct effects on depression, physical recovery, and activity levels. Partner emotional support has a direct effect on depression. The findings provide direction for developing social support interventions aimed at improving recovery outcomes.

Illness Related Stress Interacts with Perception of the Self as Ill to Predict Depression in Psychosis

Drawing from the field of cognitive vulnerability to depression, we hypothesized that in persistent psychosis, perception of the self as ill interacts with illness-related stress to predict depressive symptoms. Fifty-five patients with dual diagnosis (i.e., psychosis and substance abuse disorder) participating in a community-based intervention were assessed as to their depressive symptoms, perception of the self as ill, and illness-related stress focusing on stigmatization and exposure to community violence. As expected, illness-related stress predicted depressive symptoms under high, but not low, levels of the experience of the self as ill. These effects were obtained when both hopelessness depression symptoms and “regular” depressive symptoms were examined. Findings encourage further application of the field of cognitive vulnerability to depression in psychosis research and treatment.

Diminished Neural and Cognitive Responses to Facial Expressions of Disgust in Patients with Psoriasis: A Functional Magnetic Resonance Imaging Study

Psoriasis produces significant psychosocial disability; however, little is understood about the neurocognitive mechanisms that mediate the adverse consequences of the social stigma associated with visible skin lesions, such as disgusted facial expressions of others. Both the feeling of disgust and the observation of disgust in others are known to activate the insula cortex. We investigated whether the social impact of psoriasis is associated with altered cognitive processing of disgust using (i) a covert recognition of faces task conducted using functional magnetic resonance imaging (fMRI) and (ii) the facial expression recognition task (FERT), a decision-making task, conducted outside the scanner to assess the ability to recognize overtly different intensities of disgust. Thirteen right-handed male patients with psoriasis and 13 age-matched male controls were included. In the fMRI study, psoriasis patients had significantly (P<0.005) smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls. These data were corroborated by FERT, in that patients were less able than controls to identify all intensities of disgust tested. We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions.

Psychiatric comorbidity in adult eczema

Atopic eczema (AE) is a common dermatological condition that causes significant problems in everyday life and high levels of illness-related stress in substantial proportions of patients. The extent to which adult AE is associated with clinically relevant psychiatric morbidity is unclear. To investigate the association between adult AE and major psychiatric/psychosomatic disorders. Case-control study utilizing the GKV database Saxony, an interdisciplinary administrative outpatient database from Germany. All patients documented as having AE at least twice within the study period (2003-2004) (n = 3769, mean age 44 years) were individually matched by age and sex to 3769 controls without AE. Logistic regression models were fitted to investigate the relationship of AE with affective, stress-related, behaviour and schizophrenic disorders, considering sociodemographic characteristics, consulting behaviour and allergic comorbidities as potential confounding factors. Eczema was independently associated with affective [adjusted odds ratio (OR) 1.42, 95% confidence interval (CI) 1.13-1.79], stress-related (OR 1.55, 95% CI 1.35-1.77), behaviour (OR 1.52, 95% CI 1.03-2.23) and schizophrenic disorders (OR 2.12, 95% CI 1.22-3.71). For each psychiatric condition the likelihood of being affected significantly increased with each physician visit due to AE, suggesting that the risk of psychiatric comorbidity increases with the severity of AE. This study indicates psychiatric comorbidity of adults with AE. Collaboration between dermatologists and mental health specialists may optimize medical care for a significant subgroup of patients with AE.

American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control

People with diabetes are more likely to be hospitalized and to have longer durations of hospital stay than those without diabetes. A recent survey estimated that 22% of all hospital inpatient days were incurred by people with diabetes and that hospital inpatient care accounted for half of the 174 billion USD total U.S. medical expenditures for this disease (1). These findings are due, in part, to the continued expansion of the worldwide epidemic of type 2 diabetes. In the U.S. alone, there are ∼1.6 million new cases of diabetes each year, with an over all prevalence of 23.6 million people (7.8% of the population, with one-fourth of the cases remaining undiagnosed). An additional 57 million American adults are at high risk for type 2 diabetes (2). Although the costs of illness-related stress hyperglycemia are not known, they are likely to be considerable in light of the poor prognosis of such patients (3–6). There is substantial observational evidence linking hyperglycemia in hospitalized patients (with or without diabetes) to poor outcomes. Cohort studies as well as a few early randomized controlled trials (RCTs) have suggested that intensive treatment of hyperglycemia improved hospital outcomes (5–8). In 2004, this evidence led the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), in collaboration with the American Diabetes Association (ADA) and other medical organizations, to develop recommendations for treatment of inpatient hyperglycemia (9). In 2005, the ADA added recommendations for treatment of hyperglycemia in the hospitalto itsannual Standards of Medical Care (10). Recommendations from the ACE and the ADA generally endorsed tight glycemic control in critical care units. For patients in general medical and surgical units, where RCT evidence regarding treatment targets was lacking, glycemic goals similar to those advised for outpatients were advocated (9, …

