Strong Illness Identity Research Articles

Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study.

Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer. A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed. Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003). The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity. These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.

Illness Perceptions of Patients with Occupational Skin Diseases in a Healthcare Centre for Tertiary Prevention: A Cross-Sectional Study.

Objectives: To investigate the illness perceptions of patients with occupational skin diseases (OSDs). Design: Cross-sectional study. Setting: Specialised healthcare centre for inpatient and outpatient individual prevention in occupational dermatology in Germany. Participants: A total of 248 patients with hand eczema (55.2% female; average age: 48.5 years, SD: 11.9) were included in the final analyses. Measures: A modified and recently validated version of the 'Revised Illness Perception Questionnaire' (IPQ-R) was used to assess illness perceptions. Severity of skin disease was evaluated with the Patient-Oriented Eczema Measure (POEM), the Osnabrueck Hand Eczema Severity Index (OHSI), and a single, self-reported global item. The Erlangen Atopy Score (EAS) was used for atopy screening. Results: We found strong illness identity, high emotional impact, and long timeline beliefs, meaning that study participants perceive their OSD on the hands as a highly symptomatic, emotionally burdening, and chronic condition. Results suggest that hand eczema has a major impact on how participants manage their own lives, particularly during everyday life and occupational activities. Study participants predominantly identified irritant or sensitising substances and activities at work as well as skin protection regimes as causes of their disease. Conclusions: Healthcare workers should consider the illness perceptions as well as the disease burden of patients with an OSD on the hands in clinical practice. Multi-professional approaches to patient care should be sought. Illness perception in (occupational) dermatological patients should be the subject of further research.

Illness perceptions predict distress in patients with chronic kidney disease

BackgroundPatients diagnosed with chronic kidney disease (CKD) report increased distress associated with their clinical diagnosis. Distress in patients with predialysis CKD, has been linked to several adverse events; including increased risk of hospitalisation, early dialysis initiation and even death, suggesting that distress is a matter of great concern during routine care in predialysis CKD.AimsThe present study aimed to assess the nature of illness perceptions and the level of distress in a CKD cohort diagnosed with different stages of kidney disease. It also aimed to explore the correlates of distress and to create a model for distress and its associated predictors making use of hierarchical regression analysis.MethodsA sample of 200 patients diagnosed with Chronic Kidney Disease were recruited for this study from the nephrology outpatient clinics of Mater Dei Hospital, Malta. The participants were assessed for their; illness perceptions, treatment beliefs, level of depression and anxiety, coping style, as well as treatment adherence. Routine clinical information was also collected for participants, including a co-morbidity score.ResultsA percentage of 33.5% of the participants reported moderate distress, whilst 9.5% reported severe distress. Stronger illness identity, a perception of timeline as being increasingly chronic or cyclical in nature, greater consequences and higher emotional representations were associated with more advanced stages of CKD. In contrast, lower personal and treatment control and poorer illness coherence were associated with more advanced stages of CKD. Results from the hierarchical regression analysis showed that illness perceptions contributed significantly to distress over and above the clinical kidney factors. Being female, having low haemoglobin and specific illness perceptions including; perceptions of greater symptomatology, longer timeline, low personal control and strong emotional representations, as well as resorting to maladaptive coping, were all significantly associated with distress symptoms. Nevertheless, illness perceptions accounted for the greatest variance in distress thus indicating that the contribution of illness perceptions is greater than that made by the other known covariates.ConclusionIllness perceptions hold a principal role in explaining distress in CKD, relative to other traditional covariates. For this reason, illness perceptions should be addressed as a primary modifiable component in the development of distress in CKD.

