Mishel Uncertainty In Illness Scale Research Articles

Uncertainty and depression in people with Parkinson's disease: A cross-sectional study.

Adults with chronic disease may experience uncertainty and depression when coping with their illness. This study identifies degrees of uncertainty and depression, as well as factors associated with depression in people with Parkinson's disease. The 120 participants included patients who visited the neurology outpatient department of a tertiary hospital in Seoul and individuals who attended public events managed by the Korean Parkinson's Disease Association. The mean age of the sample was 65.01 and 50.8% of patients were men. The mean scores of uncertainty and depression, measured using the Mishel Uncertainty in Illness Scale and Short Form Geriatric Depression Scale were 99.03 and 6.73, respectively. Approximately 68% of participants scored above the cut-off score for depression. Multiple regression analyses showed that uncertainty, perceived health status, and fatigue were factors significantly associated with depression. Nurses should be aware of and address these factors and their effects in order to implement interventions to prevent depression in people with Parkinson's disease.

Locus of control, quality of life, anxiety, and depression among Malaysian breast cancer patients: The mediating role of uncertainty.

The main objective of this study was to investigate the mediating role of uncertainty in the relationship between locus of control with quality of life, anxiety, and depression. A descriptive and correlational survey was conducted in a private hospital in Kuala Lumpur, Malaysia. A convenience sample of 118 Malaysian breast cancer patients voluntarily participated in the study and responded to a set of questionnaires including: socio-demographic questionnaire, the short form of Locus of Control Scale, the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Hospital Anxiety and Depression Scale (HADS), and the Short-Form Mishel Uncertainty in Illness Scale (SF-MUIS). The results revealed that breast cancer patients with higher internal locus of control and lower external locus of control experience a higher quality of life, lower anxiety, and lower depression. Also, uncertainty mediated the relationship between locus of control with quality of life and depression (quasi-significant). The findings indicated the need for early, targeted psychological interventions seeking to gradually shift cancer patients' locus of control from external to internal in order to improve their quality of life and reduce their depression and anxiety. Moreover, health care providers by providing relevant information to cancer patients, especially for externally oriented patients, can reduce their uncertainty which in turn would improve their quality of life.

Caregiving Immediately After Stroke: A Study of Uncertainty in Caregivers of Older Adults.

Caregivers of stroke survivors experience high rates of mental and physical morbidity. Stroke has sudden onset, and the outcome is not immediately known. Uncertainties surrounding the new caregiving role may not only necessitate major changes in the lives of family caregivers but also contribute to negative health outcomes for the caregiver. The purposes of this study were to describe caregiver uncertainty across the early weeks after a family member's stroke and to explore characteristics of caregivers and stroke survivors associated with that uncertainty. A prospective, longitudinal exploratory observational study was conducted with a convenience sample of 40 caregivers and older adult (≥65 years) stroke survivors recruited from urban acute care settings in the mid-Atlantic region. Caregivers were enrolled by 2 weeks poststroke (T1) and revisited 4 weeks later (T2). Uncertainty was measured usingthe Mishel Uncertainty in Illness Scale for Family Members. An unadjusted linear mixed model was computed to examine significant associations between each caregiver or stroke survivor characteristic and repeated measures of uncertainty. Uncertainty at T1 (83.73 ± 23.47) was higher than reported in other caregiver populations and remained high 6 weeks poststroke (T2: 85.23 ± 23.94). Each of the following characteristics was independently associated with greater caregiver uncertainty: caregivers' older age (p = .019), being a spouse (p = .01), higher stress (p < .001), more depressive symptoms (p = .001), more comorbidities (p = .035), and poorer coping capacity (p = .002) and stroke survivors' recurrent stroke (p = .034), poorer functional status (p = .009), and insurance type (p = .008). Caregivers experienced persistently high uncertainty during the first 6 weeks poststroke. Better understanding of uncertainty, its associated characteristics, and its outcomes may help clinicians identify caregivers at highest risk who may benefit from targeted interventions.

