Individuals exposed adverse childhood experiences (ACEs) are at increased risk of developing chronic illnesses in adulthood including heart disease, cancer, diabetes, and chronic pain. A relationship between ACEs and health risk factors contributing to chronic disease such as smoking, obesity, and sedentary lifestyle has also been established in prior literature. There is evidence that higher that individuals in forensic inpatient mental health samples are disproportionally exposed to ACEs, which may increase odds of chronic disease development. Despite this evidence, little research has examined the prevalence of ACEs and relationships between ACEs and chronic health conditions and risky health behaviors in this population. This study evaluated these variables using archival data collected as part of a large interdisciplinary study from a forensic psychiatric facility. A list of clients (N=182) meeting inclusion criteria was randomly generated and a comprehensive record review was used to ascertain ACE scores and rates of health-risk behaviors and chronic conditions. Findings offered support for increased rates of childhood adversity and a significant relationship between ACE scores and health-risk behaviors within a forensic inpatient mental health population. However, relationships between ACEs and chronic illnesses and health-risk behaviors and chronic illnesses failed to reach significance. The lack of significance in these relationships suggests that ACEs are less singularly predictive of chronic illness within this population and instead different factors may drive the development of chronic illness.

A recent review suggested that self-compassion promotes use of adaptive rather than maladaptive coping. Less is known about how self-compassion is linked to stress and coping in the context of a chronic stressor. Across two primarily female chronic illness samples, inflammatory bowel disease (N = 155) and arthritis (N = 164), a model linking self-compassion to lower stress through coping styles and coping efficacy was tested. Path analyses revealed significant indirect effects for adaptive coping styles (active, positive reframing, and acceptance), and negatively for maladaptive coping styles (behavioral disengagement and self-blame) in both samples. Findings suggest that the relative balance of adaptive and maladaptive coping strategies used by self-compassionate people is associated with better coping outcomes in the context of chronic illness.

Purpose: Despite a growing literature on the benefits of gratitude for adjustment to chronic illness, little is known about gratitude in medical populations compared to healthy populations, or the degree to which potential deficits in gratitude might impact quality of life. The purpose of the present study was to (1) examine levels of gratitude and quality of life in fibromyalgia patients and healthy controls and (2) consider the role of gratitude in explaining quality of life differences between fibromyalgia patients and healthy controls. Methods: Participants were 173 fibromyalgia patients and 81 healthy controls. All participants completed measures of gratitude, quality of life, and socio-demographics. Results: Although gratitude was positively associated with quality of life, levels of gratitude and quality of life were lower in the fibromyalgia sample relative to the healthy controls. This difference in gratitude partially mediated differences in quality of life between the two groups after controlling for socio-demographic variables. Conclusions: Our findings suggest that gratitude is a valuable positive psychological trait for quality of life in people with fibromyalgia. Interventions to improve gratitude in this patient population may also bring enhancement in quality of life.

The Stress and Coping Cyclical Amplification Model of Perfectionism in Illness posits, that in the context of a chronic illness, both perfectionistic strivings and concerns contribute to poor health outcomes. Similarly, person-centred models, such as the tripartite model of perfectionism, claim that high levels of both perfectionism concerns and strivings reflect an “unhealthy” perfectionism that takes a toll on well-being. To date there are few comparative tests of these models for physical and mental health outcomes in healthy versus chronically ill individuals. The aim of the current study was to investigate the implications of perfectionism for health by testing how within-person combinations of perfectionism varied in relation to health outcomes, and between fibromyalgia patients (n = 89) and healthy controls (n = 123). Supporting both models, within-person combinations of high perfectionistic strivings and concerns were associated with high stress and poor mental and physical health compared to other within-person combinations. These links were more robust for fibromyalgia patients compared to controls, and stress mediated the association with physical health outcomes only for the fibromyalgia patients. Findings support the value of taking a person-centred approach for understanding how perfectionistic strivings contributes to poor health in the context of chronic illness.

Emerging evidence indicates self-compassion can be beneficial for medical populations and for medical adherence; yet, research to date has not fully examined the reasons for this association. This study examined the association of dispositional self-compassion to adherence across five medical samples and tested the extent to which perceived stress accounted for this association. Five medical samples (total N = 709), including fibromyalgia, chronic fatigue syndrome, and cancer patients, recruited from various sources, completed online surveys. Self-compassion was positively associated with adherence in all five samples. A meta-analysis of the associations revealed a small average effect size (average r = .22, [0.15, 0.29]) of self-compassion and adherence and non-significant heterogeneity among the effects (Q (4) = 3.15, p = .532). A meta-analysis of the kappa2 values from the indirect effects of self-compassion on adherence revealed that, on average, 11% of the variance in medical adherence that was explained by self-compassion could be attributed to lower perceived stress. Overall, findings demonstrate that dispositional self-compassion is associated with better medical adherence among people with fibromyalgia, chronic fatigue syndrome, and cancer, due in part to lower stress. This research contributes to a growing evidence base indicating the value of self-compassion for health-related behaviours in a variety of medical populations.