Abstract P880: Assessing Measures of Patients Health Perceptions of Stroke Survivors as a Potential Tool for Health Care Disparities Research

Introduction: Patient centered research in stroke health care disparities is needed. Due to a call for the development of theory-based interventions for the reduction of stroke through behavior change, there have been new studies looking at the perception of an individual’s risk of stroke to create prevention models from those results. Leventhal’s Common Sense Model of Self-Regulation posits that individuals form beliefs about their illness and treatment that determines how they cope and their health behaviors in the future. The Illness Perceptions Questionnaire-Revised (IPQ-R) and Brief Illness Perceptions Questionnaire (BIPQ) are validated measures of these illness beliefs. Methods: A literature review was conducted with the following search criteria: (“illness perception” OR “illness belief”) AND (“stroke” OR “TIA” OR “transient ischemic attack” OR “cerebrovascular event” OR “cerebrovascular accident” OR “CVA”). MEDLINE, WorldCat, PubMed, George Smathers Library, and Google Scholar Database were searched. Systematic reviews and meta-analyses were excluded. Results: The initial results had 452 articles and 21 were chosen for data analysis. These articles were grouped into four categories: IPQ-R, IPQ-R &amp; Medication Adherence, BIPQ, and BIPQ &amp; Medication Adherence. Patients were most concerned about having another stroke and their symptoms becoming chronic. Medication beliefs are a stronger predictor of treatment adherence. Lastly, patients with stronger illness identity, causal beliefs, negative consequences, and lower coherence leads to greater distress in patients and caregivers. Conclusions: These results demonstrate that patients overall have concerns about their treatments, chronicity of stroke symptoms, and recurrence, and these concerns may not be effectively addressed during the routine clinic care demonstrated by effects on treatment adherence and patient and caregiver distress. Thus, patient perceptions questionnaires may be in particular a useful tool for health care disparities research in stroke.

Perception of Illness and Its Association with Treatment Willingness in Patients with Newly Diagnosed Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments. In a cross-sectional study enrolling patients with newly diagnosed NAFLD, the sociodemographic, anthropometric, biochemical, and radiological determinants of enhanced illness perceptions (measured by the BIPQ score) were investigated using univariate and multivariable binary logistic regression analyses. Finally, the association between individual domains of the BIPQ and willingness to participate in comprehensive medical management was explored. In total, 264 patients (mean age 53 ± 11.9years, 59.8% males) were enrolled in the final analysis. The mean and median BIPQ scores in the study population were 30.3 ± 12.8 and 31.0 (IQR, 22.0-40.0), respectively. The variables having a significant independent association with heightened perceptions (BIPQ > 31) were family history of liver disease (aOR, 5.93; 95% CI, 1.42-24.74), obesity (aOR, 3.33; 95% CI, 1.57-7.05), diabetes mellitus (aOR, 2.35; 95% CI, 1.01-5.49), and transaminitis (aOR, 2.85; 95% CI, 1.42-5.69). Patients with a higher level of illness perceptions (31.6 ± 12.9 vs 27.8 ± 12.3, p = 0.022) were more likely to express a willingness to participate in the comprehensive management plan, with 3 of the 8 domains (consequence, identity, and treatment control) mainly affecting willingness. A family history of liver disease, obesity, diabetes, and transaminitis were independently associated with increased illness perceptions. A belief in serious consequences, a strong illness identity, and higher perceived treatment control were significantly associated with the willingness to undergo comprehensive care for NAFLD.

Distinct Distress Symptom Trajectories Over 3 Years Are Associated With Baseline Illness Perceptions in Individuals With Coronary Heart Disease.

Depression and anxiety symptoms (termed distress) are common among coronary heart disease (CHD) patients and associated with poor outcomes. Illness perceptions predict distinct outcome trajectories in other long-term conditions, yet it is not known how they relate to distress trajectories in CHD. This study aimed to examine whether baseline illness perceptions are associated with distress symptom trajectories among primary care CHD patients. This is a secondary analysis of 803 CHD patients from the UPBEAT-UK study, who completed the Hospital Anxiety and Depression Scale every 6 months for 3 years. Baseline assessments included the Brief Illness Perception Questionnaire. Using latent class growth analysis, Palacios et al. (2018) identified five distinct distress symptom trajectories ("stable low," "chronic high," "improving," "worsening," and "fluctuating") in this cohort. Adjusted multinomial logistic regression analyses were used to test the association between baseline illness perceptions and distress symptom trajectories. Compared with the stable low distress trajectory, stronger illness identity (odds ratio [OR] = 1.31, p < .01), higher perceived consequences (OR = 1.47, p < .01), illness-related emotion (OR = 1.66, p < .01), and illness concerns (OR = 1.36, p < .01) increased the odds of having chronic high distress. Stronger illness coherence (OR = 0.89, p < .05) and personal (OR = 0.77, p < .01) and treatment control (OR = 0.75, p < .01) reduced the odds of chronic high distress. Worsening distress symptoms were associated with weaker perceptions of treatment control, higher perceived consequences, and greater illness-related concerns and emotions. Illness perceptions of CHD are associated with distress symptom trajectories. Therapeutically modifying unhelpful illness perceptions in CHD patients who experience high levels of distress could potentially improve mental health outcomes.

Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis

AimsThis paper aims to systematically review the illness perceptions of stroke patients and to examine the association between illness representation and psychological distress in empirical research studies. BackgroundPatients’ perceptions of health threats determine their coping behavior. Several recent studies have focused on illness belief and distress in stroke patients. This information is suitable for a meta-analysis to further understand stroke patients’ illness perceptions. DesignSystematic review and meta-analysis. MethodAn electronic literature search was conducted using the CINAHL, MEDLINE, PubMed, Cochrane library, and Google Scholar databases. Search strategies were title (stroke or cerebrovascular accident or CVA or cerebral vascular event or transient ischemic attack or TIA) and keyword (disease or illness) and keyword (perceptions or attitudes or opinion or experience or view or reflection or beliefs). The literature search covers the period of January 1990 to October 2018. Seven articles were included in the meta-analysis and Fisher’s z was calculated with correlation coefficient or regression coefficient values for eight illness representation dimensions and psychological distress. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 3.0 software. ResultsA total of 49 studies were reviewed, and seven studies with a total of 507 participants were eligible for the meta-analysis. For patients’ perceived anxiety and depression, six of seven studies, with 285 to 461 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that stroke patients’ perception of a strong illness identity, timeline-acute/chronic, timeline-cyclical, consequences, and emotional responses were significantly and positively related to anxiety and depression. The pooled z-value ranged from 0.189 to 0.460. Conversely, for protective-related factors, such as stroke patients’ perceived personal control, treatment control, and illness coherence, only perceived illness coherence was significantly negatively associated with depression (z-value, -0.122; 95% CI: -0.241, -0.002). For patients’ perceived overall distress, three of seven studies with 173 participants showed that there were significant and positive associations between identity, consequence, emotions, and distress (z-value ranges = 0.493–0.711) as well as a significant and negative association between illness coherence and overall distress (z-value, -0.226; 95% CI: -0.379, -0.073). ConclusionAn association between illness representation and distress exists in stroke patients. Risk factors are the most significant in terms of this relationship, and protective factors do not have a protective health impact. Protection factors need to be promoted to reduce patient distress.

Emerging adult identity following adolescent experiences with psychotropic medications: A retrospective study

ABSTRACTThis study examines the perceptions of mental illness identity among a group of emerging adults based on their retrospective experiences with diagnoses and psychotropic medication use during their earlier formative adolescent years. A short questionnaire was administered via online social media platforms to volunteers between the ages of 19 and 30 and who self-identified as having taken psychotropic medication between the ages of 12 and 18 (N = 46). Correlation analysis revealed that several variables were associated with a stronger illness identity, including participant’s happiness with their medication experiences, the belief that medication made them more like their “true” selves, and the belief that their diagnosis was accurate. Content analysis of participant narratives suggested themes related to discontinuation and barriers to adherence. These results contribute to the growing knowledge base around lived experiences of psychiatric medication use and suggest further study on how to advance more informed and compassionate mental health care.

Impulse control disorders in Parkinson’s disease: Predominant role of psychological determinants

Objectives: Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission.Design: The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants.Main outcome measures: One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS).Results: Increased use of a ‘negative’ coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone.Conclusions: This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.

Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China

In western countries, negative illness perceptions are associated with poor health status and affect health outcomes in primary care populations. The aim of this study is to examine the relationship between illness perception and mental and physical health status in general hospital outpatients in China. This multicentre, cross-sectional study analysed a total of 281 consecutive patients from four general hospital outpatient departments of internal medicine and traditional Chinese medicine in Beijing and Kunming. The patients answered questionnaires concerning illness perception (Brief-IPQ), somatic symptom severity (Patient Health Questionnaire-15), illness behaviour (Scale for the Assessment of Illness Behaviour), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (Twelve-Item Short Form Health Survey). Negative illness perception, especially negative emotional reactions, perceived illness consequences, encumbering illness concerns, and strong illness identity were significantly associated with high emotional distress, impairing illness consequences, and a low mental and physical quality of life. Using a multiple linear regression model, five strongest correlates of negative illness perception were high anxiety, seeking diagnosis verification, low mental and physical quality of life and high somatic symptom severity. The variance explained by this model was 35%. Chinese general hospital outpatients showed associations between negative illness perceptions and poor mental and physical health status that were similar to those of primary care patients in western countries. The main difference was that no association with perceived illness control was found in Chinese patients. Chinese physicians should be sensitised to their patients’ negative illness perceptions and should focus on helping patients cope with uncertainty and anxiety by providing an understandable illness model and increasing control beliefs.

Pecularities of illness perception and health locus of control of alcohol addicts

Leventhal’s common sense model is a popular model for studying responses to health threats. The central prediction of the model is that coping responses are determined by an interrelated set of beliefs known as illness perceptions, which appear to be directly related to patient’s receptivity to the treatment and outcomes of the illness. The examination of how individuals perceive alcohol addiction may be important in prevention and may help health-care professionals individualize treatment strategies, thereby improving illness outcomes. The goal of the research was to determine the pecularities of and correlations between illness perception and health locus of control of alcohol-addicted people. The object and methods of research: 70 individuals with the diagnosis of alcohol addiction, currently going through alcohol detoxification in an addiction centre (49 men and 21 women). They completed the Brief Illness Perception Questionnaire (Broadbent et al., 2006) and Multidimensional Health Locus of Control Scale (MHLC; Wallston et al., 1978).Results of the study: Illness perception and health locus of control was not related to age, sex and education. The research showed that the participants who had a spouse had a more powerful others’ health control orientation than those who hadn’t (U = 419.5; p &lt; 0.05). The research showed a statistically significant correlation between powerful others’ health control orientation and a shorter addiction duration (r = –0.249; p &lt; 0.05). The longer addiction duration was positively related to the illness recognition (r = 0.481; p &lt; 0.001) and the perception of a longer illness duration (r = 0.353; p &lt; 0.05). The longest abstinence period was positively related to a better illness recognition (r = 0.270; p &lt; 0.05) and the perception of a longer illness duration (r = 0.457; p &lt; 0.05) and more severe illness consequences (r = 0.323; p &lt; 0.05).Statistical analysis showed a lot of statistically significant correlations betveen illness perception dimensions: more negative consequences and a stronger illness identity were related to more concern about the illness and more negative emotions. The perception of illness coherence and a shorter duration of the illness was related to a better perceived personal control over the illnesss. The stronger concern about the illness was related to a better treatment control perception. The better illness recognition was related to the perception of longer illness duration, less personal control over the illness and more concern about the illness. The strength of the symptoms was positively related to a better illness coherence perception.The research showed a significant correlation between illness perception and health locus of control only for men: the internal health locus of control was related to the perception of a shorter illness duration (r = –0.402; p &lt; 0.01) and less concern about the illness (r = –0.285; p &lt; 0.05). The powerful others’ health control orientation was related to the perception of better treatment (r = 0.341; p &lt; = 0,05) and personal control (r = 0.332; p &lt; 0.05), more severe symptoms of illness (r = 0.032; p &lt; 0.05), more concern (r = 0.404; p &lt; 0.01) and negative emotions (r = 0.310; p &lt; 0.05). Statistical analysis showed that alcoholics had an internal health control orientation. Illness recognition was associated with negative alcohol-related consequences, but not with the strength of symptoms. The implications and limitations of the findings, the implications for practice and research are discussed.

