Illness-related Stress Research Articles

Confronting life with rheumatoid arthritis.

Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife. The purpose of this study was to identify and describe, at three points in time and over two 6-month intervals, the illness-related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress-related emotions and the coping strategies they used to manage the illness-related stressors. A longitudinal, descriptive design was used to assess older people's perceptions of illness-related stress, their stress emotions and the coping strategies used to manage the illness-related stressors. Findings. The majority of participants most frequently identified physical limitations as their illness-related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis. The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.

Parent factors and adolescent sickle cell disease: associations with patterns of health service use.

To examine relationships among parent characteristics (parent-adolescent relationship, parents' illness knowledge, and parents' perceptions of illness-related burden) and use of routine and urgent health services among adolescents with sickle cell disease (SCD). Seventy adolescents, ages 12-18, and their parents completed questionnaires assessing illness knowledge, perceptions of illness burden, parent-adolescent relationships, and adolescents' psychological functioning. Information about pain, routine services (i.e., care at home, clinic visits) and urgent service use (i.e., emergency department visits, hospitalizations) was obtained from parents and medical records. After we controlled for disease severity and life events, parents' perception of more illness-related stress was the strongest predictor of both types of service use. Greater parental knowledge about SCD also related to higher frequency of routine service use. Disease severity was strongly associated with frequency of urgent service use. Both parent characteristics and disease severity were associated with patterns of service use. Enhancing aspects of parental functioning may help families make adaptive decisions regarding health care services for SCD pain management.

Worry about child health in mothers of hospitalized medically fragile infants.

This study examined child health worry among mothers of medically fragile infants with differing health problems and identified factors associated with maternal worry. Medically fragile infants were term (38%) and preterm (62%) infants who had a life-threatening health problem that necessitated a long hospitalization and dependence on technology for survival. The 78 mothers were recruited during their infants' hospitalization. Their mean age was 26 years. Most had a high school education, were married, and were from diverse ethnic/racial backgrounds. Descriptive correlational design using data from a larger longitudinal study. Mothers completed questionnaires while the infants were hospitalized. Instruments measured worry about the child's health (Child Health Worry Scale), maternal characteristics (demographic questionnaire), satisfaction with family (Family APGAR scale), illness-related stress (Parental Stressor Scale: Infant Hospitalization), and illness-related factors (diagnostic category, age/days hospitalized, and technology dependence). The highest source of worry was medical problems, followed by worry about whether the child would be normal, when the child could come home, and whether the child would always be sick. There was no significant difference in level of worry among mothers of infants with chronic lung disease, congenital airway anomalies, severe gastrointestinal problems, complex congenital heart disease, neurologic diagnoses, and those grouped as other. Fewer days hospitalized, lower maternal education, and higher stress associated with the child's appearance and behavior were related to higher levels of maternal worry. Mothers of critically ill infants, regardless of the type of diagnosis, worry about aspects of their infant's health. Mothers, especially mothers with a low educational level, need support from nurses to understand and cope with their infant's illness to reduce distress associated with worry.

A Model for Supporting the Patient's Coping with Chronic Illness

The focus of this literature study is the concept of coping from the perspective of nursing. For the analysis of Benner and Wrubel's model Fawcett's analytical structure was used. The paper describes how the nurse can use the model as a basis for guiding the patient towards successful coping with regard to well-being. The nurse interprets the experience of stress and assesses the coping requirements and the available coping resources on the basis of three questions: Coping with what? To what end? With what resources? An urgent complementary question should be how the patient copes with the illness-related stress. The nurse contributes to improving the well-being of the patient by understanding his or her perception of the illness situation and by supporting and reinforcing coping resources, mobilising hope and fostering a sense of meaning and coherence. All this is of particular importance when the illness is chronic. One conclusion deriving from the analysis is that the model needs to be completed with a clearer family perspective; another is that students and newly-qualified nurses need guidance and training in the interpretation of paradigm cases. Furthermore there is need for inductive, phenomenological research directed towards a deepening of Benner and Wrubel's model on the basis of patients' own experiences of stress, coping and caring.

Assessing illness-related stress in psoriasis: The psychometric properties of the Psoriasis Life Stress Inventory

The purpose of the present study was to undertake a clinical and psychometric reappraisal of the Psoriasis Life Stress Inventory (PLSI). Total PLSI score was inversely related to age of onset of psoriasis, but bore no significant relationship to duration or to clinical severity. Similarly, patients' stress score did not differ with regards to the nature of their current treatment, to their beliefs as to what was responsible for exacerbation or improvement of their condition, or to the patients' gender. Factor analysis extracted two factors which suggested that the psychosocial impact of psoriasis results from stress associated with: (i) engaging in anticipatory/avoidance coping behavior that is effected to limit the sociocognitive intrusiveness of psoriasis; and (ii) stress resulting from patients' beliefs or actual experiences of being evaluated by others solely on the basis of their skin. The internal reliability of the scale can be improved by the deletion of three items. Revision of the PLSI is recommended to render it psychometrically and clinically acceptable for use in the UK.

Psychological adjustment of adults with sickle cell anemia: stability over 20 months, correlates, and predictors.

The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African-American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia.

