Factors associated with self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease: a cross-sectional study

Illness perceptions and health-related quality of life in individuals with overweight and obesity

INTRODUCTION

To understand how individuals (self-)manage obesity, insight is needed into how patients perceive their condition and how this perception translates into health outcomes (e.g., health-related quality of life, HRQOL). Our objectives were (1) to examine illness perceptions in individuals with overweight and obesity, and (2) to investigate associations of these perceptions with physical and mental HRQOL.

METHODS

In a cross-sectional analysis of the Netherlands Epidemiology of Obesity Study (n = 6432; 52% women), illness perceptions were assessed using the Brief Illness Perception Questionnaire, and HRQOL was assessed using the 36-Item Short-Form Health Survey. Illness perceptions were calculated for different categories of overall, abdominal, and metabolically unhealthy obesity. We investigated associations of illness perceptions with HRQOL using BMI-stratified multivariable linear regression analyses.

RESULTS

Compared to individuals with normal weight, individuals with obesity believed to a higher extent that their condition had more serious consequences [Mean Difference (95%CI): 1.8 (1.6-2.0)], persisted for a longer time [3.4 (3.2-3.6)], manifested in more symptoms [3.8 (3.6-4.0)], caused more worry [4.2 (3.9-4.4)] and emotional distress [2.0 (1.8-2.2)], but was more manageable with medical treatment [3.1 (2.9-3.4)]. They perceived to a lesser extent that they had personal control [-2.2 (-2.4, -2.0)] and understanding [-0.3 (-0.5, -0.1)] regarding their condition. These negative perceptions were less pronounced in individuals with abdominal obesity. Behaviour/Lifestyle was attributed by 73% of participants to be the cause of their obesity. Stronger negative illness perceptions were associated with impaired HRQOL, particularly the physical component.

CONCLUSION

Individuals with obesity perceived their conditions as threatening, and this seemed somewhat stronger in individuals with overall obesity than those with abdominal obesity. Behaviour/Lifestyle is a crucial target intervention and empowering self-management behaviour to achieve a healthy body weight may deliver promising results. In addition, strategies that aim to change negative perceptions of obesity into more adaptive ones may improve HRQOL.

Depression and Associated Factors in Chinese Patients With Chronic Kidney Disease Without Dialysis: A Cross-Sectional Study

Background: Chronic kidney disease (CKD) has been a globally public health problem over the past decades. The maintenance of physical and mental health is of importance for patients nowadays. Notably, depression is prevalent and associated with various adverse events in CKD patients without dialysis. Prior studies have reported that pain, negative illness perception, pain, and low self-esteem are potential risk factors of depression, while few studies have comprehensively investigated the mechanisms among these factors and depression among this population.

Purpose: This study aims to investigate the prevalence of depression and further explore the factors associated with depression among CKD patients without dialysis in China.

Design and Methods: We conducted a cross-sectional study in patients with diagnosed CKD to investigate the prevalence of depression was by the Beck Depression Inventory-II (BDI-II). The data on pain interference, illness perception, and self-esteem were also collected via self-administered questionnaires. A structural equation model (SEM) was used to examine the factors associated with depression.

Main Findings: From June to October 2019, we successfully interviewed 334 CKD patients at the outpatient clinics. Their mean age was 45.6 years (ranging from 19 to 74 years), and 48.5% were male. Most respondents were at early CKD stages (77.5% stage 1–3) and the prevalence of depression was 22.2%. We found a moderate association between illness perception and depression, which was modified by self-esteem. Similar but weaker association was found between pain interference and depression.

Conclusion and Recommendations: Negative illness perception, low self-esteem and severe pain interference were associated with depression among Chinese CKD patients without dialysis. Future studies are warranted to investigate the underlying mechanism and formulate the intervention strategies for this high-risk population.