Illness cognitions in head and neck squamous cell carcinoma: predicting quality of life outcome

Goals of workThis paper presents an observational study of the longitudinal effects of cancer treatment on quality of life (QoL) in patients treated for head and neck squamous cell carcinoma (HNSCC), and evaluated the contribution of patients' baseline illness cognitions to the prediction of QoL 2 years after diagnosis.Patients and methodsOne hundred seventy-seven patients eligible for primary treatment for HNSCC completed the Illness Perception Questionnaire-Revised at baseline and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 at baseline, at 1-year and 2-year follow-ups.Main resultsCompared to baseline, patients reported better emotional functioning at both follow-ups (p < 0.001), worse social functioning at 12 months (p < 0.05), and better global health status at 24 months (p < 0.05). Patients' own implicit common sense beliefs about their illness added small but significant amounts of variance to the prediction of QoL after 2 years. Less belief in own behavior causing the illness predicted better functioning and better global health. Strong illness identity beliefs predicted worse functioning and worse global health. Negative perceptions about the duration of the illness (chronic timeline beliefs) and more negative perceived consequences also predicted worse QoL.ConclusionsOur results on the negative perceptions about the duration of the illness, perceived consequences, and high symptom awareness predicting worse QoL illustrate the detrimental effects of uncertainty and negative expectations about the future course of the illness. The identification of these cognitive factors provides possible targets for counseling strategies to assist patients in long-term adjustment to HNSCC.

Illness perceptions, coping and quality of life in patients with alopecia

Alopecia can have substantial psychological consequences, but there has been no research looking at patients' beliefs about their condition nor how they relate to quality of life (QoL). To investigate the relationships between illness perceptions, coping and QoL in patients with alopecia. The study employed a cross-sectional design. In total, 214 individuals with alopecia were recruited from four internet support groups. There were 171 women and 43 men (mean age 35 years). Participants completed an online questionnaire comprising the Revised Illness Perception Questionnaire, the Dermatology Life Quality Index and the brief COPE. The findings indicate several areas in which alopecia impacted on individuals' QoL, particularly in relation to symptoms and feelings. Women reported poorer QoL compared with men. Impaired QoL was associated with a strong illness identity, beliefs in the serious consequences of alopecia and strong emotional representations. Hierarchical multiple regressions indicated that illness perceptions accounted for 35% of the variance in QoL after controlling for demographic and disease factors, with coping adding a further 7% to the regression model. Although alopecia is not a life-threatening condition, it can impair QoL by negatively impacting on self-awareness. The strong relationships found between patients' beliefs about their condition and QoL suggests that health professionals should recognize the psychological impact of alopecia and address negative beliefs and emotions surrounding the condition in treatment programmes.

Can illness perceptions and coping predict psychological distress amongst allergy sufferers?

The aim of the present study was to measure the extent to which illness perceptions and coping strategies are associated with the levels of psychological distress amongst allergy sufferers. One hundred and fifty-six allergy sufferers (all members of Allergy U.K.) completed a postal survey consisting of the Revised Illness Perception Questionnaire (IPQ-R) and the COPE. Psychological distress was measured using the General Health Questionnaire (GHQ-28) and the Perceived Stress Scale (PSS). Multiple regression analyses indicated that illness perceptions explained between 6 and 26% of variance on measures of psychological distress; coping strategies explained between 12 and 25%. A strong illness identity and emotional representations of the allergy were associated with higher levels of psychological distress; as were less adaptive coping strategies such as focusing on and venting of emotions. Strong personal control beliefs were associated with the lower levels of distress, as were adaptive coping strategies such as positive reinterpretation and growth. Coping partially mediated the link between the illness perceptions and the outcome; however, illness identity, emotional representations and personal control retained an independent significant association with psychological distress. The findings support a role for illness perceptions and coping in explaining levels of psychological distress amongst allergy sufferers. This has implications for targeted health interventions aimed at reducing the strength of illness identity and emotional representations and increasing a sense of control and the use of more adaptive coping strategies.

Illness perceptions in depersonalization disorder: Testing an illness attribution model

AbstractDepersonalization disorder (DPD) remains poorly understood and controversial in terms of diagnosis and treatment. Little is known about the cognitive representation of this disorder. In this study, 80 participants with DPD were assessed using the Revised Illness Perception Questionnaire to determine the nature of their perceptions, causal attributions and whether these correlate with levels of depersonalization and affect. Illness perceptions were generally negative; the nature of symptoms was described as mainly psychological but causal attributions were equally divided between psychological and physical. Over half of the sample believed that symptoms were due to ‘physical changes in the brain’. A strong illness identity, psychological illness attributions and high levels of depression were associated with greater depersonalization disorder severity. High levels of anxiety were also prevalent but the relationship between anxiety and depersonalization was unclear. The findings offer some support for a cognitive model of understanding depersonalization disorder, namely that attribution processes are linked to perceived symptom severity and a wide range of experiences come to be seen as part of the disorder. Copyright © 2007 John Wiley &amp; Sons, Ltd.

