Psychosocial Illness Research Articles

Structural Equation Modeling of Self-Management in Patients with Hemodialysis

The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective. Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed. The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (β=.84), hope and cognitive illness representation (β=.37 and β=.27) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome. This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.

An evaluation of health-related quality of life in patients with systemic lupus erythematosus using PROMIS and Neuro-QoL.

Systemic lupus erythematosus (SLE) is a multi-organ chronic autoimmune disease that can negatively affect patients' health-related quality of life (HRQOL). This study evaluated HRQOL of SLE patients using questionnaires from the Patient-Reported Outcomes Measurement Information System (PROMIS) and Quality of Life in Neurological Disorders (Neuro-QoL). Individuals with SLE completed an online survey consisting of the PROMIS-29 health profile, PROMIS Psychosocial Illness Impact-Negative, and Neuro-QoL Applied Cognition. PROMIS and Neuro-QoL scores have a mean of 50 in the US general population. Patients self-rated SLE disease severity as negligible, mild, moderate, or severe. Of the 333 participants (mean age 45years; 92% female; 26% Black; mean SLE disease duration 12years, 56% with SLE disease severity as moderate or severe), mean HRQOL scores were worse than those of the general population by ≥0.5 SD with the greatest deficits observed in the domains of fatigue, applied cognition, psychosocial illness impact-negative, pain interference, and physical function. Greater SLE disease severity was associated with worse mean HRQOL scores (all p<0.05). Pain severity was also associated with worse HRQOL scores on all domains (p<0.05) except for satisfaction with social role. Test-retest reliability exceeded 0.70 for all PROMIS and Neuro-QoL scores. PROMIS-29 and Neuro-QoL are valid tools to assess HRQOL in patients with SLE. These patients reported substantial deficits that correlated with their SLE disease severity, with pain being an important independent contributor. These deficits should be monitored in SLE patients during their routine clinical care and evaluated when investigating new therapies.

Välfärdsstatens manifesta och latenta problem med den ökande psykosociala ohälsan i arbetslivet

The welfare state’s manifest and latent problems with the increasing psychosocial illness in working life This article describes how the debate on psychosocial illness in working life generates manifest and latent problems for the welfare state. Psychosocial illness in working life generates claims and expectations of compensation and interventions directed at the welfare state. Drawing on a systems-theoretical framework, the article argues that the welfare state cannot fulfil these expectations because the enormous complexity and the plurality of factors underlying psychosocial illness makes simple and effective solutions impossible. The causal relations are numerous, diffuse and diffcult to isolate. Next to this manifest problem, the fact that effective regulatory measures are hardly possible creates a latent problem for the welfare state. Despite its powerlessness, the state needs to maintain its self-description as a problem-solving instance. However, the diffuse and ambiguous causal relations underlying psychosocial illness in working life can be transformed into a resource for the welfare state. Precisely this diffuseness and ambiguity increases the discretionary power and capability for action to deal with the claims and expectations of compensation in a way that protects the self-description despite the inability to solve the manifest social problem. If there is a multitude of possible causal explanations depending on how the problem is framed, and given that each causal explanation imposes its own solutions, the state can treat the ambiguous causalities that research findings offer as a smorgasbord for its own purposes. The state can choose among the causes those interventions that seem most appropriate to solve the latent problem: the protection of the welfare state’s self-description as a problem-solving, caring institution with capability for action. Because the argument is complex, the article provides a detailed introduction of the systems-theoretical concepts. Furthermore, the argument is illustrated with the help of the case of the working milieu of school in suburbs with high degrees of ethnic diversity.

‘You just censored two native artists’: Art as antidote, resisting the Vancouver Olympics

Abstract This article theorizes resistance in the context of the Vancouver 2010 Olympics. Drawing on the work of Powhatan-Renapé and Lenape scholar Jack Forbes, this article situates anti-Olympic resistance within the context of struggles against what Forbes refers to as ‘wétiko psychosis’. As a kind of psycho-social illness, wétiko psychosis speaks to the pervasive capitalism at work within the Olympic machine and Indigenous relationships to capitalism and the Games. In turn, it then considers the role of art, in particular the image of the thunderbird created by Kwakwakwa’kw artist and activist Gord Hill and TsuuT’ina/Nak’azdli artist and activist Riel Manywounds, in the landscape of anti-Olympic resistance. This article argues that the thunderbird stands is both an antidote and vaccination for the kinds of consumptive sickness contemporary Olympics are plagued with. Lastly, I discuss how the thunderbird’s visual presence in the Olympic archive further reinforces its power.

