The goal of this study was to examine differences in the psychological characteristics of patients admitted to the hospital for acute or chronic Myocardial Infarction (MI) or Unstable Angina (UA). Depression, anger, anxiety, curiosity, defensiveness, social support, and coping were evaluated for 165 patients (86 MI and 79 UA), who were tested on the Cardiology Stepdown Ward of Tampa General Hospital. The following psychological measures were administered to these patients: the Beck Depression Inventory (BDI), the State-Trait Anger Expression Inventory (STAXI-2), the Rationality/Emotional Defensiveness (R/ED) Scale, the Adult Form of the Coping Responses Inventory (CRI-Adult), the Interpersonal Support Evaluation List (ISEL), the Illness Perception Questionnaire (IPQ), the State-Trait Personality Inventory (STPI), and the Structured Clinical Interview (SCID-I) for the DSM - IV. Significantly more chronic patients than acute patients met criteria for depression as measured by the SCID following admission to the hospital, and more UA than MI patients also met these criteria. However, no differences were found between the acute and chronic MI and UA patients two weeks prior to admission. Results of this study also indicated that chronic patients and UA patients reported a greater frequency of illness symptoms and tended to cope with their heart disease through avoidant strategies. Chronic patients endorsed higher levels of state and trait anger compared with acute patients, and UA patients were less likely to believe that their illness could be cured or controlled (Control of Cure) than MI patients. Based on the results of this study, it appears that avoidance coping may be an insufficient strategy for addressing negative emotions of chronic patients and UA patients. In addition, perceived lack of control over the success of treatment may be related to depression for UA patients. These findings have important implications for the development and implementation of interventions designed to address perceived control over treatment effectiveness and coping skills for negative emotions in the treatment and rehabilitation of cardiac patients.

Treatment of head and neck cancer with radiation therapy is associated with adverse side effects to the oral cavity and surrounding areas. These complications include mucositis, mucosal fibrosis and atrophy, salivary gland dysfunction, increased risk of dental caries, increased susceptibility to infections, tissue necrosis, taste dysfunction, and muscular and/or cutaneous fibrosis. The often permanent nature of the radiation-induced damage necessitates the maintenance of a strict oral care program, involving frequent flossing and brushing in addition to daily fluoride applications, for the rest of the patient's life. An additional concern among patients with head and neck cancer is the use of tobacco and alcohol. Both are known risk factors in the development of head and neck cancers and failure to abstain from either after diagnosis increases the risk for relapse and development of secondary cancers. The present study was a longitudinal investigation of several factors that may influence patients' consistency in following their prescribed oral care program and abstaining from alcohol and tobacco use, including, but not limited to, patient satisfaction with the doctor-patient communication, patient coping, and patient illness perceptions. The study examined an integrative model seeking to explain patient adherence to the oral care regimen as well as tobacco and alcohol use. While results were inconclusive with respect to the model, there were several interesting findings, which were consistent with previous literature examining doctor-patient communication and illness perceptions among other cancer populations. Results from this study suggested that both satisfaction with doctor-patient communication and coping play an important role in forming patients’ illness perceptions. Furthermore beliefs about the severity of oral complications emerged as a predictor of oral care at follow-up. / text

