Sociodemographic, Disease Status, and Illness Perceptions Predictors of Global Self-ratings of Health and Quality of Life Among those with Coronary Heart Disease – One Year Follow-up Study

The role of sex and gender in somatic complaints among patients with coronary heart disease: A longitudinal study on acute and long-term changes

BACKGROUND

Somatic complaints are persistently reported in patients with coronary heart disease (CHD). Sex and gender influence health and well-being in a variety of ways, but it is unknown how they affect somatic complaints over time after percutaneous coronary intervention (PCI). Therefore, we examined the association between sex and gender on somatic health complaints during the first month (acute) and the first two years (recovery) after PCI.

METHODS

514 patients (Mage = 64.2 ± 8.9, 84.2% male) completed the somatic scale of the Health Complaints Scale (including the subscales: cardiopulmonary complaints, fatigue, sleep problems) at baseline, one, 12-, and 24-months post-PCI. In a follow-up study, they filled in additional questionnaires to gauge gender norms, traits, and identity. Linear mixed modeling analyses were used to assess the influence of sex, gender, their interaction, and covariates on somatic complaints for the acute and recovery phases separately.

RESULTS

A general decline in somatic complaints over time was observed during the acute phase, followed by a stabilization in the recovery phase. Females and individuals with more feminine traits, norms, and identities reported increased somatic complaints. Males with more pronounced feminine norms and females with more masculine norms likewise reported more somatic, cardiopulmonary, and fatigue complaints. Furthermore, age, cardiac history, and comorbid diseases partly explained the associations with somatic complaints.

CONCLUSION

While somatic complaints improve post-PCI, there are still conspicuous sex and gender differences that need to be considered. Future research should further elaborate upon these discrepancies and incorporate sex and gender in prevention and develop tailored interventions to diminish somatic complaints.

Symptom perceptions in functional disorders, major health conditions, and healthy controls: A general population study

Background

The present study investigated differences in symptom perceptions between individuals with functional disorders (FD), major health conditions, and FDs + major health conditions, respectively, and a group of healthy individuals. Furthermore, it investigated the relevance of FDs among other health-related and psychological correlates of symptom perceptions in the framework of the Common Sense Model of Self-Regulation (CMS).

Method

This cross-sectional study used epidemiological data from the Danish Study of Functional Disorders part two (N = 7,459 participants, 54% female, 51.99 ± 13.4 years). Symptom perceptions were assessed using the Brief Illness Perception Questionnaire (B-IPQ) and compared between the four health condition groups. Multiple regression analyses were performed to examine associations between symptom perceptions, FDs, and other health-related and psychological correlates from the CMS framework.

Results

Individuals with FDs (n = 976) and those with FDs + major health conditions (n = 162) reported less favorable symptom perceptions compared to the other two groups, particularly regarding perceived consequences, timeline, and emotional representations (effect size range Cohen’s d = 0.12-0.66). The presence of a FD was significantly associated with all B-IPQ items, even in the context of 16 other relevant health-related and psychological correlates from the CMS framework, whereas symptom presence last year or last week was not.

Conclusion

In the general population, symptom perceptions seem to play a more salient role in FD than in individuals with well-defined physical illness. Symptom perceptions should therefore be targeted in both primary and secondary interventions for FDs.

Association between cognitive representation of illness and the outcome of patients with premature coronary artery disease

OBJECTIVE

To assess whether illness perception (IP) in overall and each of its three dimensions (cognitive, emotional and comprehension) have an independent prognostic value in men and women with premature coronary artery disease (CAD).

METHODS

In a prospective cohort, 778 patients (370 men and 408 women) with premature CAD(diagnosed in men aged<45 y and women aged<55 y), who had completed brief illness perception questionnaire were followed up for 4 years. Outcome event was defined as composite of all-cause mortality, nonfatal myocardial infarction(MI), repeated revascularization or/and stroke. Analysis was performed for men and women separately. High scores for each item of illness perception indicate positive perception.

