The impact of chronic disease: a sociomedical profile of rheumatoid arthritis

A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty-five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty-three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.

Impact of chronic illness on the patient's spouse

The spouse of a chronically ill person can experience a variety of undesirable reactions, such as anxiety, self-blame, or anger. Using a case example that involves Alzheimer's disease--a presenile condition--the author explains how social workers can help clients cope with and adjust to the problems created by a spouse's illness.

Successful 'normalizing' tactics of parents of chronically-ill children

To be or to parent a chronically-ill child is a difficult experience. Parents can initiate 'normalizing' tactics that alleviate the child's feeling of being different and enable a sense of control with the possibility to influence the quality of life of the child and the family. Following up among 20 parents of chronically-ill children, the author was able to identify a number of principles which underlined the 'normalizing' tactics. These principles, it is suggested, should be helpful to nurses and other health workers when guiding and advising parents and others who come into daily contact with chronically-ill children.

[Strategies for coping with chronic disease. Study of adult hemophiliacs]

The present study was performed to investigate the coping modes of 43 adult hemophiliacs. The individual experiences of the patients were taken into account by the biographic method. The evaluation was managed according to a categorial system which is primarily oriented at the "Daseinstechniken" as defined by Thomae (1968). Referring to the situative classes of "illness", "fields of education and profession" and "contact sphere" the patients' reaction patterns were more specific to the situation than to the personality. All in all "accepting the situation" turned out to be the most frequent form of reaction.

A sequential criterion analysis for assessing coping with chronic illness

A three-stage sequential criterion analysis based on the Goldfried-D'Zurilla behavior model is presented as a heuristic approach for studying chronic illness. The three interrelated stages consist of: (a) problem identification, (b) response enumeration, and (c) response evaluation. The utility of this systematic approach for understanding the adaptive process, helping to identify patients who might benefit from intervention, providing content for actual intervention, and reducing the myth of homogeneity among chronic patient populations for both clinicians and researches, is discussed. Examples of the utility of the criterion analysis are provided throughout the paper.

Life events, emotional support, and health of older people

The effects of life events, emotional support, interaction of life events and emotional support, and age on indices of physical and psychological health were examined within a hierarchical multiple-regression design. Fifty older people who were randomly selected from among the residents of a high-rise apartment building provided retrospective data on their life events and emotional support. These same subjects provided more recent data on their functional health, distress arising from chronic health problems, and four indices of morale (agitation, attitude toward own aging, lonely dissatisfaction, and a combined index of the morale dimensions). As expected, significant multivariate effects were demonstrated on all but two measures: distress arising from chronic health problems and attitude toward aging. Examination of the independent contributions to these effects showed variations depending on the health index of focus. Expected moderations of the effects of life events by emotional support effects were not demonstrated. Results are discussed in relationship to previous research and the theoretical expectation that emotional support would moderate the effects of life events on health.

Diagnosing mental illness in the elderly

Diagnosing mental illness in the elderly is difficult because changes in physical and psychologic functioning may mimic psychiatric disorders. The reverse is also true. Although chronologic age is not related directly to predisposition to mental illness, the stresses experienced by elderly persons as a result of declining health and loss of social status may result in mental disorders. Accurate diagnosis, which takes all these factors into account, is particularly important for the rational treatment of elderly patients.

The development of an impact-on-family scale: preliminary findings

While descriptions of the effects of chronic childhood illness on the family appear in the literature, there have been few attempts to develop a formal measure of this impact. As part of a longitudinal study of chronic illness in childhood, the development of a measure was undertaken. The conceptual framework and methodology employed in scale development are described. A 24-item scale is presented which elicits variability in response and which is internally consistent. A factor analysis reveals that 4 dimensions of impact are contained in the measure: Financial, Social/Familial, Personal Strain, and Mastery. Psychometric data were derived from administration of the instrument to 100 mothers of chronically ill children. The potential usefulness of the scale in health research is discussed.

The psychological management of the patient with chronic illness and his family

Chronic illness, whether physical or mental, has a profound psychological effect on the affected individuals and their families. It is necessary for the general practitioner to have a good grasp of these aspects of the care of such patients and their families, not only in order to be of assistance in alleviating the emotional stresses which chronic illness places on them, but also so as to ensure maximal compliance with the treatment regimen of the illness itself. Studies have demonstrated that the most important factor determining patient compliance is the quality of the doctor-patient relationship. Special mention is made of the 'illness solution' in families and the ways in which the general practitioner can deal with this situation.