Relationship among Nesbitt score of high risk pregnancy, uncertainty in illness and anxiety level in pregnant patients

Objective To investigate and analyze the status and relation among Nesbitt score of high risk pregnancy, uncertainty in illness and anxiety level in pregnant patients. Methods Totally 158 pregnant patients were recruited and investigated with the general information questionnaire, Nesbitt score of high risk pregnancy, Mishel uncertainty in illness scale (MUIS) and state-trait anxiety inventory (SAI). The results were analyzed. Results The Nesbitt score of high risk pregnancy in hospitalized pregnant women was (62.69±18.21) points; the score of MUIS was (61.11±13.71) points, which was at a medium level; the score of SAI was (43.96±9.86) points, which was at a medium level. Negative correlation was found between Nesbitt score and MUIS score, and significant positive correlation was found between MUIS and SAI, while no significant positive correlation between Nesbitt score and SAI score. Conclusions According to the Nesbitt score of high risk pregnancy, nurses should judge the cognition of pregnant patients in disease, to evaluate their anxiety level; nurses should explore effective healthy education, to decrease the anxiety level of pregnant patients, so that they can have an optimal attitude to face the treatment and pregnancy outcomes. Key words: Nesbitt score of high risk pregnancy; Uncertainty in illness; Anxiety level; Hospitalized pregnant patient

Role of Emotional Intelligence as a Mediating Factor Between Uncertainty and Anxiety Hospital in Chronic Renal Patients

Renal diseases are distressing and it is, especially, the aspect of uncertainty that exerts an influence on patients’ emotional adjustment to illness. The present study investigates the relationship between uncertainty and trait emotional intelligence (EI), and the role of EI as mediator in the relationship between uncertainty, anxiety, and depression in nephropathy patients. Fifty patients were asked to complete a worksheet including the Hospital Anxiety and Depression Scale, Trait Emotional Intelligence Questionnaire—Short Form, and Mishel Uncertainty in Illness Scale. Structural equation modeling has been used to examine whether trait EI mediates the relationship between uncertainty, anxiety, and depression. Through structural equation modeling, it has been demonstrated that trait EI mediated the relationship between uncertainty, anxiety, and depression. These findings suggest to develop coaching programs aimed at strengthening nephropathy patients’ emotional responses to uncertainty; in this way, it could be possible to observe an improvement in patients’ quality of life.

Study of uncertainty in illness among patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization

Objective To describe uncertainty in illness of patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization (TACE) and to identify the related factors. Methods A descriptive and correlative design was used. By convenience sampling, 95 patients with hepatocellular carcinoma were recruited from Sun Yat-Sen University Cancer Center in this study. Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness and information needs of patients with hepatocellular carcinoma intending to undergo TACE and the demographic questionnaire and Information Needs Assessment Scale were used to measure demographic data, disease and treatment characteristics and information needs of patients. Results The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle (77.61±9.15) points. The mean score of indeterminacy subscale was (50.16 ± 6.16) points. Uncertainty in illness of patients with hepatocellular carcinoma intending to undergo TACE was affected by the degree of education background, domicile, family economic status, way to pay for the medical expenses, course of diseases, how many times he (she) used to undergo assisted treatments and the level of information needs. Conclusions The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle and it is important to assess patients' uncertainty in illness at clinical work and to take effective interventions to content patients' information needs to decrease the level of uncertainty. Key words: Liver neoplasms; Transcatheter artery chemoembolization; Uncertainty in illness; Information needs

Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy.

This study examines relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in gastric cancer patients after gastrectomy. Data were collected from 146 patients at an outpatient clinic of a university hospital in Seoul, Korea from October to November 2012. The Gastrointestinal Symptoms Rating Scale, the Mishel Uncertainty in Illness Scale, and questions on perceived recovery of physical, psychological, and social functions were analyzed. High gastrointestinal symptom scores were reported in women younger patients (F = 5.55, P = 0.005), and in patients without a family history of gastric cancer. The uncertainty score was higher in patients with low economic (F = 3.84, P = 0.024) and educational status and no family history. Regression analysis revealed uncertainty was the strongest factor associated with recovery. Nurses can assist patients and families to predict and deal with health problems by offering education on progress from diagnosis to postoperative management, promoting all aspects of recovery after gastrectomy.

Do higher levels of uncertainty in illness reduce the perceived health related quality of life of Multiple Sclerosis (MS) patients?