RESULTS

Among men, 90 patients (24.3%) experienced events: 14(3.8%) death, 23(6.2%) nonfatal MI, 9(2.4%) strokes, and 44(11.9%) revascularization. Men with and without event showed no difference regarding the traditional risk factors, depression and anxiety symptoms. Among women, 72(17.6%) had events: 11(2.7%) death, 23(5.6%) nonfatal MI, 7(1.7%) strokes and 31(7.6%) revascularization; who had a lower education, more severe CAD, and more depressive symptoms. After adjustments for potential confounders, overall IP and only its cognitive dimension were significantly associated with the outcome in women:1-score increase in the women's cognitive perception resulted in an 18% decrease in the event (HR = 0.82, 95% CI:0.72 to 0.95; P = 0.007). In the men, this effect remained nonsignificant either for IP or its dimensions.

CONCLUSIONS

Positive cognitive representation of illness was predictive of a decreased likelihood of mortality and/or cardiovascular events in women with premature CAD. Interventional studies are needed to confirm the results.

Illness perception amongst adults with multimorbidity at primary care clinics in Southwest Nigeria

Background

Although shreds of evidence are emerging to show the role of illness perceptions in the health outcomes of patients, most of the previous studies have been on single chronic conditions.

Aim

To assess the illness perceptions and the associated factors amongst adults with multimorbidity.

Setting

General outpatient clinics of the University College Hospital, Ibadan, Nigeria.

Methods

A cross-sectional study was conducted amongst a systematic sample of 403 adults with multimorbidity. Data on illness perception and other variables were collected using interviewer-administered questionnaires. Descriptive statistics, chi-square test, t-test and analysis of variance were employed for analyses.

Results

The age of the participants ranged from 18 to 97 years, with a mean of 60.9 years (standard deviation [s.d.] ± 14.3 years). The majority of participants (57.3%) were women. Ninety-four (23.3%) respondents had only two morbid conditions, whilst 31.2% had at least four morbid conditions. Prioritisation sub-domain of illness perception recorded the highest score (mean = 2.0, s.d. ± 0.8), whilst the treatment burden sub-domain was the lowest (mean = 0.8, s.d. ± 0.7). A significant bivariate relationship was observed between emotional representation (p = 0.001), prioritisation (p = 0.013) and causal relationship (p = 0.013) sub-domains and age group of study participants. Emotional burden associated with illnesses declined as educational level increased (p = 0.039).

Conclusion

Patient’s characteristics such as age, education and the number of morbidities are associated with illness perception. Healthcare providers should pay attention to these factors whilst addressing illness perception as a way to achieve better clinical outcomes.

Psychological factors and self-rated health: An observative study on cardiological patients

This study investigated the association of illness representations, awareness of bodily states and health complaints to self-rated health in N = 150 consecutive patients with heart disease (ischaemic disease, heart failure and heart valve disease) and explored differences between ‘health optimist’ and ‘health pessimist’ patients. After controlling for medical variables, health complaints accounted for 14.2 per cent of patients’ self-rated health, and illness representations contributed for another 16.2 per cent; body awareness was not associated with self-rated health. Also, ‘optimists’ tended to see less negative consequences from their illness and perceived greater control over illness treatment compared to ‘pessimists’. Targeting symptoms and illness representations may optimize rehabilitation outcomes.

Association between illness perception and health-related quality of life in patients with preexisting premature coronary artery disease

OBJECTIVES

Illness perception in younger age differs from that in older age. We aimed to examine the association between illness perception and health-related quality of life (HRQoL) in patients with premature coronary artery disease (CAD).

METHODS

In a cross-sectional design, between November 2016 and September 2017, a total of 779 adults (52.5% female) with premature CAD (diagnosed in men aged ≤ 45 y and women aged ≤ 55 y) completed the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Brief Illness Perception, and the Short-Form Health Survey 36 questionnaires in an outpatient clinic 8 years after the diagnosis.

RESULTS

The patients were treated with coronary artery bypass graft surgery (24.6%), percutaneous coronary intervention (39.5%), and medical treatment (35.8%). The cognitive, emotional, and comprehension aspects of illness perception had significant associations with both physical and mental health in univariable analysis (all Ps < 0.001). After adjustments for potential confounding factors, higher cognitive perception was independently associated with greater physical health [OR = 4.13, Confidence interval (CI): 3.53-4.72] and mental health (OR = 3.17, CI: 2.57-3.77). Additionally, emotional perception was also directly associated with higher physical (OR = 1.62, CI: 1.17-2.06) and mental (OR = 1.52, CI: 1.07-1.96) health; all Ps < 0.001.