Role of Depression in Quality of Life for Patients with Psoriasis

Background: It has been proposed that depression plays a role in how psoriasis affects quality of life. However, primary data are limited. Objective: To investigate the role depression plays in how patients experience psoriasis. Methods: Cross-sectional study conducted between January and May 2005. Recruitment of 265 adults with prevalent psoriasis through Internet advertisements. Standardized assessment of depressive symptoms, health-related quality of life (HRQL), illness-related stress, and clinical severity of psoriasis using validated scales. Results: Thirty-two percent of all participants screened positive for depression. We observed a graded relationship between depressive symptoms and HRQL impairment (p < 0.001). Only 16.5% of those with high depression scores were currently treated for depression. Both dissatisfaction with antipsoriatic treatment and illness-related stress were highly associated with depression. After adjustment for HRQL, patients with more severe psoriasis were less likely depressed, although this association failed to reach statistical significance (multiadjusted odds ratio 0.37; 95% CI 0.13–1.02; p = 0.06). Conclusion: Patients with high subjective distress and low objective measures of psoriasis should be evaluated for depression.

Understanding the relationship between objective disease severity, psoriatic symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis — a structural equations modeling approach

Objectives The aim of this study was to assess associations between objective disease severity, psoriasis symptoms, illness-related stress (IRS), health-related quality of life (HRQL) and depressive symptoms in patients with psoriasis. Method Cross-sectional study conducted between January and May 2005. Recruitment of 265 adult patients with psoriasis through Internet advertisements. Analysis of the validity of different measurement models and the fit of hypothesized structural models using a structural equations modeling approach. Results Thirty-two percent of the participants screened positive for depression. Because of poor discriminant validity (correlation: 0.919), IRS and HRQL were considered as one factor. The final measurement model had adequate validity and fit. A significant proportion of the variance of depressive symptoms was explained by HRQL (standardized direct effect: 0.916; P<.001). After adjustment for HRQL, objective severity of psoriasis was inversely related to depressive symptoms (standardized direct effect: −0.250; P=.094). Conclusion In psoriasis — a condition without direct brain involvement — specific disease-related problems in everyday life seem to cause depression in a significant proportion of patients. It is therefore critically important to regularly assess and work to maximize HRQL in psoriasis patients. Patients with high HRQL impairment despite objectively mild psoriasis should be screened for depression.

Depressive Symptoms in Mothers of Prematurely Born Infants

This longitudinal, descriptive study described the level of depressive symptoms in mothers of preterm infants from birth through 27 months corrected age and examined factors associated with depressive symptoms. The framework for the study was guided by an ecological developmental systems perspective and an adaptation of the Preterm Parental Distress Model. In this model, we hypothesize that a mother's emotional distress to the birth and parenting of a prematurely born child is influenced by personal and family factors, severity of the infant's health status, and illness-related stress and worry. Participants were 102 mothers of preterm infants who were off the ventilator and not otherwise dependent on major technology at enrollment. Mean depressive symptoms scores on the Center for Epidemiologic Studies Depression Scale (CES-D) during hospitalization were high and more than half the mothers (63%) had scores of > or =16 indicating risk of depression. Depressive scores declined over time until 6 months and then were fairly stable. Unmarried mothers, mothers of infants who were rehospitalized, and mothers who reported more maternal role alteration stress during hospitalization and worry about the child's health had more depressive symptoms through the first year. Mothers who reported more parental role alteration stress during hospitalization (odds ratio [OR] = 1.570, 95% confidence interval [CI]: 1.171-2.104) and more worry about the child's health (OR = 2.350, 95% CI: 1.842-2.998) were more likely to experience elevated CES-D scores that put them at risk of depression. Also, mothers of rehospitalized infants had decreasing odds of elevated CES-D scores over time (OR = 0.982 per week, 95% CI: 0.968-0.996). Findings have implications for the support of mothers during hospitalization and in the early years of parenting a preterm infant.

Understanding the relationship between clinical signs and symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis—A structional equations modeling approach

Understanding the relationship between clinical signs and symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis—A structional equations modeling approach

Coping With Illness-Related Stress Among Urban Children With Asthma

The effect of problem-focused and avoidant coping on social withdrawal was investigated among a sample of 31 urban children with asthma experiencing varied levels of illness-related stress. Two main and two moderating effects were examined. Neither problem-focused nor avoidant coping was significantly associated with withdrawal when the child's asthma symptoms and stressors were controlled. However, a pattern emerged in analyses of the interaction between coping and stress level. Higher levels of both problem-focused and avoidant coping were associated with lower levels of social withdrawal, but only for children with low levels of asthma-related stress.

Illness-related factors, stress and coping strategies in relation to psychological distress in HIV-infected persons in Hong Kong

This study examined the relationships among illness-related factors, stress, coping strategies and psychological distress in HIV-infected persons in Hong Kong (N=118). Multiple regression analyses were used to examine the models of psychological distress as a function of demographic factors, illness-related factors, psychosocial stressors and coping. Results showed that positive thinking was inversely related to psychological distress and avoidance was associated with higher level of anxiety. However, the use of problem solving was found to be inversely related to anxiety. Results are discussed in the context of Chinese culture and the service in Hong Kong.