Background: Multiple Sclerosis (MS) represents one of the most common causes of neurological disability and the unpredictability and severity of its manifestations determine uncertainty in illness. While MS patients’ Health Related Quality of Life (HRQoL) has been frequently assessed, the impact of uncertainty on HRQoL has not been adequately considered to date. The objective of the study was to reduce this gap in the literature.Design: One hundred and twenty patients with relapsing-remittingMS were interviewed in order to gather information about their assessment of HRQoL, measured with the Visual Analogue Scale (VAS) and their perceptions of uncertainty in illness assessed through the Mishel Uncertainty in Illness Scale (MUIS). The relationship between HRQoL and two dimensions of uncertainty, namely “ambiguity” and “inconsistency”, have been tested with diverse Tobit and Probit specifications.Results: Inconsistency exhibited a negative and significant correlation in all the specifications of the model. Marginal effects suggested how a unit change in the total score of the inconsistency scale determined an increase of 6.2% in the probability to report a VAS score higher than 60 (median score in the sample). Ambiguity and inconsistency, jointly considered, had a marginal effect of 2.1%.Conclusions: This study contributes to the assessment of the patient’s general status over the standard parameters for quality of life. It may represent the starting point for further analyses on the impact of separate facets of the Uncertainty in Illness on HRQoL, experienced not only by MS patients, but also by other patients suffering from chronic conditions.

Investigation and correlation analyze on uncertainty in illness and coping styles among young patients with acute myocardial infarction

Objective To investigate the uncertainty in illness and coping styles among young patients with acute myocardial infarction (AMI) and analyze their correlation. Methods We used Mishel Uncertainty in Illness Scale (MUIS) and the Medical Coping Modes Questionnaire (MCMQ) to assessed 134 young AMI patients cross section study, and analyzed the correlation among the results. Results Total score regarding young AMI patients′ uncertainty in illness was (125.45±24.49); the average facing score and the avoidance score and the yield score regarding MCMQ were (20.08±4.82), (15.18±2.83) and (7.14±2.69) respectively. Analysis indicated that both the facing and the avoidance score were negatively correlated with the total score of MUIS (r=-0.351, -0.267; P<0.05); the yield score were positively correlated with the total score of MUIS (r=0.344, P<0.01). Conclusions The uncertainty of illness is at high level among young AMI patients, coping it in a positive way is helpful with decreasing patients′ uncertainty in illness. Key words: Acute myocardial infarction; Youth; Uncertainty in illness; Coping style; Correlation

Relationship between uncertainty in illness, mood state and coping style in patients with temporomandibular disorders

ObjectiveTo investigate the relationship between uncertainty in illness, mood state and coping style in patients with temporomandibular disorders (TMD) in the hospital, in order to identify nursing measures. MethodsChinese versions of the Mishel Uncertainty In Illness Scale (MUIS), Brief Profile Of Mood States (BPOMS) and Medical Coping Modes Questionnaire (MCMQ) were used to assess uncertainty in illness, mood state and coping style, respectively, in 126 patients with TMD. ResultsThe total score of uncertainty in illness of the patients was 91.33 ± 16.38, which was at middle level. The total score of mood state was 37.93 ± 17.0. The order of coping style rated from high to low was confrontation (18.81 ± 3.65), avoidance (15.44 ± 4.26) and acceptance (10.41 ± 5.04). Acceptance was positively correlated with uncertainty in illness (r = 0.463, p < 0.001), and mood state (r = 0.187, p < 0.05). Avoidance and confrontation were negatively correlated with uncertainty in illness and mood state (r=−0.286, p < 0.01), (r=−0.175, p < 0.05), (r=−0.171, p < 0.05), (r=−0.221, p < 0.01). ConclusionsBoth uncertainty in illness and mood state were related to coping style. These data suggest that nurses should be trained to offer appropriate guidance to help decrease patients' uncertainty in illness and relieve their negative emotions.

Uncertainty, Self-efficacy, and Self-care Behavior in Patients With Breast Cancer Undergoing Chemotherapy in China.