CONCLUSIONS

Of the 3 different aspects of illness perception, cognitive perception appeared to have the greatest influence on HRQoL, either physical or mental health. Further studies are needed to investigate whether cognitive interventions can improve HRQoL in premature CAD patients and, thus, their outcome.

Exploring the illness representations of people with psoriatic arthritis: a secondary analysis of focus group data

BACKGROUND

PsA is an inflammatory arthritis associated with psoriasis, affecting the joints and connective tissue. According to the common-sense model (CSM), patients develop illness beliefs when faced with new symptoms, which determine their emotional and behavioural response to the condition. The CSM includes five beliefs: identity, consequence, cause, time line and control. These are important determinants of outcomes and have been shown to influence adherence to medication.

METHODS

A secondary analysis of eight focus groups held across five hospital sites and including 41 participants was undertaken. Participants were sampled for a range of phenotypes and domains of disease activity: men = 20 and women = 21; mean (s.d.): age = 58 (11.4) years; disease duration = 9 (8.3) years; and HAQ = 1 (0.7).

RESULTS

The analysis provided evidence to support the existence of the five illness beliefs among patients with PsA and evidence that these representations affected the way patients engaged with their condition. The results showed that many participants experienced high levels of uncertainty in relationship to the illness representation. The role of external social and environmental factors was also shown to influence participants' illness representations and the way they made sense of their PsA.

CONCLUSION

This research highlights a new theme of uncertainty within illness representations and how this impacts on the way in which people living with PsA manage their condition. A greater understanding of the uncertainty that patients might have about their condition and its treatment could provide clinicians with an opportunity to address misinformed illness representations.

Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis

To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.

Impact of Orofacial Dysfunction on the Quality of Life of Adult Patients With Cleft Lip and Palate

OBJECTIVE

This study assessed the prevalence of orofacial dysfunctions (ODs) and quality of life (QoL) in adults with and without a cleft lip and palate.

DESIGN

Cross sectional.

SETTING

Craniofacial Center, Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil.

METHODS

The study was composed of a sample of 120 patients: 60 adults in the cleft lip and palate group (CLPG) and 60 adults in the control group with no craniofacial anomalies. Each patient underwent an interview and clinical examination, using the Nordic Orofacial Test-Screening (NOT-S) and the 36-Item Short Form Survey. Data were analyzed using Mann-Whitney U test, χ², and the Spearman correlation coefficients.

RESULTS

There was a higher prevalence of OD in CLPG (P < .001) on the NOT-S. The adults in the CLPG had higher QoL in the areas of general health (P = .003), physical function (P = .014), social function (P < .001), and vitality (P = .006). The CLPG had significant associations between higher OD and lower QoL for general health (P = .004), emotional role function (P = .028), and vitality (P = .05).

CONCLUSION

Orofacial dysfunctions were more prevalent in adults with a cleft, negatively impacting their QoL in general health, emotional role function, and vitality. However, adults with a cleft also had significantly higher QoL, reflecting possible resiliency when compared to adults without a cleft.

Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients

PURPOSE

We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual's illness perceptions as well as what coping strategies they engage in.

DESIGN

Descriptive, cross-sectional questionnaire-based study.

SUBJECTS AND SETTING

One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

METHODS

Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

RESULTS

Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

CONCLUSIONS

Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

Measurement of Health-Related and Oral Health–Related Quality of Life among Individuals with Nonsyndromic Orofacial Clefts: A Systematic Review and Meta-Analysis

Objective

To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate.

Design

Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis.

Main Outcome Measures

Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated.

Results

Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and health-related quality of life between children with and without cleft lip and/or palate, and oral health–related quality of life between adolescents with and without cleft lip and/or palate. A random-effect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference = 0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of health-related quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons.

Conclusion

The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.