Adjustment to Chronic Arthritis of Childhood: The Roles of Illness-Related Stress and Attitude Toward Illness

To examine the relationship of psychosocial stress and attitude toward illness to psychological adjustment among youth with chronic arthritis. Seventy-five youths with chronic arthritis aged 8-18 years were administered a semi-structured interview assessing illness-related and nonillness-related stressors in important life domains. Children also completed measures of attitude toward illness, depressive symptoms, and anxiety. Parents completed a measure of child psychosocial adjustment. Higher levels of illness-related and nonillness-related stress were associated with higher levels of anxiety and depressive symptoms and parent-reported adjustment problems, while a more positive attitude toward illness was associated with lower levels of anxiety and depressive symptoms. Attitude toward illness moderated the relationship between stress and depressive symptoms. Results suggest the importance of assessing life stress and attitude toward illness among youth with arthritis and developing interventions to help children cope with arthritis-related stressors and promote a more positive attitude toward illness.

Ovarian Cancer Patients' Psychological Distress: The Role of Physical Impairment, Perceived Unsupportive Family and Friend Behaviors, Perceived Control, and Self-Esteem.

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer.

Narrative Therapy to Prevent Illness-Related Stress Disorder

Cancer strikes more than 47% of males and 38% of females (Landis, Murry, Bolden, & Wingo, 1998) during their lifetimes. People are living longer (American Cancer Society, 2000) but not necessarily more satisfactory lives in the posttreatment period (Baum & Posluszny, 2001; Kangas, Henry, & Bryant, 2002). Mortality rates from cancer are decreasing to the point that the American Cancer Society has now considered certain cancers chronic rather than acute illnesses. With an expected life span of many years, attention has turned to the impact of the event in the posttreatment phase. Cancer patients experience heightened anxiety just prior to the completion of treatment as they prepare to transition from the medical system monitoring their health to monitoring it themselves (Eakes, Rakfal, Keel, & Gaiser, 1996; Kaasa et al., 1993; Tjemsland, Soreide, & Malt, 1996a, 1996b). Anxiety rises again after the completion of treatment due to the fear of recurrence (Andrykowski, Cordova, McGrath, Sloan, & Kenady, 2000; Hampton & Frombach, 2000; Mundy et al., 2000). Research has found that approximately 13% of cancer patients experience symptoms of posttraumatic stress disorder (PTSD) in the posttreatment phase of cancer recovery, and 46% experience subclinical signs of distress. Subclinical signs mean that the person is experiencing considerable distress but the distress has not reached the level of a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994). More than 94% of cancer patients report that the experience was the most traumatic event they have ever experienced (Andrykowski et al., 2000; Baum & Posluszny, 2001; Kangas et al., 2002). There is no doubt that cancer is a traumatic stressor and that there is a paucity of interventions to assist patients with long-term reactions (Kangas et al., 2002; Solomon & Johnson, 2002). Adjustment to living with or having had cancer is multidimensional, involving emotional, cognitive, behavioral, physical, and social features (Stanton, Collins, & Sworowski, 2001). Emotional components include depression and anxiety; cognitive components include a sense of foreshortened future, the inability to concentrate, preoccupation, and appraisals of the illness and oneself; behavioral demands include role fulfillment or changes and meeting the demands of the illness; social components involve personal relationships, social comparisons, support, and the stigma of cancer, for example, discrimination in the workforce due to being a medical risk; and, finally, existential components include reevaluation of the meaning and purpose of one's life and setting priorities accordingly (Stanton et al., 2001). Although considered multifaceted, the types of interventions offered cancer patients include education, social support groups, and psychoeducational groups on effective coping and problem solving (F. I. Fawzy, Fawzy, & Canada, 2001; Scheier & Carver, 2001). The predominant therapies used in cancer interventions are the cognitive and behavioral approaches. These approaches are symptom focused; identify factors related to a particular problem; and attempt to modify the factors that cause or maintain the problem, specifically the social environment, thoughts, and feelings (Redd & Jacobsen, 2001). These approaches have been found to be highly effective with compliance (Richardson, Shelton, Krailo, & Levine, 1990), coping (Blanchard, Toseland, & McCallion, 1996; N. W. Fawzy, 1996), symptom control (Burish, Snyder, & Jenkins, 1991; Cain, Kohorn, Quinlan, Latimer, & Schwartz, 1986; Decker, Cline-Elsen, & Gallagher, 1992; Spiegel & Bloom, 1983), and increasing a sense of control (Baider, Uziely, & Kaplan De-Nour, 1994; F. I. Fawzy et al., 1990; Watson, Greer, Pruyn, & Van den Borne, 1990). They also fit well within the medical system's philosophy of identifying and treating what is wrong now. …