Psychosocial interventions for schizophrenia

Introduction Schizophrenia is a stress-related neurobiological disorder characterized by disturbances in the form and content of an individual's thought and perceptual processes. People with schizophrenia are faced with social impairment, which affects their global functioning. Aims The authors aim to clarify the role of interventions for the treatment and recovery of people with Methods The authors conducted a literature search in MEDLINE, PsycINFO, and Cochrane Library using the following words psychosocial illness management and recovery, rehabilitation and schizophrenia. Results In schizophrenia as in other psychiatric diseases, a multimodal approach will increase the success of the intervention. On point of view, the interventions take into consideration three factors: the characteristics of the individuals, the community requirements and the supportiveness of the environment. According to literature treatments for schizophrenia is based on the recovery model of mental health and the expanded stress-vulnerability model. Psychosocial evidence-based practices include social skills training which help individuals to practice and acquire behavioral skills in social interactions; cognitive behavior therapy targets maladaptive thoughts and behaviors; cognitive remediation approaches impairment in information processing skills to indirectly improve social functioning. Other practices are family psychoeducation, supported employment and assertive community treatment. Although the later improves daily living skills, it has little impact on functioning. Conclusions Psychosocial interventions are important for treatment and recovery of people with Depending on the used practices, it reduces the number of relapses as well as it improves social functioning of people with

Psychosocial Illness in Children with Type 1 Diabetes Mellitus: Prevalence, Pattern and Risk Factors.

Type 1 Diabetes Mellitus (T1DM) and psychosocial illness influence each other in multiple ways. The extent of psychosocial disorders in children with T1DM remains largely unstudied in India. To assess the prevalence, severity, pattern and variables affecting psychosocial illness in children with type 1 diabetes mellitus. This observational study included 84 children (6-14 years of age) having T1DM at least for 1 year and 100 non diabetic children for comparison. "DSM-5 parent/guardian-Rated Level 1 & 2 Cross-Cutting Symptom Measure -Child age 6-17" was used to assess psychosocial illness, specific domains and severity. Socio-demographic variables were studied and HbA1c levels were measured. Significantly higher prevalence of psychosocial illness was observed in children with T1DM as compared with non diabetic group (55.95% vs 20%; p<0.0001). The prevalence for mild, moderate and severe psychosocial illness was 8.33%, 27.38% and 20.24% respectively in diabetic children. Most common psychosocial abnormality was irritation (38.1%), followed by depression (36.9%) and anxiety (32.1%). The prevalence of psychosocial illness was significantly higher in T1DM patients with poorer metabolic control (HbA1c>7.5, p=0.014). Significant association of psychosocial illness was also noticed with poor dietary compliance (p=0.021) and higher mean HbA1c level (p<0.001). This study established T1DM as a risk factor for development of psychosocial illness. Irritation, depression and anxiety were most common abnormalities. Significant association of psychosocial illness with poor dietary compliance and poor metabolic control was observed. Psychosocial assessment of every diabetic child is suggested for optimal management.

Intermittent Exotropia and Mental Illness

Background and PurposeAlthough adverse psychosocial effects are well documented among patients afflicted with strabismus, recent studies have shown that children with intermittent exotropia, unlike the more prevalent forms of esotropia, are at an increased risk for developing frank mental illness by early adulthood. The purpose of the study was to provide a brief overview of current findings regarding the nonophthalmic aspects of this common condition.Patients and MethodRecent reports will be reviewed regarding psychosocial effects and mental illness among children with intermittent exotropia.ResultsChildren with intermittent exotropia have been shown to have a nearly three-fold increased incidence of developing mental illness, compared to controls, by the third decade of life. Moreover, males had significantly more mental health morbidity than females. Although quality of life measures have demonstrated improved psychosocial outcomes among children who underwent successful strabismus surgery, frank mental illness appears to be less amenable to such intervention.ConclusionIn addition to the adverse psychosocial affects observed in children with strabismus, intermittent exotropia, especially among boys, appears to confer a specific risk for developing frank mental illness. Clinicians managing such patients should consider the entire physical and psychological aspects of this condition and develop strategies for minimizing adverse psychosocial outcomes.

