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Joos A, Popkirov S, Lahmann C, Jöbges M, Herrmann C, Maner P, Schörner K, Birke G, Hartmann A. Illness perception in functional neurological disorder: low illness coherence and personal control. BMJ Neurol Open 2024; 6:e000648. [PMID: 38800069 PMCID: PMC11116876 DOI: 10.1136/bmjno-2024-000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Illness perception refers to patients' subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND) often encounter a fragmented biomedical attitude, which leaves them without clear concepts. In this context, illness perception is relevant. Methods Illness perception was assessed in FND patients and compared with samples of psychosomatic patients (PSM) as well as poststroke patients (STR). The three samples (FND, n=87; PSM, n=97 and STR, n=92) were almost all in inpatient treatment or rehabilitation. Illness perception was assessed with the revised German version of the Illness Perception Questionnaire (IPQ-R). For assessments of correlations, depressive symptoms were tested with the Patient Health Questionnaire-9, dissociative and functional neurological symptoms by the German adaption of the Dissociative Experiences Scale and biopsychosocial complexity by the INTERMED Self-Assessment questionnaire. Results Apart from the chronicity subscale, all dimensions of the IPQ-R differed between groups. FND patients perceived lower illness coherence and personal control than both other groups and attributed their illness more to chance than to behavioural risk factors. PSM patients had the strongest emotional representations. There were only few correlations with dissociative scores and biopsychosocial complexity. Conclusion Illness perception is an important issue in patients with FND with particular emphasis on low illness coherence and personal control. Missing associations with biopsychosocial complexity suggest that subjective illness perception is an important complementary but separate issue, which likely influences therapeutic alliance and self-management in FND. Future studies should assess its influences on outcome. Trial registration number DRKS00024685; German Clinical Trials Register; www.drks.de.
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Affiliation(s)
- Andreas Joos
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Claas Lahmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Jöbges
- Kliniken Schmieder Konstanz, Konstanz, Baden-Württemberg, Germany
| | | | - Philipp Maner
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Schörner
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Armin Hartmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Kordvarkane Z, Oshvandi K, Mohammadi Y, Azizi A. Effect of education based on the Common-Sense Model of Self-Regulation on blood pressure and self-management of hypertensive patients: A clinical trial study. Int J Nurs Sci 2023; 10:294-301. [PMID: 37545783 PMCID: PMC10401356 DOI: 10.1016/j.ijnss.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Objective This study aimed to determine the impact of training based on the Common-Sense Model of Self-Regulation (CSM) on blood pressure and self-management of patients with hypertension. Methods This randomized controlled trial study was conducted. Seventy-two hypertensive patients were referred to the Farshchian Hospital clinic in Hamadan from April 2021 to March 2022. Samples were selected and randomly assigned to the intervention group (n = 36) and control group (n = 36). The intervention group participated in a training program based on the CSM in five sessions of 30-45 min for one month. Phone follow-up was also done once every three days. The control group only received routine clinic education. The clinic's nurse measured the patients' blood pressure, and the participants completed the self-management questionnaire before and three months after the start of the study. Results A total of 68 participants completed the study. Results showed that before the intervention, there was no statistically significant difference in the mean scores of self-management and its dimensions, systolic, diastolic, and mean arterial pressure between intervention and control groups (P > 0.05). However, after the intervention, the mean of systolic blood pressure (116.21 ± 14.52 vs. 128.62 ± 16.88) mmHg, mean arterial pressure (88.03 ± 8.47 vs. 98.11 ± 11.69) mmHg and the scores of self-management and its dimensions among patients in the intervention group were decreased comparison with control group (P < 0.05). Conclusions Education based on the CSM improved self-management and blood pressure reduction in hypertensive patients, so nurses should use it as an effective educational model.