Positive psychological characteristics in patients with metabolic syndrome associated with prospective changes in diet and anthropometric factors

The prevalence of metabolic syndrome (MetS) is increasing worldwide, and diet therapy plays a key role in treating this disease. Since most patients show difficulties in adhering to nutritional interventions, research on the association of positive psychological characteristics with greater engagement in physical health is relevant to this field. The present study aimed to evaluate the association between positive psychology attributes (optimism, hope, self-esteem, positive/negative affect and life satisfaction) and changes in diet quality and anthropometric parameters of individuals with MetS who received nutritional counseling. The study assessed 63 patients at a nutrition outpatient clinic. Anthropometric parameters and 24-hour food recall data (for evaluation of the Brazilian Healthy Eating Index-Revised-BHEI-R) were collected at the first visit and subsequent return visit (on average five months later). Psychological data were collected at the first visit using validated and standardized scales. The results were adjusted in relation to the depression scores of the patients, which were evaluated using the Beck Depression Inventory-II (BDI-II). Changes in anthropometric factors and in the BHEI-R were assessed, and their associations with the psychological attributes were investigated. The results indicated that positive affect and hope were associated with improvement in the BHEI-R scores (Cohen effect sizes -0.65 and -0.58; p = 0.012 and 0.025, respectively). A significant association was also observed between optimism and a reduction in abdominal circumference (Cohen effect size 0.56; p = 0.031). The associations remained significant even after adjusting for the BDI-II scores (p = 0.022, p = 0.037 and p = 0.05, respectively). No statistically significant associations were observed for the other attributes assessed.The study suggests that some attributes may have a greater influence on the nutritional treatment of MetS and that future studies should be conducted in order to enable effective multidisciplinary interventions to treat MetS.

The impact of obesity on self-esteem and academic achievement among university students

BACKGROUND

Previous studies showed that obesity was correlated with many negative social and health outcomes including poor academic achievement and low self-esteem.

PURPOSE

To determine the prevalence of obesity and to identify the impact of obesity on self-esteem and academic performance among university students.

METHOD

The study used a correlational design to achieve the study objectives. It was conducted at the University of Jordan (UJ). The study population was all university students in at UJ. A convenience sampling technique was conducted to select 419 students. A self-administered questionnaire was designed to collect data from the sample. The body of the questionnaire was divided into two sections: a demographic data section, and the second section aimed to measure the students' self-esteem using the Rosenberg Self-Esteem Scale (SES).

RESULTS

The response rate in this study was 91.1%. The results showed that 33 students were obese (7.88%), 116 students were overweight (27.68%), 266 students were normal weight (63.48%), and four students were underweight (0.95%). The results showed that there was a significant negative relationship between obesity and self-esteem (total item) (r = -0.231, 0.000*). The results showed that there was a significant negative relationship between obesity and academic achievement (r = -0.131, 0.002).

CONCLUSION

There was a significant impact of obesity on the self-esteem and academic performance among university students.

Self-esteem in patients with inflammatory bowel disease

Purpose

The purpose of this study was to explore self-esteem and associations between self-esteem and sociodemographic, clinical, and psychological factors in patients with inflammatory bowel disease (IBD), a disease of chronic relapsing inflammation of the gastrointestinal tract. IBD symptoms, including pain, fatigue, and diarrhea, as well as potential life-long medical treatment and surgery, may be demanding, cause significant challenges, and influence self-esteem.

Methods

In this cross-sectional multicenter study, participants were recruited from nine hospitals in the southeastern and western regions of Norway from March 2013 to April 2014. Data were collected using self-report questionnaires. Self-esteem was assessed by the Rosenberg Self-Esteem Scale, fatigue was assessed by the Fatigue Questionnaire, self-efficacy was assessed by the General Self-Efficacy Scale, and disease activity was assessed by the Simple Clinical Colitis Activity Index for ulcerative colitis (UC) and Harvey Bradshaw Index for Crohn’s disease (CD). Multiple linear regression analysis was applied to examine associations between self-esteem and sociodemographic, clinical, and psychological factors.

Results

In total, 411 of 452 (91%) patients had evaluable data and were included in this study. The mean scores on self-esteem, self-efficacy, total fatigue, anxiety, and depression were similar between UC patients and CD patients. Male gender, being employed, and higher self-efficacy were independently associated with higher self-esteem, whereas anxiety and depression were independently associated with lower self-esteem. Neither disease activity nor fatigue were associated with self-esteem in the final multiple regression analyses.

Conclusion

Patient-centered interventions that improve self-esteem and reduce anxiety and depression seem to be important to optimize IBD management.

Psychometric Characteristics of the Revised Illness Perception Questionnaire (IPQ-R) in People Undergoing Weight Loss Surgery

The Illness Perception Questionnaire-Revised (IPQ-R) has been used extensively across many health conditions to measure patient illness and treatment perceptions. The constructs have an association with treatment adaptation and adherence which, in turn, are considered core factors involved in bariatric surgery outcome. This study examines the factorial validity and internal reliability of a modified (IPQ-R) in bariatric surgery candidates. After wording modifications, participants (N = 310) completed the IPQ-R as part of standard pre-surgery assessments. After removal of two items, confirmatory factor analysis (CFA) supported the original 7-factor solution of the Beliefs scale, with good to marginal subscale internal consistency. Exploratory factor analysis (EFA), with two items removed only partially supported the original 5-factor Causal Attributions scale. Internal consistency was unacceptably low for two subscales. Further research is needed to generate new items which better fit the IPQ-R to this population before research can explore the relevance of illness perceptions.