Assessment of fatigue in rheumatoid arthritis and its relation to pain and disease activity measures

Fatigue is a serious outcome of rheumatoid arthritis (RA). Inflammatory synovitis is potentially an important causal factor for RA fatigue. Other factors include psychosocial factors, health beliefs, illness perceptions, and poor social support. Fatigue also has strong relationships to pain and depression. The aim of the study was to define the amount of fatigue experienced by RA patients, and determine the relative contribution of RA disease activity to fatigue in comparison with factors such as pain and treatment in established RA cases using different instruments to assess fatigue [visual analog scale (VAS) fatigue and the vitality subscale of the Medical Outcomes Study Short Form 36 (SF-36) questionnaire]. A total of 50 adult patients diagnosed with RA according to the 1987 Revised American College of Rheumatology – 42 of them being female and the remaining eight being male, with a mean age of 45.36 ± 9.6 years and a mean disease duration of 7.78 ± 4.1 years – were included in the study. Fatigue was measured using a 100 mm VAS and the SF-36 vitality scores. We measured pain using 100 mm VAS, Disease Activity Score for 28 joint counts (DAS28), early morning stiffness, the modified Health Assessment Questionnaire score, and the physician global assessment score. Fatigue was common in RA patients. Out of 50 patients, 42 patients had fatigue (VAS ≥ 20 mm), and at the same time 26 had high fatigue scores (VAS350 mm). The mean SF-36 energy and vitality score was 60.5 ± 23.1. The VAS fatigue scores and the SF-36 vitality scores were significantly correlated with disease activity measures, including duration of morning stiffness (P = 0.001), articular index (P < 0.0001), VAS pain (P < 0.0001), DAS28 (P < 0.0001), C reactive protein (CRP) (P = 0.04 and 0.001, respectively), erythrocyte sedimentation rate (ESR) (P = 0.04), and rheumatoid factor positivity (P = 0.04 and 0.01, respectively). Pain had the strongest association with fatigue, followed by articular index, duration of morning stiffness, ESR, DAS28, and finally CRP in that order. High fatigue levels are common in RA and are mainly linked to pain. VAS fatigue scores are simple measurements that can be used for assessment of fatigue in patients with RA.

Psychosocial illness among the drug abusers undergoing detoxification in Dhaka, Bangladesh

Abuse of drugs is a worldwide problem. Drug addiction is increasing tremendously in the South Asian countries especially in Bangladesh where such addiction is widespread among the younger age groups. It causes rapid erosion of educational, cultural, moral and family values. On the basis of defined criteria a total of 300 drug abusers who undergoing detoxification at the outpatient department of Central Drug Addiction Treatment Centre, Tejgaon, Dhaka were selected. The study was done for a period of one year from July 2013 to June 2014. Data were collected by face to face interview using pre-tested questionnaire. The analysis was done by computer using SPSS version 22.0. About 68% of the drug abusers had taken drugs for 2-5 years and 38% had taken three drugs during their life time. The major influencing factor for taking drugs was for peer pressure. Among the drug abusers 77% had taken Ganja, 60% Heroin as their first drug and 37% Yaba as their last drug. The depression was measured by the Beck's Depression Inventory that showed 55% of the drug abusers had moderate depression, 23% borderline clinical depression, 15% mild mood disturbance, 4% severe depression, and 3% had extreme depression. There were s ignificant associations between the duration of taking drugs (p&lt;0.001), the number of taking drugs (p&lt;0.006), and the age of first use of drugs (p&lt;0.019) with depression. Majority of the drug abusers had depression and a significant number of them were involved in antisocial activities as well as violence. Family and social participation, behavioral therapies and proper medical management are essential to control drug addiction.South East Asia Journal of Public Health Vol.4(2) 2014: 36-41

The Combined Influence of Psychosocial Factors on Illness Behavior Among Women

Distinctions in illness behavior for women, such as use of health services, may result from gender-specific biological risks for disease but could also be explained by the relationships among social, psychological, and behavioral factors. The purpose of this study was to determine if illness behavior in women might be related to associations among social support satisfaction, perceived health status, coping skills, and perceived stress. Data were collected November–December 2005 from 205 female college students through self-report using questionnaires. Structural equation modeling was used to test relationships among psychosocial factors. The final model revealed associations between psychosocial factors and illness behavior for women along two paths. First, high perceived stress and poor perceived health status were associated with more reported illness behavior. Second, greater use of total coping skills, greater social support satisfaction, and good perceived health status were associated with less reported illness behavior. Consideration of multiple health-related factors may provide a more complete picture of how psychosocial factors are related to illness behavior for women. Specifically, interactions among stress, coping, social support, and perceived health status may be important to women’s health. Our results suggest that interventions should focus on skill-building and strategies to improve self-perception of health.