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Affiliation(s)
- Zohre Kordvarkane
- Student Research Committee, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azim Azizi
- Member of Chronic Diseases (Home Care) Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
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Tonapa SI, Mulyadi M, Yusuf A, Lee BO. Longitudinal Association Among Illness Perceptions, Coping, and Quality of Life After Extremity Injury. Orthop Nurs 2023; 42:83-91. [PMID: 36944201 DOI: 10.1097/nor.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This longitudinal cohort study examined changes in illness perceptions, coping strategies, and quality of life in hospitalized participants who had sustained extremity injuries, and examined the associations among these changes. A sample of 138 patients with extremity injuries was recruited between August 2019 and April 2020 from the trauma units of two similar referral medical centers, each with a capacity of over 200 beds in Surabaya City, Indonesia. Outcome measures were assessed prior to hospital discharge and 3 months post-discharge, including the Brief Illness Perception Questionnaire, the Brief Coping Orientation to Problems Experienced, and the World Health Organization Quality of Life. Hierarchical multiple regression analyses were conducted. We found that lower scores for illness perceptions (i.e., how a participant appraised and understood their medical condition and its possible consequences) and maladaptive coping strategies were significantly associated with lower quality of life scores. In addition, scores for adaptive coping strategies moderated the association between illness perceptions and quality of life. Our findings suggest that clinicians should endeavor to improve patients' illness perceptions and adaptive coping strategies during the first 3 months post-injury to promote improvement in quality of life following extremity injury.
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Affiliation(s)
- Santo Imanuel Tonapa
- Santo Imanuel Tonapa, MSN, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, and School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Mulyadi Mulyadi, PhD, RN, School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Ah Yusuf, SKp, MKes, DR, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Bih-O Lee, PhD, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mulyadi Mulyadi
- Santo Imanuel Tonapa, MSN, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, and School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Mulyadi Mulyadi, PhD, RN, School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Ah Yusuf, SKp, MKes, DR, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Bih-O Lee, PhD, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ah Yusuf
- Santo Imanuel Tonapa, MSN, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, and School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Mulyadi Mulyadi, PhD, RN, School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Ah Yusuf, SKp, MKes, DR, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Bih-O Lee, PhD, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bih-O Lee
- Santo Imanuel Tonapa, MSN, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, and School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Mulyadi Mulyadi, PhD, RN, School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Ah Yusuf, SKp, MKes, DR, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Bih-O Lee, PhD, RN, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Beyazgul B, Koruk İ, Kuzan R. Effect of elderly individuals' perceptions and attitudes toward COVID-19 pandemic on rejecting COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2079338. [PMID: 35687362 PMCID: PMC9467538 DOI: 10.1080/21645515.2022.2079338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite the fact that COVID-19 vaccines serve as an important tool for protection against COVID-19 infection, in individuals aged above 65 years, as well as the entire community, there are significant problems associated with getting vaccinated. The aim of this study is to determine the effect of perceptions and attitudes toward the COVID-19 epidemic in individuals over the age of 65 living in Şanlıurfa, Turkey in 2021, on the situation of having COVID-19 vaccination. The study is designed as a case-control type of research. The study population was comprised of individuals aged 65 years and above located in Şanlıurfa, Turkey. The Case Group consisted of individuals, who rejected the COVID-19 vaccination and the Control Group consisted of individuals who have received the vaccine. The individuals recruited in the Case and Control Groups were selected by means of the snowball sampling method. The study included a total of 240 individuals including 120 in the Case Group and 120 in the Control Group. Rate of vaccine rejection was higher in individuals who believed that the media exaggerated the pandemic, the disease had low contagiousness, the pandemic was a conspiracy, the environmental pollution had no role in the disease, the domestic measures taken against the epidemic were inadequate, the personal hygiene could not protect from disease, and who did not believe that the disease was inevitable [p < 0.05]. Governments have a lot of responsibilities in providing accurate information about vaccination to people and increasing confidence in the health system.