The Patients’ Illness Perceptions and the Use of Primary Health Care

To investigate if primary care patients' perceptions of a current health problem were associated with use of health care. One thousand seven hundred eighty-five patients presenting a new health problem to 1 of 38 physicians from 28 general practices in Aarhus County, Denmark. Patients completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Register data on primary health care utilization 3 years before and 2 years after baseline were obtained. Odds ratios were estimated to examine associations between previous health care use and illness perceptions. Linear regression analysis was performed to examine if illness perceptions predicted later health care use. Previous use: Higher use was associated with psychosocial, stress, and lifestyle attributions. Accident/chance attributions were associated with higher use for patients with a chronic disorder but with lower use for patients without a chronic disorder. A strong illness identity (number of self-reported symptoms), illness worry, a long timeline perspective, a belief that the symptoms would have serious consequences, and all emotional distress variables were associated with higher use. Use during follow-up: Infection/lowered immunity attributions were associated with higher use for patients with a chronic disorder, whereas psychosocial and lifestyle attributions were associated with higher use for all patients. Illness worry and all emotional distress variables predicted higher health care use. A strong illness identity, a long timeline perspective, a belief in serious consequences, and stress and accident/chance attributions were among the strongest predictors of health care use in a multivariate model including all variables. Patients' perceptions of a current health problem are associated with health care use and may offer an obvious starting point for a biopsychosocial approach in primary care.

Psychosocial aspects of Turkish mothers of children with juvenile idiopathic arthritis

To the editor: Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease. In JIA, as in other chronic pediatric illnesses, a child’s illness affects the daily activities and functioning of the entire family. Families must deal with illness-related stressors such as the need for frequent medical visits, demands of the multicomponent treatment regimen, and unpredictable illness course. Adjustment problems were reported among mothers of children with JIA. Fifty percent of the mothers reported psychiatric distress [1]. We investigated the psychological profile of mothers of children with JIA, their attitudes to their children and their family functioning. In addition, parameters such as severity and duration of JIA, and pain that could affect the status of mothers were evaluated. Twenty-seven children with JIA, 29 healthy controls, and their mothers were evaluated in our outpatient clinic. Childhood Health Assessment Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument, and Family Assessment Device were used for assessment parameters. The three criteria of the core set of outcome variables [2] such as physician’s global assessment, number of joints with active arthritis, and erythrocyte sedimentation rate (ESR) were selected as severity parameters. The duration and severity of JIA, and pain were correlated with mothers’ psychological well-being, attitudes, and functioning. There were statistically significant correlations between ESR in JIA cases and state anxiety (r=0.416, P=0.034), and between pain assessment-visual analog scale in JIA cases and attitude of maternal hostility and rejection (r=0.466, P=0.016) and marital discordance (r=0.418, P=0.034) in mother’s scales who have children with JIA. There was a significant positive correlation between the duration of JIA and behavior control (r=0.441, P=0.024) in mothers’ scales who had children with JIA. In addition, statistically significant negative correlation was found between the duration of JIA and state anxiety between the duration of JIA and state anxiety (r= 0.445, P=0.02). We showed increased duration of JIA-caused problems in the behavioral control of mothers of children with JIA. It was indicated that state anxiety of the mothers, which is defined as a transient momentary emotional status that results from situational stress that fluctuates in time and intensity, was associated with increased ESR in children with JIA in the present study. The ESR is an objective parameter in monitoring the disease activity of children with JIA. In addition, the sudden increase in ESR levels could be easily recognized by the mothers of children with chronic arthritis. This condition might have contributed to the mothers’ awareness, leading to anxiety. Because of this reason the mothers might be overprotective and behave in a more controlling manner toward their child. As in our findings, Scharloo et al. [3] indicated that a strong illness identity, passive coping, long illness duration, and unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning in mothers. There was a positive correlation between pain in JIA cases and hostility and rejection of maternal role and marital discordance in mothers’ scales who have children with JIA. Williamson et al. [4] suggested that the A. P. Akay (&) AE A. Ozbek AE B. Baykara Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey E-mail: pekcanlara@yahoo.com Tel.: +90-232-4123559 Fax: +902322776686

