Personal perception of chronic illness

To determine the effects of loneliness on illness perception in persons with a chronic disease. How an illness is perceived not only affects all dimensions of a person's life but also plays an important role in his/her coping with the complications and consequences of the disease. One of the factors that influence the illness perception is loneliness. The study is a descriptive study. The study sample included 206 individuals over the 18years of age, conscious, having had a chronic illness at least 1year, having no communication problems and agreeing to participate in the study after being informed about the study. Data were collected with the Personal Information Form, the Illness Perception Questionnaire and the University of California Los Angeles Loneliness Scale. The forms were administered to the participants in an unoccupied patient room, and the data were collected through face-to-face interviews. The results of the study revealed that individuals with a chronic disease perceived emotional symptoms accompanying the disease more intensely that they accepted their disease was a chronic one and that their personal control and treatment control of the disease were at a middle level. The mean score the participants obtained from the University of California Los Angeles Loneliness Scale was 38.49±11.15. There was a significant negative correlation between this mean score and the mean scores obtained from the following subscales consequences, treatment control, illness perception and emotional representations. In this study, it was concluded that the participants perceived their loneliness level as moderate and that their illness perception was negatively affected as their loneliness levels increased. The knowledge of clinical nurses about perception of patients with chronic illnesses and conditions affecting that perception will enhance compliance with the illness management or treatment strategies. Clinical nurses should observe residents closely for signs of depression and loneliness and support their sense of coherence to reduce emotional and social loneliness.

Frequent attenders are believed to represent a problem in Primary Care, with human, economic and social impact. The present study aimed to describe these patients' sociodemographic and pathological characteristics. A cross-sectional study with analytical component was conducted in the population of frequent attenders in a Portuguese Primary Health Care Practice, between January 2007 and December 2009, allocated to six General Practitioners. Sociodemographic characteristics as well as data related to physical and mental illness were collected from clinical records. Associations between variables were tested with χ-square and t-test. The top quartile of frequent attenders was compared with the remaining population. The adopted significance level was 0.05. Of the 582 individuals evaluated, with a mean age of 55.4 years (men 58.6 and women 54.3; p = 0.006), 85% had chronic physical illness and 42% had chronic psychiatric illness. In the upper quartile of frequent attenders was observed a higher prevalence of chronic psychiatric illness (p < 0.001), as well as multiple pathology (p = 0.01), when compared to the remaining population. Individuals with physical illness were older (mean age: 58.0 years vs 40.1 years; p < 0.001) while those with chronic psychiatric illness were younger (mean age 53.7 years vs 56.6; p = 0.035). It was drawn a profile of the frequent attender consistent with international literature, at a time when there are no studies in Portuguese Primary Care settings. Information and selection bias were detected and minimized. In order to discriminate between frequent attenders, the upper quartile was compared with the remaining population. Some features seemed to be more associated with frequent attendance, such as advanced age, low educational level and the presence of chronic psychiatric illness. The frequent attender of this Portuguese Primary Care Practice is a female, in the sixth decade of life, with low educational level, married or living as a couple, coming from a nuclear family, and often with chronic illness. Knowledge of these patients may allow the development of strategies that lead to more cost-effective health care services. This study shows some guidelines for studies on this important population.

Anxiety and depression are common among patients with chronic physical illnesses and have a significant impact on morbidity, quality of life, and health service utilisation. Psychological treatment of anxiety and depression has small to moderate efficacy in this group and is not commonly based on a model of causal mechanisms. A novel approach to understanding and improving mental health outcomes in physical illnesses is needed. One approach may be to explore the role of metacognitive beliefs which are reliably associated with anxiety and depression in individuals with mental health difficulties. The current systematic review aimed to evaluate the contribution of metacognitive beliefs to anxiety and depression across physical illnesses. Systematic searches were conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies published between 1997 and January 2019. 13 eligible studies were identified that in sum comprised 2851 participants. Metacognitive beliefs were found to have reliable, moderate, positive and significant associations with anxiety and depression symptoms across a range of physical illnesses. There appeared to be commonality and some specificity in the relationships. Negative metacognitive beliefs concerned with uncontrollability and danger of worry were associated with both anxiety and depression across all physical illnesses assessed, whilst more specific associations emerged for individual medical conditions where positive beliefs about worry, cognitive confidence and cognitive self-consciousness were unique correlates. Negative metacognitive beliefs of uncontrollability and danger significantly and positively predicted symptoms of anxiety and depression after controlling for factors including age, gender, disease factors and cognition (illness perceptions and intolerance of uncertainty). The results suggest that the metacognitive model of psychological disorder is applicable to psychological symptoms of anxiety and depression across a range of chronic medical conditions, implying that metacognitive therapy might be helpful in improving outcomes in multiple morbidities that involve poor mental and medical health.