Mental Health in Primary Care: Perceptions of Augmented Care for Individuals With Serious Mental Illness

Individuals with serious mental illness are at increased risk of developing secondary physical illnesses because of lifestyle and psychiatric treatment–related factors. Many individuals with mental illness participate in primary care clinics, such as Placer County Community Clinic (PCCC), which provides primary care and medication-only psychiatric services to low-income county residents. This qualitative study describes an augmented care program provided to this population at PCCC and explores participant experiences with that program. The augmented program consisted of a full-time social worker and part-time registered nurse working as a team to coordinate care between providers, and provide psychosocial education and illness management support. Previous studies have demonstrated that similar programs result in improved clinical outcomes for people with mental illness but have largely not included perspectives of participants in these pilot programs. This article includes participant reports about medical service needs, barriers, and beneficial elements of the augmented program. Medical service needs included the need to provide input in treatment and to be personally valued. Barriers ranged from doubts about provider qualifications to concerns about medication. Elements of the augmented care program that participants found beneficial were those involving care coordination, social support, and weight management support.

The psychosocial impact of cancer: evidence in support of independent general positive and negative components

Considerable research has demonstrated the negative psychosocial impact of cancer. Recent work has highlighted positive psychosocial outcomes. Research is now needed to evaluate the relationship between negative and positive impacts. This paper reports the development and validation of a measurement model capturing positive and negative psychosocial illness impacts. The sample included 754 cancer patients on- or post-treatment. Item development was informed by literature review, expert input patient interviews and the results of a pilot study of 205 cancer patients, resulting in 43 positive and 46 negative items. Factor analyses were used to evaluate the dimensionality of the item pools. Analysis of variance (ANOVA) was used to examine relationships between psychosocial illness impact and other variables. Unidimensionality was demonstrated within but not across negative and positive impact items. ANOVA results showed differential relationships between negative and positive impacts, respectively, and patient sociodemographic and clinical variables. Positive and negative psychosocial illness impacts are best conceptualized and measured as two independent factors. Computerized adaptive tests and short-form measures developed from this comprehensive psychosocial illness impact item bank may benefit future research and clinical applications.

An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis

ObjectiveTo examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA). MethodsA sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI. ResultsLower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes. ConclusionsThe findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.

Predicting moderate improvement and decline in pediatric asthma quality of life over 24 months.

To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP). Participants from 4 CAMP clinical centers were administered the Pediatric Asthma Quality of Life questionnaire and protocol measures of asthma symptoms, lung function, and psychological measures. Multivariate logistic regression analyses determined predictors of moderate change in quality of life. Subclinical levels of depression predicted moderate improvement in child-reported quality of life. Level of depressed affect together with clinical asthma features predicted moderate decline. Improvement in parent quality of life was predicted by perception of illness burden, whereas family features and a child missing school predicted moderate decline. This ancillary study provided an opportunity to examine the determinants of 24-month change in parent and child of quality of life within a subset of the CAMP participants. Moderate changes in quality of life occur in clinical studies and have both psychosocial correlates and illness characteristics.

Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire study

To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. Prospective controlled cohort study. A tertiary care facility. Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. Psychosocial functioning, illness perceptions, and treatment perceptions. Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life.

Patients Admitted to a Maximum Security Forensic Psychiatry Unit in Norway: A Case File Analysis of Demographic, Psychosocial, Clinical and Criminal Characteristics

Every year, 25 to 30 patients are admitted to the maximum security unit at Ullevål University Hospital in Oslo, Norway. The unit has 25 beds and covers a catchment area of some 2.4 million inhabitants. The main scope of this study was to monitor and analyze demographic, psychosocial, clinical, and criminal characteristics of the patient population, with a special focus on possible associations between psychosocial conditions, mental illness, substance abuse, violence, and criminality. Three independent raters scrutinized hospital case files from index hospitalization of all patients (N = 125) that had been admitted during a 4-year period. A codebook specially developed for this research was used, and the scoring was subsequently determined by consensus between the raters. Being exposed to physical or sexual abuse in childhood was associated with the father being mentally ill (multivariate logistic regression, OR = 19.4, 95% CI = 3.4–111). Having a history of violence was associated with previous conviction (OR = 2.6, 95% CI = 1.01–6.8). Homicide was associated with personality disorder (OR = 19.0, 95% CI = 1.9–187.0) and having previously been admitted to a psychiatric institution (OR = 9.9, 95% CI = 2.5–39.4). Our findings are discussed in relation to methodological flaws and other research in the area.