Perceptions of psychosis, coping, appraisals, and psychological distress in the relatives of patients with schizophrenia: An exploration using self‐regulation theory

Following Leventhal's self-regulation model, the purpose of the present study was to provide an examination of the relationship between psychosis perceptions, coping strategies, appraisals, and distress in the relatives of patients with schizophrenia. Cross-sectional study. Participants were 42 relatives of patients with schizophrenia who completed the Hospital Anxiety and Depression Scale (HADS), a brief coping strategies measure (COPE), the Revised Illness Perception Questionnaire (IPQR), and a measure of primary and secondary appraisals (Family Questionnaire). In general, carers who viewed their relative's psychosis as chronic, who had a stronger illness identity (experience of symptoms), who held a stronger belief in the severity of its consequences, and who reported weaker beliefs in treatment control but stronger beliefs that their relative could exert control over their condition had higher distress scores. Coping through seeking emotional support, the use of religion/spirituality, active coping, acceptance, and positive reframing were associated with less distress, while coping through self-blame was associated with higher distress scores. Hierarchical regression demonstrated that illness perceptions and coping (acceptance, positive reframing, and self-blame), respectively, made significant additional contributions to the variance in distress when entered after demographics, and primary and secondary appraisals. Furthermore, a mediational analysis suggested that coping strategies characterized by greater positive reframing, less self-blame, and greater acceptance mediated the relationship between distress, and both illness identity and carer's beliefs about how much personal control the patient could exercise over their condition. There was no mediational effect of coping on the relationship between distress and carers' perceptions about symptom control through medical treatment. Results provide partial but not unequivocal support for the self-regulation model in the current sample. Findings may invite us to consider the further use of the self-regulation/common sense model as a framework for understanding distress in the carers of people with a diagnosis of schizophrenia.

The illness representations of multiple sclerosis and their relations to outcome.

The main aims of the present study were to explore the illness representations of individuals with multiple sclerosis (MS) and investigate the relationship of these beliefs to outcome. Based on Leventhal et al.'s self-regulation model, the commonly accepted generic five-component structure of illness representations including identity, time-line, consequences, cause, and cure/controllability was used. A cross-sectional, correlational design was employed for the study. Interrelationships among the illness representation components and the relationships between the components and outcome were explored using Pearson's r. To determine the contribution of the illness representation components to the explained variance in outcome, a series of stepwise multiple regression analyses was used. A total of 99 participants took part in the study. A series of measures were completed to assess (1). illness representations and (2). five specific areas of outcome. Participants' illness representations of MS were consistent with the medical nature and understanding of this illness indicating that they held the perceptions of a strong illness identity, chronic time-line, no particular cause and no cure. Beliefs in the serious consequences of MS and limited control were also reported. Some important interrelationships among the illness representation components were demonstrated where a strong illness identity, chronic time-line view and perception of low control were related to more serious consequences. Overall, evidence was provided to suggest that illness representations contribute to outcome. The consequences component was associated with, and contributed to, the explained variance for each of the five outcome areas, indicating that the perception that MS has many negative effects on an individual's life was associated with greater levels of difficulty in all of the outcome areas. In addition, for each of the outcome variables, different combinations of illness representation components explained their variance. For example, higher levels of depression were associated with perceptions of a stronger illness identity, more serious consequences, acute time-line, and low control. Overall support is provided for the application of the five-component structure of illness representations to MS and the likely contribution of such beliefs to outcome. The concept of illness representations therefore provides a useful framework for understanding the psychosocial effects of this illness.

A Meta-Analytic Review of the Common-Sense Model of Illness Representations

A meta-analysis of empirical studies ( N = 45) adopting Leventhal, Meyer and Nerenz's (1980) Common Sense Model (CSM) of illness representations is presented. The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across illness types. A content analysis classified coping strategies into seven distinctive categories and health outcomes into six categories. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies. Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological well-being, social functioning and vitality and negatively related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality. The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.