The relationship between illness perceptions and cardiac misconceptions after Myocardial Infarction

Research about cardiac misconceptions has focused on identifying the most common erroneous beliefs and understanding their impact on patients' outcomes. However, less is known about the underlying structure of cardiac misconceptions and how they relate to other belief dimensions. The aims of the present study were: (a) to characterize illness perceptions and cardiac misconceptions in a sample of Myocardial Infarction (MI) patients; (b) to analyse the structure of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ); and (c) to examine whether illness perceptions are likely to influence cardiac misconceptions. This cross-sectional study included 127 first-MI patients from both sexes, aged up to 70 years old. Confirmatory factor analysis and structural equation modelling were performed with AMOS. The main results showed that a two-dimension (stress avoidance and exercise avoidance) version of the YCBQ offered the best fit to the data. A significant impact of psychological attributions was observed on cardiac misconceptions, as well as a moderate impact of emotional response explaining 26% of the variance. Although exploratory, this study gives a significant contribution to research in this field, as clarification on the different concepts and the way they relate is needed. Our findings suggest that further investigation into the concepts of cardiac knowledge and cardiac misconceptions may have an important role in understanding health behaviours in the context of heart disease.

Quality of life in women with coronary artery disease

Background:

Coronary artery disease (CAD) as a chronic disease can affect physical, mental, and social aspects of health as well as the perception of wellbeing. Advanced treatments of the disease emphasize on functionality and quality of life (QOL).

Objectives:

The present study aimed to investigate the QOL and its related factors among women with CAD.

Patients and Methods:

This was a descriptive cross-sectional study conducted on 200 women with CAD, referring to the Heart Clinic of Shahid Rajaei Cardiovascular Center in Tehran, Iran. The participants were selected by convenient sampling method. Data were collected using the Persian version of Ferrans and Powers QOL index (QLI) cardiac version and then analyzed using descriptive statistics and statistical tests (independent t-test, one-way ANOVA, and Scheffe’s test).

Results:

The mean score of overall QOL was 16.91 ± 3.54, ranging between 7.17-27.63. Regarding the instrument subscales, the mean scores were as follows: health and functioning: 15.48 ± 4.32, social and economic: 16.18 ± 3.65, psychological/spiritual: 18.04 ± 4.36, and familial: 20.12 ± 4.57. There was a significant relationship between QOL and marital status (P = 0.004), education (P = 0.007), income (P < 0.001) and disease duration (P = 0.047). However, there was no significant association between QOL and age, job and comorbidity.

Conclusions:

Based on the findings, participants had average levels of overall QOL. Some domains showed the need to improve QOL of women with CAD. Results of the present study revealed the necessity of designing and performing educational and supportive interventions to improve the QOL in women with CAD, especially among patients with low socio-economic status.

Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department

OBJECTIVE

Many patients who attend an emergency department (ED) with chest pain receive a diagnosis of non-cardiac chest pain (NCCP), and often suffer poor psychological outcomes and continued pain. This study assessed the role of illness representations in explaining psychological distress and continued chest pain in patients attending an ED.

METHODS

ED NCCP patients (N = 138) completed measures assessing illness representations, anxiety, depression and quality of life (QoL) at baseline, and chest pain at one month.

RESULTS

Illness representations explained significant amounts of the variance in anxiety (Adj. R² = .38), depression (Adj. R² = .18) and mental QoL (Adj. R² = .36). A belief in psychological causes had the strongest associations with outcomes. At one month, 28.7% of participants reported experiencing frequent pain, 13.2% infrequent pain and 58.1% no pain. Anxiety, depression and poor QoL, but not illness representations, were associated with continued chest pain.

CONCLUSIONS

The findings suggest that (i) continued chest pain is related to psychological distress and poor QoL, (ii) interventions should be aimed at reducing psychological distress and improving QoL and (iii) given the associations between perceived psychological causes and psychological distress/QoL, NCCP patients in the ED might benefit from psychological therapies to manage their chest pain.

The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: study protocol for a randomised controlled trial

BACKGROUND

Osteoarthritis is a leading cause of disability in developed nations. In Australia it afflicts 16.5% of the adult population. Total joint arthroplasty is considered the treatment of choice for end stage osteoarthritis. The number of total joint arthroplasties undertaken in Australia has doubled over the last decade (more than 80,000 procedures in 2011). The incidence of pre-operative psychological distress in this group of patients is reported between 30% and 60% and pre-operative psychological distress is associated with poorer pain and functional outcomes after surgery. This study will use a mindfulness-based psychological intervention to enhance outcomes in people undergoing total joint arthroplasty and, in addition, will test hypotheses about coping with chronic illness in an aged population. This study is the first of its kind and will provide a greater understanding of the role of a mental health enhancement program on the physical recovery of total joint arthroplasty patients.