Treatment for breast cancer causes uncertainty in the face of new and distressing experiences and often results in the need for self-care. Identifying how uncertainty influences self-care behavior is essential to design interventions that enhance self-care capacity and improve patient outcomes. The aims of this study were to describe the levels of uncertainty, self-efficacy, and self-care behavior in Chinese women receiving chemotherapy for breast cancer and to determine if self-efficacy mediates the relationship between uncertainty and self-care behavior. A cross-sectional descriptive correlational design was used. Ninety-seven participants completed the Generalized Self-efficacy Scale, the Mishel Uncertainty in Illness Scale, and the Appraisal of Self-care Agency Scale-Revised. Descriptive statistics were used to analyze the levels of uncertainty, self-efficacy, and self-care behaviors in the sample. Multiple regression was used to test the mediating effect of self-efficacy in the relationship between uncertainty and self-care behavior. Mean ratings of uncertainty (76.70), self-efficacy (27.15), and self-care behavior (53.96) all fell in the moderate range. Both uncertainty and self-efficacy independently predicted self-care behavior, explaining 18.2% of the variance, but self-efficacy did not mediate the relationship between uncertainty and self-care behavior. Research is needed to further evaluate the proposed relationships using instruments specific to/related to cancer and evaluate change over time. Self-care interventions that have been efficacious in Western populations could be revised to assist Chinese women to reduce uncertainty and enhance self-efficacy in coping with breast cancer. Self-care intervention programs should include strategies to reduce uncertainty and enhance self-efficacy in coping with breast cancer treatment.

Adaptation of the Mishel Uncertainty of Illness Scale (MUIS) for chronic patients in Italy.

Uncertainty is a component of the illness experience and is likely to increase the burden of managing chronic illness, as cardiac pathologies and renal diseases. The impact of uncertainty should be taken into account and addressed with targeted intervention programmes. The purpose of this study is to contribute to the diffusion of the assessment of uncertainty in illness by validating the Mishel uncertainty in illness scale (MUIS) on chronic Italian patients. The MUIS questionnaire was administered to 200 patients suffering from cardiac diseases and 50 patients with renal diseases. A confirmatory factor analysis was run for each of the MUIS dimensions (ambiguity, inconsistency, complexity and unpredictability). After some item reduction, three of the four MUIS scales, namely, ambiguity, inconsistency and complexity, exhibited satisfactory reliability coefficients (with Cronbach's alphas of, respectively, 0.796, 0.778 and 0.705), highly significant standardized regression weights and satisfactory/highly satisfactory fit indexes. Nevertheless, as the correlations among the scales mentioned earlier were high (all above 0.8) and statistically significant, the three subsets of ambiguity, complexity and inconsistency items were allowed to load onto a new single factor. A monodimensional uncertainty construct, grouping the majority of the items encompassed by these three MUIS scales, was successfully validated. This study provides researchers with an easy-to-administer instrument which is useful to investigate a crucial aspect related with patients' quality of life. Although a unique uncertainty construct is proposed, the in-depth analysis of the replies to each single item of the MUIS could help to monitor patients' emotional responses to the diagnosis and to the course of this disease and it might be useful to define appropriate strategies of coping and to focus on patients' quests for simplicity and clarity of treatment.

Investigation and analysis of life quality and uncertainty feeling in illness among the families of patients in Neurosurgery Department

Objective To investigate and analyze uncertainty in illness and life quality among family members of patients in Neurosurgery Department, and explore the corresponding nursing. Methods A total of 125 family members were collected as the research object. Using The Mishel uncertainty in illness scale, medical outcomes study simplified 36 item scale (SF-36), the investigation and analysis of uncertainty in illness and quality of life had been done. Results The total score of uncertainty feeling in illness was (89.47±10.92), of which average single clause obtained (2.99±0.38). The clarity acquired the highest score, but shortage of information was lowest score. For each dimensions of life quality, the score of body function reached highest (90.57±13.31) comparing with lowest score (60.31±32.63) for affection role. Conclusions The uncertainty level in illness of patient′s family members in Neurosurgery Department is high, mainly for the uncertain and unpredictability, and the quality of life is affected. Nursing staffs should pay increasing attention to the family members of patients by the health education, communication, corresponding strategy guidance and other measures, to help families to reduce the uncertainty in illness, so as to improve the quality of life of patients and their families. Key words: Neurosurgery Department; Family member; Quality of life; Uncertainty in illness

Uncertainty in Elderly Women with Osteoarthritis: Relationship to Pain, Self-care Agency and Health Conservation