This thesis used attachment theory and the common sense model of illness as theoretical backgrounds to examine the mechanisms that contribute to the quality of the support seeking behaviour and social interactions between patients with type 2 diabetes and their partners. Specifically, this thesis examined actor and spouse effects of working models of attachment on health outcomes, and illness perceptions on health outcomes for both patients and partners. Furthermore, it determined if support seeking, supportive interactions, and negative interactions mediated between the attachment and health outcomes and illness perception and health outcomes. At study entry, 70 patients with type 2 diabetes and their partners completed measures on attachment, illness perceptions, support seeking, receipt of supportive interactions and of negative interactions, satisfaction with support received, and health outcomes. Health outcomes included psychological distress and physical health for patients and partners, and diabetes well-being for patients only. Six months later, participants again completed measures on supportive and negative interactions, satisfaction with support received, and health outcomes. The data were examined both cross-sectionally (including mediational analyses) and longitudinally. The cross-sectional analyses revealed a number of actor and spouse effects in the relationships between attachment and health outcomes, and illness perceptions and health outcomes. Patients who scored higher on attachment-anxiety experienced higher levels of psychological distress and lower levels of diabetes well-being. Also, the partners of these patients experienced higher levels of psychological well-being. Furthermore, covert support seeking behaviour and negative interactions were found to be significant mediators between patient attachment-anxiety and patient psychological distress and diabetes well-being. In addition, support satisfaction mediated the relationship between patient attachment-anxiety and patient psychological distress. Illness perceptions, specifically timeline cyclical perceptions, were also shown to be related to health outcomes, and receipt of negative interactions. Patients and partners who scored higher on timeline cyclical experienced higher levels of psychological distress. Also receipt of negative interactions mediated the relationship between timeline cyclical and psychological distress. Some significant changes over time found when the data were examined longitudinally. For example, patients who scored higher on attachment-anxiety at study entry experienced higher levels of psychological distress over time, and had a partner who also experienced higher levels of psychological distress over time. In addition, partners who scored higher on personal control and who had a spouse (patient) who scored higher on timeline cyclical at study entry experienced higher levels of psychological distress overt time. Taken together, both the cross-sectional and longitudinal findings emphasize the contribution of the partner and his or her interactions with the patient to patient well-being. In the same manner, the results also highlight the effect of the patient’s illness on the partner’s well-being. These findings have important practical implications, especially for practitioners who aim to design intervention to help patients and their partners better adapt to the patient’s illness.

Background: Intra-articular corticosteroid injections (IACI) are a commonly used treatment for painful knee osteoarthritis (OA). Response to treatment varies the reason for which is unclear. Further there are no data concerning the impact of accuracy of injection and psychological factors including illness perceptions, pain catastrophizing and depression on outcome following IACI.Objectives: i) to undertake a systematic review looking at predictors of response to IACI in patients with symptomatic knee OA and, ii) to determine the role of psychological factors and accuracy of injection in predicting response to IACI.Methods: A systematic review was conducted using electronic databases for randomised trials and observational studies looking at predictors of response to IACI in knee and hip OA. An observational study of 141 consenting patients (105 primary OA and 36 secondary OA in the context of well controlled rheumatoid arthritis) receiving routine IACI as part of clinical care for knee OA was conducted including baseline assessment and outcome assessments at 3 and 9 weeks. Response was defined as at least 40% reduction of pain from baseline, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Assessment included ultrasound (US) for features of synovial inflammation), radiographs, and assessment of psychological factors including the revised illness perception questionnaire (IPQR). Accuracy of injection was assessed using US. Characteristics of responders and non-responders to IACI at 3 and 9 weeks were determined using univariate statistics and significant factors entered into logistic regression models. Results: The systematic review found no consistent evidence for any disease or non-disease related predictor of response and no systematic exploration of the effects of psychological factors or accuracy of injection on treatment response. In the observational study, 83 (53%) of 141 subjects were responders to IACI at 3 weeks and 56 (44%) at 9 weeks. In univariate analysis, responders to treatment had higher scores for the IPQR domain treatment control and lower scores for IPQR consequences, depression and pain catastrophizing at both 3 and 9 weeks. Physical and patient related factors, including accuracy of injection and US features, were not associated with outcome, with the exceptions of higher baseline pain and previous experience of injection being associated with non-response at 9 weeks. In multiple regression, treatment control was the only independent predictor of response at 3 weeks. At 9 weeks, treatment control, consequences and depression were independent predictors of treatment outcome. Conclusion: In this observational study illness perceptions and depression predicted the outcome of IACI at 3 and 9 weeks. By contrast, physical factors including accuracy of injection did not influence outcome. Further work is needed to replicate these findings and elucidate mechanisms for these effects.