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Affiliation(s)
- Burcu Beyazgul
- Harran University, Medical Faculty, Public Health Department, Şanlıurfa, Turkey
| | - İbrahim Koruk
- Harran University, Medical Faculty, Public Health Department, Şanlıurfa, Turkey
| | - Rüstem Kuzan
- Harran University, Medical Faculty, Public Health Department, Şanlıurfa, Turkey
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Cannon M, Crede M, Kimber JM, Brunkow A, Nelson R, McAndrew LM. The Common-Sense Model and Mental Illness Outcomes: A Meta-Analysis. Clin Psychol Psychother 2022; 29:1186-1202. [PMID: 35112427 DOI: 10.1002/cpp.2721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
Psychotherapists can improve their patients' outcomes during and after therapy by improving patients' self-management. Patients who do not effectively manage their mental illness generally have worse outcomes. Leventhal's Common-Sense Model of Self-Regulation theorizes that patients' perceptions of their illness (illness representations) guide their self-management, influencing health outcomes. The present study quantified the relations between illness representations, self-management, and outcomes for mental illnesses. We conducted a meta-analysis and included articles if they reported: 1) on adults with mental illnesses; and 2) the correlation between mental illness representations and mental illness outcomes. 25 articles were included which represented 28 independent samples. The pattern of correlations among illness representations (identity, consequences, timeline, control, coherence, and emotional representations), self-management strategies (attendance, engagement, and adherence to treatment) and mental illness outcomes (symptom severity and quality of life) was consistent with analyses from previous studies of mental and physical illnesses. The results found threat-related illness representations mostly had a large relationship with worse mental illness outcomes and self-management. Protective illness representations had a small-to-large relationship with better mental illness outcomes and self-management. The results suggest patients' perceptions of their mental illness may be a critical indicator of their mental illness outcomes, including symptom severity and quality of life. This theory-driven meta-analysis supports calls for the inclusion of illness representations in psychotherapy for mental illness.
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Affiliation(s)
- Margeaux Cannon
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Marcus Crede
- Iowa State University 901 Stange Rd. Ames, IA, USA
| | - Justin M Kimber
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Alexandria Brunkow
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Rebecca Nelson
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Lisa M McAndrew
- University at Albany, State University of New York 1400, Washington, NY, USA
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"We're on a Merry-Go-Round": Reflections of Patients and Carers after Completing Treatment for Sarcoma. ACTA ACUST UNITED AC 2021; 28:3003-3014. [PMID: 34436029 PMCID: PMC8395482 DOI: 10.3390/curroncol28040263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/25/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
Sarcoma is a rare cancer that has a significant impact on patients’ and carers’ quality of life. Despite this, there has been a paucity of research exploring the diverse experiences of patients and carers following sarcoma treatment. The aim of this study was to explore patients’ and carers’ reflections on life after treatment for sarcoma. A qualitative research design with a social constructionist epistemology was used. Participants included patients previously treated for sarcoma (n = 21) and family carers of patients treated for sarcoma (n = 16). Participants completed semi-structured interviews which were analysed using thematic analysis. Three primary themes were identified: “This journey is never going to be over”, “But what happens when I am better?”, and finding a silver lining. Participants represented sarcoma as having a long-term, and sometimes indefinite, threat on their life that they had limited control over. Conclusions: This study highlight the heterogeneous and ongoing needs of sarcoma survivors and their families. Patients and carers strove to translate their experiences in a meaningful way, such as by improving outcomes for other people affected by sarcoma. Parental carers in particular attempted to protect the patient from the ongoing stress of managing the disease.