The study investigated the association between body mass index (BMI) and depression based upon glycated hemoglobin levels (HBA1C) among United States veterans. Based on Bandura's social cognitive theory, a cross-sectional analysis examined the association between BMI and depression on HBA1C regulation, and if the interaction between BMI and depression affects HBAIC regulation among veterans. Multiple regression analysis was used to test the multivariate associations between depression and BMI on the outcome variable of HBA1C. Linearity, normality, and homoscedasticity were assessed using normal probability plots and residual analysis. Durbin-Watson statistics were used to test for autocorrelations, and variance inflation factor was used to check for multicollinearity. There was not a statistically significant difference between those who were depressed (Mdn = 32.76, IQR = 7.8) and those who were not depressed (Mdn = 33.27, IQR = 5.0) in terms of BMI (U = 774.0, p = 0.47). When depression, BMI, an interaction term for depression*BMI, and other predictor variables were entered into the regression model, these variables did not account for a significant increase in shared variance in HBA1C (Î?R2 = 0.17, F (14, 74) = 0.17, p = 0.37). Social change implications generated from this study include better resource utilization, improved quality of care, increased veteran satisfaction and improved veteran experience across the healthcare system. The findings from the study can be used to expand access to specialized services for chronically ill veterans, coordinate resources, better outcomes and facilitate seamless care coordination between mental health and primary care providers

Ways in which the implementation of the Patient Protection and Affordable Care Act (ACA) affect parents with chronically ill children are not well understood. The purpose of this phenomenographic study was to gain greater insight into the perceived experiences of parents of chronically ill children regarding implementation of the ACA in a southern state. Argyris's intervention theory provided the framework for the study. Face-to-face interviews were conducted with a purposeful sample of 12 female parents who are caregivers of chronically ill children. Data were analyzed and coded to identify categories and themes. Findings indicated that parents view physicians and policymakers as key actors in their communities to create more equitable services for parents of chronically ill children through the expansion of Medicaid services in southern state. Many participants did not perceive that the ACA had made significant changes to services received prior to its implementation. Findings may assist health care providers, insurance companies, legislators, and other policymakers to develop appropriate health care policies and interventions to lessen the financial burden experienced by parents of chronically ill children. Providing more support services that address the physical, emotional, and financial needs of parents may improve the health outcomes of their chronically ill children.

Informal caregivers have played a significant social and economic role in the care and treatment of individuals diagnosed with chronic illness. However, caregiving can have harmful effects on a caregiver's physical, psychological, and emotional well-being. Using caregiver stress theory as the theoretical framework, the purpose of this archival research was to determine the predictive relationship of stress in relation to caregiver quality of life for 309 selected cases. Correlational and hierarchical multiple linear regression analyses were used to examine the relationship between the independent variables and the dependent variable. The independent variables examined were environment and context, stressors related to the demands of caregiving, self-appraisal of ability to cope, and caregivers' knowledge and use of community and family resources. The dependent variable was the caregiver's quality of life. Findings showed that independent variables of environment and context (gender, age, marital status, education, employment status, income level) accounted for 14% of the variance in caregiver quality of life. The remaining independent variables (caregiver stressors, self-appraisal of ability to cope, and knowledge and use of resources) accounted for an additional 4% of the variance. The set of independent variables in this study collectively accounted for 18% of the variability in caregiver quality of life. Caregiver knowledge and use of resources had the strongest predictive relationship with caregiver quality of life. Researchers and practitioners may use the findings to assist in identifying antecedents to caregiver stress and the strongest predictors of caregiver stress, as well as in developing appropriate and efficient interventions and social support resources to meet caregivers' specific needs, reduce their stress, and promote and enhance their quality of life.

Thesis (M.Pharm) -- University of Limpopo, 2013 / Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.

The American older adult population is rapidly growing and projected to double by 2030. There is high proportion of completed suicides in later life subsequent to several biopsychosocial variables. Medical populations, particularly Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure (HF), have greater risk of depression, suicidality, and lower quality of life. Current geropsychology suicide research tends to focus on risk factors, a deficit approach. In contrast, the present study utilized a strength-based approach to study late life suicide by predicting life sustaining cognitions, reasons for living (RFL). This study explored the influence of physical health related quality of life (HRQOL) and depression on RFL in a sample of 75 depressed and chronically ill middle aged and older adults enrolled in a randomized clinical trial. The results indicate insignificant relationships between demographic variables (e.g. age, gender, and illness type) and reasons for living. Despite the statistically significant negative correlations between depression and physical and mental HRQOL at baseline and week five, only week five depression significantly predicted RFL (Β = -1.369, ΔR2 = .063, p= .034), after the effects of age and baseline depression were held constant. In conclusion, the present study supports integrative primary care modalities of treatment for late life depression and highlights the importance of incorporating protective factors in suicide risk assessments. Future research should consider utilizing population specific instruments and alternative medical and social variables.