Purpose: The purpose of this study was to examine the relationship of uncertainty to pain, self-care agency and health conservation and to identify factors affecting uncertainty in elderly women with osteoarthritis. Methods: Participants, 156 women aged 65 years or older, were outpatients at A orthopedic clinic in D city and were diagnosed with osteoarthritis. Data were collected using the Visual Analogue Scale (pain), Self-As-Carer Inventory (Geden & Taylor, 1988), Health Conservation Scale (Sung, 2005a) and Mishel Uncertainty in Illness Scale (Mishel, 1988) and analyzed using t-test, one-way ANOVA, Pearson's correlation, and stepwise multiple regression. Results: Uncertainty was positively correlated with the degree of pain and negatively correlated with self-care agency and health conservation in elderly women with osteoarthritis. Health conservation was the strongest predictor (β=-.28) of uncertainty in elderly women with osteoarthritis, followed by assistance from spouse (β=-.25) and monthly allowance (β=-.24). These variables accounted for 29% of the total variance in uncertainty. Conclusion: Findings from the study suggest the need to develop and utilize nursing interventions targeting improvements in health conservation to reduce uncertainty in elderly women with osteoarthritis.

Illness uncertainty in breast cancer patients: Validation of the 5-item short form of the Mishel Uncertainty in Illness Scale

PurposeSeveral studies have shown that uncertainty about disease and fear of disease progression affects psychosocial adjustment and quality of life. The purpose of this study was to validate a Norwegian short version of the “The Mishel Uncertainty in Illness Scale” (SF-MUIS) and to examine the impact of uncertainty in illness in breast cancer patients. Method and sample209 patients in breast cancer treatment completed questionnaires for SF-MUIS, Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy-Breast (FACT-ES), and eight questions concerning quality of the patient information provided (IQP). Relationship between scores on uncertainty in illness and anxiety, depression, social support, emotional well-being, the quality of patient information provided, and age were studied by multiple regression analyses. ResultsOrdinal coefficient alpha for the Norwegian version of SF-MUIS was 0.70. Scores on SF-MUIS correlated significantly with scores on HADS (P = 0.001), FACT-ES (P = 0.001), and IQP (P = 0.001) indicating good convergent validity. The patients reported a moderate degree of uncertainty in illness. However, those who had been diagnosed with breast cancer for a year, reported higher scores than those newly diagnosed (P=<0.0001). Information provided was the sole significant predictor of illness uncertainty (P=<0.0001). ConclusionThe results of the present study confirm that the Norwegian version of the SF-MUIS is a suitable tool for assessment of uncertainty in breast cancer patients, who reported a moderate degree of uncertainty in illness.

Cross-cultural adaptation of the Mishel uncertainty in illness scale, in a population with chronic kidney disease treated with hemodialysis

The aim of this article is to translate and adapt the Mishel uncertainty scale to the Spanish context. A cross-sectional study for transcultural adaptation and validation of the Mishel uncertainty scale. The study population were patients with chronic renal disease treated with hemodialysis. The original English version of the "Mishel uncertainty in illness scale" was translated into Spanish, then back-translated into English, and all the discrepancies were resolved after consulting with experts. A panel including 11 experts in renal care assessed this culturally adapted Spanish version, in order to score the content validity. It was administered to 116 patients in order to calculate the psychometric properties scale. Construct validity was calculated using factor analysis, and internal consistency using Cronbach's alpha coefficient. Relationships between variables related to the main theory were analyzed. The Spanish version has 17 items, distributed in 2 dimensions: ambiguity and complexity. A content validity index average of 0.7 and a Cronbach's alpha 0.72. Statistically significant association was found between uncertainty, gender, educational level and disease relapse. Cross-cultural adaptation of the Mishel uncertainty in illness scale preserves equivalence with the original. Content validation identified most useful items for chronic renal patients. The multidimensional nature of the scale is reaffirmed. The association between uncertainty and the level of education is also confirmed.