The Stress of Life with Rheumatoid Arthritis as Perceived by Older Adults

Health care professionals need to understand the lived experience of the older individual with rheumatoid arthritis (RA) so that they can suggest interventions to enhance the person's capacity to cope effectively under the adversity of RA in daily living. The purpose of this descriptive study was to identify and describe the illness-related stresses as perceived by elderly persons with RA; to identify the stress emotions they experienced and the coping strategies they used to manage the perceived stresses. The investigation was based on the Lazarus and Folkman phenomenological theory of psychological stress and coping. In audiotaped home interviews, 77 participants responded to four open-ended questions. Content analysis of the data indicated that the majority of the participants reported physical limitations as an illness-related stress. In response to their illness-related stress, the participants most frequently expressed the emotion of harm followed by challenge. The majority of the participants used ...

Pediatric Compliance and the Roles of Distinct Treatment Characteristics, Treatment Attitudes, and Family Stress

Much research and clinical practice derives from the assumption that there is a set of psychological-social variables that commonly influence medical (non)compliance. This assumption may lead to overly general strategies for managing specific illnesses in children with chronic illness. With this concern in mind, a study was made of health provider ratings of compliance, treatment attitudes, and illness-related family stress for three pediatric cohorts (N = 75, ages 8 to 20 years): boys with hemophilia (n = 31), sickle cell disease (n = 22), or asthma (n = 22). Between-group differences were found on compliance and treatment attitudes (p < .05), with patients with sickle cell demonstrating greater treatment cooperation than their counterparts and boys with hemophilia expressing more positive outlooks on medical advice and about health outcomes (Newman-Keuls test, p < .05). Positive treatment attitudes were associated with specific compliance behaviors for boys with hemophilia (p < .045) but not for other groups.

The trauma triangle

Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy. In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation ("learning to live with") and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems.

Family and childhood adjustment in cystic fibrosis

Family adaptation has been commonly associated with the psychological adjustment of chronically ill children. However, few studies have attempted to systematically evaluate this association and its relationship to illness severity. We studied 44 children ages 7 to 15 and their families at a large cystic fibrosis center and obtained measures of 1) impact of illness on the family; 2) family functioning; 3) behavioral adjustment; 4) social competence; 5) ratings of anxiety, depressive, and eating disorder symptoms; and 6) ratings of illness severity and duration. Impact of illness on the family and overall family dysfunction were significantly correlated with illness severity, but not duration. However, impact of illness on the family was significantly correlated with internalizing behavioral symptoms, while family dysfunction was correlated with depressive symptomatology. These findings suggest that illness-related stress is primarily reflected in general emotional and behavioral symptoms, with familial adaptation either ameliorating or exacerbating their development into depressive symptomatology.

Coping and life satisfaction in elderly women with osteoarthritis

The relationships among illness-related stress and emotions, coping strategies, socio-economic status and life satisfaction of 90 elderly women with osteoarthritis were explored in this descriptive, correlational study. Results of self-report interview data indicated that the women experienced both positive and negative emotions in relation to their day-to-day life with osteoarthritis. The coping behaviours used to manage the perceived stress of osteoarthritis included confrontive, palliative and emotive strategies. Path analysis supported a significant and positive relationship between coping and life satisfaction and between objective and subjective measures of life satisfaction.

The effects of chronic illness on the spouse. Social resources as stress buffers.

This study examined the effects of rheumatoid arthritis (RA) on spouses' psychological well-being and the role of social resources in enhancing adaptation in the face of illness-related stress. Spouses of 42 patients with RA completed a mailed questionnaire assessing marital adjustment, social support received from the person with RA and from the close social network, and depressive symptoms. Illness-related stress was assessed using rheumatologists' assessments of patients' disease severity and patients' self-reports of depressive symptoms. Social resources within and outside the marriage were related to spouses' well-being through different pathways. Marital adjustment had a direct effect on well-being, such that greater marital adjustment was related to lower depression. In contrast, support from the social network operated in a stress-buffering fashion: When the patient's illness was more severe, spouses with greater network support experienced fewer depressive symptoms. Implications of these findings for psychosocial interventions are discussed.

Does “Telling” Less Protect More? Relationships Among Age, Information Disclosure, and What Children with Cancer See and Feel

Parents report telling young children less about the diagnosis, treatment, and prognosis of cancer than older children and adolescents. This is often based on the desire to spare children from being overwhelmed. 43 children diagnosed with cancer reported on information disclosed to them at diagnosis, their causal attributions, illness-related stress, and coping strategies. Consistent with parental reports, children under 9 years (n = 18) were told less than children 9-14 years (n = 15) and adolescents (n = 10). Young children's reports of illness impact differed from older children and adolescents only with respect to school and social domains. Younger children reported fewer cognitive strategies than older children and adolescents. Even though young children were told much less than older children they reported similar levels of distress. This suggests that nondisclosure fails to mask the salient and distressing aspects of the illness.

Increased plasma MHPG in dexamethasone-resistant depressed patients.

Severely depressed patients frequently show inadequate suppression of serum cortisol levels by dexamethasone. In a study of 15 depressed patients, we found a robust correlation between plasma levels of cortisol and 3-methoxy-4-hydroxy-phenylglycol after dexamethasone administration. These results suggest that dexamethasone resistance and adrenergic activation reflect parallel responses to illness-related stress in some depressed patients.