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Breland JY, Patel ML, Wong JJ, Hoggatt KJ. Weight Perceptions and Weight Loss Attempts: Military Service Matters. Mil Med 2020; 185:e397-e402. [PMID: 31822913 DOI: 10.1093/milmed/usz413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service. MATERIALS AND METHODS Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board. RESULTS Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34). CONCLUSIONS This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025
| | - Michele L Patel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr., Durham, NC 27708
| | - Jessie J Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, 616 Serra Mall C100, Stanford, CA 94305-6055
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073.,Department of Epidemiology, UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095-1772
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Breland JY, Wong JJ, McAndrew LM. Are Common Sense Model constructs and self-efficacy simultaneously correlated with self-management behaviors and health outcomes: A systematic review. Health Psychol Open 2020; 7:2055102919898846. [PMID: 32030192 PMCID: PMC6978827 DOI: 10.1177/2055102919898846] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review answered two questions among adults with chronic conditions: When included in the same statistical model, are Common Sense Model constructs and self-efficacy both associated with (1) self-management behaviors and (2) health outcomes? We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included 29 articles. When included in the same statistical model, Common Sense Model constructs and self-efficacy were both correlated with outcomes. Self-efficacy was more consistently associated with self-management behaviors, and Common Sense Model constructs were more consistently associated with health outcomes. Findings support the continued inclusion and integration of both frameworks to understand and/or improve chronic illness self-management and outcomes.
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Affiliation(s)
| | - Jessie J Wong
- VA Palo Alto Health Care System, USA.,Stanford University School of Medicine, USA
| | - Lisa M McAndrew
- VA New Jersey Health Care System, USA.,University at Albany, State University of New York, USA
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Friedlander ML, Kangos K, Maestro K, Muetzelfeld H, Wright ST, Silva ND, Kimber J, Helmer DA, McAndrew LM. Introducing the System for Observing Medical Alliances (SOMA): A Tool for Studying Concordance in Patient-Physician Relationships. COUNSELING PSYCHOLOGIST 2019; 47:796-819. [PMID: 32372766 DOI: 10.1177/0011000019891434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We developed the System for Observing Medical Alliances (SOMA) to study relationships between medical providers and patients with medically unexplained symptoms (MUS). Based on literature in health psychology, medicine, and the psychotherapeutic alliance, the SOMA operationalizes three medical alliance dimensions: Engagement in the Consultation Process, Trust in the Provider, and Concordance of Illness Beliefs and Treatment Recommendations. Specific behavioral indicators, tallied as observed by trained judges, are used as the basis for rating each dimension. In a sample of 33 medical consultations with veterans who had MUS, interrater reliabilities ranged from .79 to .94. Notably, the other dimension ratings accounted for 40% of the variability in Concordance, with Trust in the Provider contributing unique variance. In addition to research, psychologists in integrated health settings can use the SOMA to consult and train medical providers on communication skills that enhance concordance.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System, University at Albany
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McAndrew LM, Crede M, Maestro K, Slotkin S, Kimber J, Phillips LA. Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis. Health Psychol Rev 2018; 13:427-446. [PMID: 30196755 DOI: 10.1080/17437199.2018.1521730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Consistent with the common-sense model of self-regulation, illness representations are considered the key to improving health outcomes for medically unexplained symptoms and illnesses (MUS). Which illness representations are related to outcomes and how they are related is not well understood. In response, we conducted a meta-analysis of the relationship between illness representations, self-management/coping, and health outcomes (perceived disease state, psychological distress, and quality of life) for patients with MUS. We reviewed 23 studies and found that threat-related illness representations and emotional representations were related to worse health outcomes and more negative coping (moderate to large effect). Generally, increases in negative coping mediated (with a moderate to large effect) the relationship of threat/emotional illness representations and health outcomes. Protective illness representations were related to better health outcomes, less use of negative coping and greater use of positive coping (small to moderate effect). The relationship of protective illness representations to better health outcomes was mediated by decreases in negative coping (moderate to large effect) and increases in positive coping (moderate effect). Perceiving a psychological cause to the MUS was related to more negative health outcomes (moderate to large effect) and more negative emotional coping (small effect). The relationship of perceiving a psychological cause and more negative health outcomes was mediated by increases in negative emotional coping. Improving our understanding of how illness representations impact health outcomes can inform efforts to improve treatments for MUS. Our results suggest behavioural treatments should focus on reducing threat-related illness representations and negative coping.
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Affiliation(s)
- Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ, USA.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | - Marcus Crede
- Department of Psychology, Iowa State University, Ames, IA, USA
| | - Kieran Maestro
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | - Sarah Slotkin
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | - Justin Kimber
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
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