METHODS/DESIGN

One hundred and fifty people with end-stage arthritis on the waiting list for total hip or knee arthroplasty will be recruited and randomly allocated to one of two groups using computer-generated block randomisation. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of a mindfulness training program (weekly group-based classes in mindfulness practice, 2 ½ hours, for 8 weeks plus a 7-hour Saturday session in Week 6) prior to total joint arthroplasty, compared to a "standard care" group who will undergo routine total joint arthroplasty. Primary outcomes will be evaluated by a blinded examiner at baseline, 3 and 12 months post-surgery, using a validated self-reported pain and physical function scale. Secondary outcomes will include i) a range of validated measures of psychological wellbeing and ii) health economic analysis. All analyses will be conducted on an intention to treat basis using linear regression models. Health economic modelling will be applied to estimate the potential cost-effectiveness of mindfulness training and total joint arthroplasty.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTRN12611001184965). Date of registration; 15th November 2011.

Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients

BACKGROUND AND AIMS

Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

METHODS

Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

CONCLUSIONS

The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients

OBJECTIVE

To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations.

METHODS

Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check.

RESULTS

21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction.

CONCLUSION

The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.

The mediator role of psychological morbidity in patients with chronic low back pain in differentiated treatments

This study analyzed the mediating role of psychological morbidity and the variables that discriminated low versus high disability, in patients receiving physiotherapy and acupuncture. A total of 203 patients answered measures of illness and medication representations, coping, depression, anxiety, quality of life, and functional disability. Morbidity was a mediator between functional disability and quality of life. Treatment consequences and quality of life, in the acupuncture group, and emotional representations, quality of life, depression, anxiety, and active strategies for pain relief, in the physiotherapy group, discriminated patients with low versus high disability. These results have important implications for identifying high-risk patients.

Indoleamine 2,3-dioxygenase activation and depressive symptoms: results from the Young Finns Study

OBJECTIVE

To examine whether the activation of indoleamine 2,3-dioxygenase (IDO), an enzyme involved in serotonin production, is associated with depressive symptoms.

METHODS

The participants were 544 women and 442 men (aged 24-39 years) from the population-based Young Finns Study who participated in a medical examination in 2001 (including IDO and depression) and 2007 (follow-up assessment for depression).

RESULTS

At baseline, IDO was associated with depressive symptoms (in the total cohort: B = 0.23, p < .001; women: B = 0.20, p = .007; men: B = 0.29, p = .002; p for interaction = .19). IDO at baseline was also associated with depressive symptoms at follow-up in women (B = 0.17, p = .03), which remained significant when adjusting for any of the biologic and behavioral risk factors. Adjusting for body mass index attenuated the association by 6%. In the final model including all baseline variables, none of the risk factors (except for baseline depressive symptoms) were associated with depressive symptoms at follow-up.

CONCLUSIONS

These data suggest that IDO activity may be a risk factor for future depression especially in women. IDO-induced alterations in serotonergic function may offer one biologic explanation to the well-established associations between inflammation and depression.

Self-reported adverse drug events and the role of illness perception and medication beliefs in ambulatory heart failure patients: A cross-sectional survey

BACKGROUND

Identifying patients with heart failure (HF) who are at risk of experiencing symptomatic adverse drug events (ADEs) is important for improving patient care and quality of life. Several demographic and clinical variables have been identified as potential risk factors for ADEs but limited knowledge is available on the impact of HF patients' beliefs and perceptions on their experience of ADEs.

OBJECTIVE

The purpose of the study was to identify the relationship between HF patients' illness perception and medication beliefs and self-reported ADEs.

DESIGN

A cross-sectional survey was performed between November 2008 and March 2009.

SETTINGS

One university medical centre, two regional hospitals and 20 general practitioners in the Netherlands participated in the study.

PARTICIPANTS

495 patients with HF were included.

METHODS

Patients completed the validated Revised Illness Perception Questionnaire (IPQ-R) and the Beliefs about Medication Questionnaire (BMQ) which collected data on their illness perception and medication beliefs. In addition, data on ADEs as experienced in the previous four weeks were collected through an open-ended question and a symptom checklist. Multivariate logistic regression was performed to identify factors associated with these ADEs.