Background: Previous research indicates that for some individuals, quality of life (QoL) post-cardiac surgery (CABG or PTCA ) declines from pre-surgery levels. Using the framework of Leventhal's Common-Sense Model, this longitudinal study examined the associations between patients' illness perceptions and coping strategies, their QoL, attendance at cardiac rehabilitation and lifestyle changes. It was hypothesised that a more negative profile of illness beliefs (weaker control beliefs, belief in more severe consequences, poorer understanding of the condition, and negative emotional representations) together with the use of more emotional coping strategies would be associated with poorer QoL. It was also hypothesised that attendance at cardiac rehabilitation would be associated with greater control beliefs, more severe consequences and a causal attribution of lifestyle. Sample and Methods: 113 patients (93 male, mean age 66 (8.93) who were about to undergo cardiac surgery were recruited from two hospitals. Questionnaire measures of illness perceptions (IPQ-R), coping (CHIP) and cardiac-specific QoL (MacNew) were administered at four time points: pre-surgery, post-surgery, post cardiac rehabilitation, and one-year follow up. Data on attendance at rehabilitation and health behaviours were collected via hospital records and patient report. Results: The best predictors of QoL were not cognitive representations of the cardiac problems, but negative emotional representations and associated emotion-focussed coping strategies, implying that an emotion-regulation intervention could be targeted to improve outcome. The predictive ability of initial QoL on QoL at later stages implies this might be best introduced pre-surgery. Having less severe consequence beliefs prior to surgery predicted greater attendance at cardiac rehabilitation. A better understanding of the cardiac condition predicted attendance at cardiac rehabilitation. There was no evidence of change in lifestyle post-rehabilitation.Discussion: The findings that emotional representations of cardiac problems and the use of emotion focussed coping strategies were predictors of quality of life suggest that interventions to foster adaptive emotion regulation may improve outcome in these patients. Findings with respect to attendance at rehabilitation varied somewhat from the previous literature, possibly because the present study sampled patients who were having elective surgery, rather than those who had recently had a heart attack. The importance of studying defined populations and also the issue of when measures are obtained in relation to cardiac events were also highlighted.

Previous studies have examined how individuals who are diagnosed with mental (McManus, Stubbings, & Martin, 2006) or physical illness (Duggan, Medway & Bunke, 2004) are stigmatized but no study has directly compared how students perceive a person living with a mental versus a physical illness. The present study explored whether participants desired greater social distance from a student who 1) suffered from schizophrenia, 2) was in remission for cancer, relative to a 3) healthy student. The study also investigated whether participants could objectively evaluate the identical written work of these students differently when they are described according to their illnesses. It was hypothesized that college students would desire the greatest social distance from students with mental illness and the least amount of social distance from students described as healthy. In addition, it was hypothesized that college students would evaluate the work of a healthy student more positively than a student who has a chronic mental or physical illness. It was also hypothesized that college students would evaluate the work of a student described as suffering from chronic physical illness more positively than the work of the student described as having a chronic mental illness. For the procedure, participants were given a vignette about a fictional student and were randomly assigned to a vignette that described the student as 1) suffering from schizophrenia which was controlled by medication, 2) in remission for cancer, or 3) healthy. The participants were then asked to evaluate this student's essay using a grading rubric. Participants then completed the Social Distance Scale (Penn, Guynan, Daily, & Spalding, 1994). Finally, students reported demographic information about themselves. A one-way between subjects Multivariate ANOVA was performed on the data, and significant differences were found among conditions for the SDS but not for the scores on the student's essay. The results suggest that the students were able to remain objective while grading the student's assignment, but required greater social distance from a student with a mental or physical illness.