Memory performance related to organic and psychosocial illness attributions in somatoform pain disorder patients

Objective Somatoform disorders are characterized by patterns of persistent bodily complaints. Organic illness attributions are assumed to represent a central supporting factor in the development and maintenance of somatoform disorders. Using group control design, we aimed to investigate the processing of illness-belief-related word stimuli in somatoform pain disorder patients. Methods Organic-related, psychosocial-related, and neutral word stimuli were presented to 14 somatoform pain patients with a predominantly organic illness attribution, 14 somatoform pain patients with a predominantly psychosocial illness attribution, and 14 control participants. Behavioral measures were taken during free recall and recognition tasks. Results Our study revealed cognitive impairment in somatoform pain patients with an organic attribution of pain symptoms as compared to somatoform pain patients with a psychosocial attribution and healthy controls in both free recall test and recognition test. However, selective processing of word stimuli was not observed for patient groups. Conclusion We conclude that the observed impairment of memory performance in somatoform pain patients with an organic illness attribution may play an important role in the illness behavior of this patient group and ultimately result in the maintenance of symptoms and a more critical clinical outcome.

Neurobiology of depression, fibromyalgia and neuropathic pain

This article synthesizes recent data suggesting that the high rates of comorbidity observed between major depression, fibromyalgia and neuropathic pain likely result from the fact that these disorders share multiple biological and environmental underpinnings. This perspective suggests that these biologically complex conditions result from similar genetic vulnerabilities interacting with environmental adversity. Shared genetic determinants include poorly functional alleles regulating monoaminergic, glutamatergic, neurotrophic, opioid and inflammatory cytokine signaling. Chief among environmental risk factors are psychosocial stress and illness, both of which promote, in vulnerable individuals, relative resistance to glucocorticoids, increased sympathetic/decreased parasympathetic activity and increased production and release of proinflamnmatory mediators. Dysregulation of stress/inflammatory pathways promotes alterations in brain circuitry that modulates mood, pain and the stress response. Over time, these functional changes likely promote disruptions in neurotrophic support and disturbances of glia-neuronal communication. These changes, in turn, have been associated with the related processes of central sensitization in pain disorders and "kindling" in depression, both of which may account for the progressive and self-perpetuating nature of these disorders, especially when inadequately treated.

Barriers to colorectal cancer screening in community health centers: A qualitative study

BackgroundColorectal cancer screening rates are low among disadvantaged patients; few studies have explored barriers to screening in community health centers. The purpose of this study was to describe barriers to/facilitators of colorectal cancer screening among diverse patients served by community health centers.MethodsWe identified twenty-three outpatients who were eligible for colorectal cancer screening and their 10 primary care physicians. Using in-depth semi-structured interviews, we asked patients to describe factors influencing their screening decisions. For each unscreened patient, we asked his or her physician to describe barriers to screening. We conducted patient interviews in English (n = 8), Spanish (n = 2), Portuguese (n = 5), Portuguese Creole (n = 1), and Haitian Creole (n = 7). We audiotaped and transcribed the interviews, and then identified major themes in the interviews.ResultsFour themes emerged: 1) Unscreened patients cited lack of trust in doctors as a barrier to screening whereas few physicians identified this barrier; 2) Unscreened patients identified lack of symptoms as the reason they had not been screened; 3) A doctor's recommendation, or lack thereof, significantly influenced patients' decisions to be screened; 4) Patients, but not their physicians, cited fatalistic views about cancer as a barrier. Conversely, physicians identified competing priorities, such as psychosocial stressors or comorbid medical illness, as barriers to screening. In this culturally diverse group of patients seen at community health centers, similar barriers to screening were reported by patients of different backgrounds, but physicians perceived other factors as more important.ConclusionFurther study of these barriers is warranted.

Matching Services to Patients' Beliefs About Depression in Dublin, Ireland

Objectives: This study explored tensions between biomedical and psychosocial illness models and between the public health goal of stigma reduction and patients’ perceptions of helplessness. Patients’ etiological beliefs and use of language are considered as possible pathways to improved care. Methods: Qualitative and quantitative data were obtained from 18 adults attending a mood disorders support group in Dublin, Ireland. Results: Respondents reported feelings of helplessness concerning the occurrence of depressive episodes. When describing episodes of wellness and depression, respondents used a “light switch” metaphor to indicate this lack of control. For several respondents, acceptance of biomedical causality was linked to helplessness. In contrast, spiritual beliefs offered hope. Conclusions: Alleviating patients’ sense of responsibility may reduce their guilt, but patients’ perceptions of illness uncontrollability may diminish their sense of agency, reinforce depressive attributional styles, and undermine overall treatment outcomes. Communication and the patients’ involvement in decisions are vital to treatment. (Psychiatric Services 58:696–699, 2007)