RESULTS

In total, 332 (67%) patients had experienced ADEs in the previous four weeks, of whom 28% reported dry mouth, 27% dizziness and 19% itchiness as the most prevalent. In the adjusted multivariate analysis, disease-related symptoms (illness identity) (OR for 1-5 symptoms 3.57; 95% CI 2.22-5.75, OR for >5 symptoms 7.37; 95% CI 3.44-15.8), and general beliefs about medication overuse (OR 1.07; 95% CI 1.01-1.13) were independently associated with experiencing ADEs, whereas none of the demographic or clinical factors were significant.

CONCLUSIONS

HF patients who perceive a high number of disease symptoms and have negative medication beliefs are at higher risk of experiencing self-reported ADEs. We suggest that future studies and interventions to improve ADE management should focus on negative medication beliefs and assisting patients in differentiating disease symptoms from ADEs.

Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease

Purpose

The effectiveness of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD) is moderated by negative emotions and clinical factors, but no studies evaluated the role of positive emotions. This study examined whether anhedonia (i.e. the lack of positive affect) moderated the effectiveness of CR on health status and somatic and cognitive symptoms.

Methods

CAD patients (n = 368) filled out the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at the start of CR, and the Short-Form Health Survey (SF-36) and the Health Complaints Scale (HCS) at the start of CR and at 3 months to assess health status and somatic and cognitive symptoms, respectively.

Results

Adjusting for clinical and demographic factors, health status improved significantly during the follow-up (F(1,357) = 10.84, P = .001). Anhedonic patients reported poorer health status compared with non-anhedonic patients, with anhedonia exerting a stable effect over time (F(1,358) = 34.80, P < .001). Somatic and cognitive symptoms decreased over time (F(1,358) = 3.85, P = .05). Anhedonics experienced more benefits in terms of somatic and cognitive symptoms over time (F(1,358) = 13.00, P < .001).

Conclusion

Anhedonic patients reported poorer health status and higher levels of somatic and cognitive symptoms prior to and after CR. Somatic and cognitive symptoms differed as a function of anhedonia over time, but health status did not. Anhedonia might provide a new avenue for secondary prevention in CAD.

Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care

Many psychological factors have been suggested to be important obstacles to recovery from low back pain, yet most studies focus on a limited number of factors. We compared a more comprehensive range of 20 factors in predicting outcome in primary care. Consecutive patients consulting 8 general practices were eligible to take part in a prospective cohort study; 1591 provided data at baseline and 810 at 6 months. Clinical outcome was defined using the Roland and Morris Disability Questionnaire (RMDQ). The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques. The sample was similar to other primary care cohorts (mean age 44 years, 59% women, mean baseline RMDQ 8.6). The 20 factors each accounted for between 0.04% and 33.3% of the variance in baseline RMDQ score. A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7% of the variance in 6 months RMDQ score; rising to 55.8% following adjustment. Four scales remained significantly associated with outcome in the multivariate model explaining 56.6% of the variance: perceptions of personal control, acute/chronic timeline, illness identify and pain self-efficacy. When all independent factors were included, depression, catastrophising and fear avoidance were no longer significant. Thus, a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients. There is clear redundancy in the measurement of psychological factors. These findings should help to focus targeted interventions for back pain in the future.

Die deutschsprachige Version des Illness Perception Questionnaire-Revised

Zusammenfassung. Ziel der Studie war es, die deutschsprachige Version des Illness Perception Questionnaire-Revised (IPQ-R) psychometrisch zu evaluieren. Hierbei wurden die faktorielle Validität, Konstruktvalidität und konkurrente Kriteriumsvalidität bestimmt sowie die interne Konsistenz und Test-Retest-Reliabilität analysiert. Die Mehrzahl der Analysen wurden in einer Querschnittsstudie an N = 817 Patienten aus sechs Rehabilitationskliniken durchgeführt. Die Prüfung der konkurrenten Kriteriumsvalidität erfolgte an einer Teilstichprobe dieser Patienten in Kontrastierung zu einer Stichprobe von N = 58 Akutpatienten. Die Test-Retest-Reliabilität wurde anhand einer Stichprobe von N = 45 Patienten aus zwei Rehabilitationskliniken ermittelt. Die faktorielle Struktur des Original-Fragebogens kann insgesamt bestätigt werden. Die Cronbachs Alpha-Koeffizienten liegen mit Werten zwischen .70 und .87 in einem befriedigend bis guten Bereich, lediglich die Skala „Behandlungskontrolle” weist mit einem α von .58 einen inakzeptablen Wert auf. Das Muster der Korrelationsmatrix ist plausibel. Der Fragebogen diskriminiert zwischen Rehabilitanden und Akutpatienten und weist mit Intraklassenkoeffizienten zwischen .55 und .87 bzw. Pearson-Korrelationskoeffizienten zwischen .56 und .87 eine ausreichende Test-Retest-Reliabilität auf. Die kognitiven Krankheitsrepräsentationen von Rehabilitanden können mit dem deutschsprachigen IPQ-R relativ reliabel und valide gemessen werden. Einige der Ergebnisse weisen jedoch auf Überarbeitungspotenzial des Fragebogens hin.