Study on the relationship among uncertainty, coping styles and personal growth of the postoperative colorectal cancer patients undergoing chemotherapy

Objective To explore the correlation of uncertainty , coping styles and personal growth in the postoperative colorectal cancer patients undergoing chemotherapy .Methods One hundred and eighty-five of the postoperative colorectal cancer patients undergoing chemotherapy were surveyed face -to-face. The demographic form , the Mishel Uncertainty in Illness Scale （ MUIS-A ） , Cancer Coping Modes Questionnaire （CCMQ）, and Growth Through Uncertainty Scale （GTUS） were used.Analysis of the correlation betwcen the data.Results Two hundred and eighteen questionnaires were sent out , and one hundred and eighty-five valid questionnaires were recovered , valid response rate was 84 .9%.The average score of uncertainty of postoperative colorectal cancer patients during chemotherapy was （88.06 ±12.02）;the level of uncertainty was middle .Face to the disease was the most often taken style of coping style of postoperative colorectal cancer chemotherapy patients, with a score of （18.44 ±3.73）, followed by avoidance/depressed, yield, fantasy, vent.Personal growth score was （153.72 ±16.35）.Personal growth score and uncertainty in illness was negatively correlated （r=-0.164,P〈0.05）.Face coping styles and personal growth score was positively correlated （r=0.347, P〈0.05）.Yield, vent, and fantasy had a negative correlation with personal growth （r=-0.229,-0.166,-0.058, respectively;P 〈0.05）.Conclusions Medical staff should pay attention to the assessment and management of uncertainty in the postoperative colorectal cancer patients undergoing chemotherapy , optimize their coping style and promote personal growth . Key words: Colorectal cancer; Chemotherapy; Uncertainty in illness; Coping; Personal growth

Spiritual wellbeing and perceived uncertainty in patients with multiple sclerosis in south-east Iran.

The increasing incidence of multiple sclerosis (MS) over the previous decade in Iran has been examined in the literature. This chronic and unpredictable disease creates psychological impairment, including uncertainty, among patients. It is important to examine the extent of uncertainty experienced by patients with MS and their spiritual wellbeing. It could also be useful to assess the relationship between these two variables. This study was conducted to examine the relationship between spiritual wellbeing and uncertainty among MS patients in south-east Iran. The sample in this cross-sectional, descriptive study comprised 200 non-hospitalised patients with MS referred to a disease centre in Kerman (south-east Iran). Using the Mishel Uncertainty in Illness Scale (MUIS-C) and spiritual wellbeing scale (SWB), data were collected and analysed. The study results showed that the total mean score of SWB was 93.81 (SD=15.25). The mean score of the sub-scale of religious wellbeing was greater than the sub-scale of existential wellbeing (50.80 vs 43.01). The mean score of uncertainty scale was 67.20 (12/35). The highest mean score belonged to the sub-category of ambiguity (32.24±7.90). Pearson correlation test showed that perceived uncertainty score negatively correlated with spiritual wellbeing (r=-0.345; p=0.000), existential wellbeing (r=-0.421; p=0/00) and religious wellbeing (r=-0.172; p=0.015). MS patients should be offered opportunities to reflect on their experiences, feelings, actions and reactions to spirituality to enhance the possibility of using their personal experiences as part of positive and constructive learning. The study results suggest that information about spirituality and spiritual care should be included in the continuous and in-service education of MS patients and nurses working with them.

Quality of life and uncertainty in illness for chronic patients

The experience of chronic illness, together with physical impairment and hospitalization in some cases, can be a difficult occurrence to manage. Illness determines changes in patients’ life style and limitations, that often cause psychological distress. It may happen that patients neither understand the meaning of the events correlated with illness, nor can predict when such events will occur. This uncertainty augments the negative impact of the state of chronic illness on patients’ quality of life. The present study has the purpose to examine the correlations between uncertainty due to chronic disease and patients’ quality of life, keeping into account the diverse coping strategies adopted and the anxiety/depression feelings developed during hospitalization. There is an inverse correlation between chronic patients’ quality of life and the diverse dimensions of uncertainty in illness as identified by the Mishel Uncertainty in Illness Scale. The paper suggests how uncertainty hampers the possibility that patients choose coping strategies, involving their active management of illness. The lower the uncertainty, the higher is the possibility of activate coping mechanisms based on the acceptance of illness, together with a reflexive attitude concerning the actions to be taken to reduce the risk of anxiety/depression during hospitalization. Finally, the present study presents some policy implications, suggesting how the medical staff should not only treat patients, but also help patients to elaborate problem solving strategies and to positively accept their chronic health state.

The social environment and illness uncertainty in chronic obstructive pulmonary disease.

Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty. Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress. Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010). The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.