Deep, Surface, or Both? A Study of Occupational Therapy Students' Learning Concepts

Background

Students' conceptualization of learning has been associated with their approaches to studying. However, whether students' learning concepts are associated with their personal characteristics is unknown.

Aim

To investigate whether sociodemographic, education-related, and personal factors were associated with the learning concepts of Norwegian occupational therapy students.

Methods

One hundred and forty-nine students (mean age 23.9 years, 79.2% women) participated in the study. The employed self-report questionnaires included the Approaches and Study Skills Inventory for Students, the Rosenberg Self-Esteem Scale, and the General Self-Efficacy Scale. Differences between student cohorts were analyzed with one-way analyses of variance and χ² tests, whereas factors associated with the students' learning concepts were analyzed with bivariate correlation and linear regression models.

Results

The students' mean scores on the deep and surface learning concept scales were similar. Spending more time on the independent study was associated with having higher scores on the unidimensional learning concept measure.

Conclusions

The students' learning concept appears to encompass a surface concept as well as a deep concept of learning, and the two ways of conceptualizing learning were positively related to each other. Over time, a mature deep concept may add to, rather than replace, a basic surface concept of learning.

Distress Tolerance Intervention for Improving Self-Management of Chronic Conditions: A Systematic Review

BACKGROUND

The inability to tolerate distress can negatively influence effective self-management (SM) of chronic conditions by interfering with the ability to focus on illness needs and impairing problem-solving and prioritizing capabilities, as well as engagement in SM activities. Interventions to increase distress tolerance offer a holistic approach to chronic disease SM and may enhance the individual's ability to apply SM skills and resources to improve quality of life and overall health. The purpose of this systematic review was to deepen understanding of the relationships among distress tolerance and goal-oriented problem-solving as an aspect of chronic disease SM.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were used to develop a search strategy, selection criteria, screening, and identification and extraction procedures. PubMed, CINAHL, PsychInfo, and Scopus were searched from 2006 to December 2017 using the following search terms: distress tolerance, chronic conditions, self-management.

RESULTS

Across the 11 studies included in the literature review, there was a high level of heterogeneity in the use of subjective and objective measures to assess distress tolerance, and only one study included instruments to measure goal-oriented problem-solving, the target of distress tolerance interventions that are assumed to influence the selected health outcome.

CONCLUSION

Further research is needed on the efficacy of distress tolerance interventions for improving SM of chronic conditions. Theory-driven interventions that explicate the precise goal-oriented problem-solving and SM behaviors that are expected to change as a result of the distress tolerance intervention will provide insight on the efficacy of the intervention and help close the theory-practice gap.

Differences and similarities in the trajectories of self-esteem and positive and negative affect in persons with chronic illness: an explorative longitudinal study

BACKGROUND

Chronic illness is a risk factor for low self-esteem, and the research literature needs to include more studies of self-esteem and its development in chronic illness groups using longitudinal and comparative designs. The aim of this study was to explore the trajectories of self-esteem and of positive and negative affect in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD).

METHODS

Patient education course attendants in Norway having morbid obesity (n=139) or COPD (n=97) participated in the study. Data concerning self-esteem, positive and negative affect, and sociodemographic background were collected at the start and at the end of the patient education, with subsequent follow-ups at 3, 6, and 12 months. Data were analyzed using linear mixed models for repeated measures.

RESULTS

Taking all measurements into account, our data revealed a statistically significant increase in self-esteem for participants with morbid obesity but not for those with COPD. There were no significant differences in levels of negative and positive affect between the two groups, and the time-trajectories were also similar. However, participants in both groups achieved lower levels of negative affect for all the successive measurement points.

CONCLUSION

An increase in self-esteem during the first year after the patient education course was observed for persons with morbid obesity, but not for persons with COPD. Initial higher levels of self-esteem in the participants with COPD may indicate that they are less troubled with low self-esteem than people with morbid obesity are. The pattern of reduced negative affect for both groups during follow-up is promising.