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- / Despite the rapidly ageing population and a predicted sevenfold increase in the prevalence of dementia in minority ethnic communities, people from these communities remain under-represented in specialist dementia services. Leventhal’s Model of Self-Regulation suggests perceptions ofillness facilitate help-seeking behaviours such as the use of services. Thisscoping exercise makes use of the model to explore perceptions ofdementia in British Indian, African and Caribbean, and East and CentralEuropean communities in the United Kingdom. Between August 2013and April 2014, culturally specific dementia awareness roadshows wereattended by people living with dementia, carers and members of thepublic. During the roadshows, 62 British Indian, 50 African and Caribbean, and 63 East and Central European attenders participated indiscussion groups and a dementia knowledge quiz. Thematic andframework analysis were conducted on the discussion group data. Threemain themes are presented: Perceptions of dementia, awareness ofdementia in the wider family and community, and awareness and use ofservices. The findings suggest that although groups attributed a biologicalbasis for memory loss, a number of misconceptions prevailed regardingthe cause of dementia. Groups also made use of religion, as opposed tomedical healthcare services, as a form of personal and treatment control. Seeking help from healthcare services was hindered by lack of awarenessof services, and culturally specific barriers such as language. The findingshave a number of implications for policy and practice including thedevelopment of public health interventions and the need to focus further on reducing barriers to accessing services.

Le Plan Alzheimer 2008-2012 a mis en lumière les représentations négatives de la maladie d’Alzheimer et leurs conséquences sur la mise en place de l’alliance thérapeutique. Les travaux récents montrent également l’impact de ces représentations chez des personnes exprimant une plainte mnésique subjective ou présentant des troubles cognitifs légers sans démence. L’objectif de ce projet était de mettre au point un questionnaire évaluant les perceptions des troubles mnésiques et d’analyser ces perceptions dans une population en cours de démarche diagnostique. Nous avons recruté des patients seuls ainsi que des dyades de patients et d’aidants. Nous cherchions à étudier l’influence des perceptions des troubles mnésiques sur l’humeur, les stratégies de coping et la qualité de vie. Les résultats mettent en lumière les facteurs d’entrée dans une démarche de soins ainsi que l’influence significative des perceptions des troubles mnésiques du patient sur ses stratégies de coping et sa qualité de vie. Nous avons également étudié l’influence des perceptions des troubles mnésiques dans une approche dyadique (patient et aidant). Ces analyses dyadiques montrent l’influence des perceptions du patient sur l’humeur et les stratégies de coping de l’aidant et l’influence des perceptions de l’aidant sur la qualité de vie psychique du patient. Ce travail de recherche souligne l’importance de mener des études longitudinales sur l’évolution des perceptions des troubles mnésiques avant et après l’annonce diagnostique afin de proposer des pistes de prise en charge adaptée aux patients et aux aidants. / The 2008-2012 Alzheimer French National Plan has highlighted the negative representations of Alzheimer's disease and their consequences on therapeutic alliance. Recent works also shows the impact of these representations in people with subjective memory complaint or with mild cognitive impairment.This research aims to develop a questionnaire evaluating the perceptions of memory disorders and to analyze these perceptions in a population engaged in a diagnosis process. We recruited a group of patients and a group of patient/caregiver dyads.We investigated the influence of subjective perceptions on mood, coping strategies and quality of life. Participants had to express a memory complaint and to start a diagnosis process at the Memory Center of Nancy. The results highlight the factors to beginning a diagnosis process and the significant influence of perceptions of memory disorders on coping strategies and quality of life. Actual level of cognitive disorders do not seem to be related to perceptions of memory disorders. We also studied the influence of perceptions of memory disorders in a dyadic approach (patient and caregiver). These dyadic analyzes show the influence of patient's perceptions on caregiver's mood and coping strategies and the influence of caregiver's perceptions on patient's quality of life. This research emphasizes the importance of conducting longitudinal studies on the evolution of perceptions of memory disorders before and after the diagnosis, in order to propose psychosocial interventions adapted to patients and caregivers