Are illness perceptions about coronary artery disease predictive of depression and quality of life outcomes?

OBJECTIVE

Depression occurs commonly in coronary artery disease (CAD) and is associated with substantial disability. Modifiable cognitive determinants of depression in this population have not been identified. We investigated the impact of potentially modifiable illness beliefs about CAD on depressive symptomatology. We also examined the association between these beliefs and health-related quality of life (HRQOL) and socio-demographic variations in illness beliefs.

METHODS

A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report 3 and 9 months post-discharge. Socio-demographic differences were analysed with independent sample t-tests. Predictive models were tested in a series of hierarchical linear regression equations that controlled for known clinical, psychosocial, and demographic correlates of outcome.

RESULTS

Negative illness beliefs, particularly those associated with the consequences of CAD, were significantly predictive of higher levels of depressive symptomatology at 3 and 9 months. Positive illness perceptions were significantly associated with better HRQOL outcomes. Older and less socially advantaged patients demonstrated more negative illness beliefs.

CONCLUSIONS

Illness beliefs are significantly associated with depressive symptomatology and HRQOL in CAD patients. These beliefs can be easily identified and constitute a meaningful and clinically accessible avenue for improving psychological morbidity and HRQOL in CAD patients. Older and more socially vulnerable patients may require heightened monitoring of their illness beliefs. Research needs to translate these and other predictive findings into interventions.

Being 'at-risk' for developing cancer: cognitive representations and psychological outcomes

This study investigated cognitive representations and psychological effects of being 'at-risk' for cancer. Perceived personal risk for cancer and causal attributions for cancer were measured in four groups: women identified as carriers of mutations in breast/ovarian cancer genes BRCA1 BRCA2, habitual smokers, X-ray technicians, and an average-risk group. Despite differences in awareness of their risk status and perceived risk for cancer, the groups did not differ in health anxiety, cancer worry interference, and self-assessed health. Motivated reasoning processes were identified as potential strategies used by individuals at-risk to regulate levels of psychological distress. Evidence for biased risk perceptions and unrealistic optimism were found among smokers, and patterns indicative of self-enhancement through self-assessments and defensive discounting of cancer causal attributions were found in the genetically susceptible group. These findings highlight the role of cognitive representations in adjustment to being at-risk for cancer.

Negative illness perceptions are associated with new-onset depression following myocardial infarction

OBJECTIVE

To test the hypothesis that negative perceptions about heart disease at the time of the myocardial infarction (MI) were associated with the onset of new episodes of depression following MI.

METHOD

We recruited 269 subjects admitted following first MI and monitored their depression status over the subsequent 12 months. At baseline, we recorded demographic information, family and personal history of cardiac disease and severity of MI; subjective health beliefs were assessed using the Illness Perceptions Questionnaire (IPQ). We assessed depression at baseline, 6 and 12 months following MI using a standardised questionnaire, validated in this population against a semistructured research interview.

RESULTS

In the days following MI, patients who subsequently developed depression were more likely to anticipate that their heart disease would last a long time (P=.012) and was unlikely to be cured (P=.038). Controlling for potential confounding variables, scores on the IPQ remained associated with subsequent depression (P = .036), with anticipation that heart disease would last a long time [odds ratio (OR)=2.7, P=.013] and that heart disease could be cured (OR=0.45, P=.048) showing strongest association.

CONCLUSIONS

Negative perceptions about heart disease in the days following admission to hospital with first MI are associated with the development of subsequent new episodes of depression.