It is a pleasure to comment on Qin and colleagues’ excellent work on suicide risk amongst patients hospitalized due to physical illness. The authors have made good use of the unique and detailed registration systems in Denmark to be able to investigate suicide risk in relation to physical illness across a broad range of illnesses. This kind of study may not be possible in most of countries, including many developed countries, which do not have such comprehensive databases for the whole population. The findings provide empirical evidence of the relevancy of suicide prevention amongst the physically ill. Furthermore, the authors have quantified the potential effect of suicide prevention by looking at the population attributable risk (PAR), which is an estimate of the suicide reduction if the risk can be removed. A 24% PAR estimate suggests that clinicians indeed could be an effective gatekeeper for preventing suicide in the patient population, although it is difficult if not impossible to remove or reduce the suicide risk amongst all patients with physical illness. The analysis of the study can be further enhanced if the age effect should be explicitly estimated. Suicide rate in men is about 2–4 times that in women 1. Usually, older males had a relatively higher rate 2. The presence of physical illness is also age and sex dependent. Chronic but not necessarily terminal illnesses are frequently found in people who die from suicide 3, 4 and these illnesses tend to be more common in old adults. This suggests that older men with physical illness would be a good target to prevent suicide. However, interestingly, the study shows a stronger effect of physical illness on suicide in females than males, as well as a larger PAR in women than men (32% versus 21%). This is in parallel to findings from a recent study based on data from UK primary care practices 5. The UK study also indicates that increased risk of suicide is confined to young female patients (<50 years) and older women with multiple physical diseases. Further studies are needed to identify sex/age groups of physically ill patients who demonstrate the greatest risk of suicide and potential for prevention. Furthermore, we feel that the role of mental illness on the association of physical illness with suicide deserves some further discussions. First, the study shows that the association weakens to some extent after controlling for history of contact with psychiatric services, including both outpatient and inpatient cares (unadjusted IRR = 2.13 versus adjusted IRR = 1.65). This attenuation is most prominent amongst the groups with likely the most severe illnesses, indicated by multiple hospitalizations and multi-morbidity. This may be partly due to the bias where more hospitalizations or more medical conditions give physicians more opportunities to detect psychological symptoms and refer the patients to psychiatric services. Second, perhaps more importantly, mental disorders may be a moderating factor on the pathway from physical illness to suicide or a confounding factor, which is associated with both physical illness and suicide. Pain, disability and physical disintegration caused by physical illnesses, as well as the traumatic experiences associated with the diagnosis of serious illnesses with poor outcomes such as cancer 6, can lead to emotional distress and depression and thus increased risk of suicide 4. The UK study based on primary care data shows increased risk of suicide amongst physically ill patients but the association can be mostly explained by clinical depression 5. One possible way to further investigate the role of mental illness on the link between physical illness and suicide is to examine the temporal relationship between hospitalizations due to physical illness and the contact with psychiatric services. Third, although the study shows evidence for an association of physical illness with suicide even after adjusting for psychiatric history, there is still possible residual confounding because many people with mental illness did not seek medical help. If this is substantial, the PAR would be an overestimate. Finally, the study shows that hospitalizations due to ‘symptoms, signs and abnormal conditions’ are associated with two times increased risk of suicide and contribute to a substantial proportion of PAR as they are relatively common amongst suicide cases (19%). These conditions may indicate undiagnosed psychological symptoms or disorders, as suggested by the authors, and the inclusion of them would lead to an overestimated PAR for physical illness. In view of the exceptional high risk for inpatients (IRR = 13.4) and patients discharged within 7 days (IRR = 10.7), it might be tempting to develop a suicide risk or depression screening tool for these groups of patients based on these results 4. To address excess risk of suicide amongst these patients, prevention strategies can also be developed to improve environmental safety within the hospital compound and the continuity of care after discharge in the first week. Prevention effect could also focus on patients with multiple hospitalizations and multiple comorbid physical illnesses, which were shown to be associated with a greater increase in suicide risk than patients with less episodes of hospitalizations and comorbid conditions in the study. Education and training in the detection and management of depression and suicide risk for a wide range of specialist clinicians treating patients with different physical illnesses may be beneficial, as the study showed increased risk of suicide across different categories of diseases examined. Clinicians should adequately treat pain and depression as well as pay attention to the safety of prescribed medications, such as analgesics and antidepressants, as they may be used in suicidal attempts. A psychiatric liaison team may also effectively identify patients with suicidal risk. More studies are needed to investigate risk and protective factors associated with suicides by patients with physical illness and a better understanding of these factors will inform prevention strategies. These factors may be context-specific as the patterns of patient care practices vary across different health care systems in different societies. Studies in different health care systems are therefore needed to inform context-specific prevention strategies. Hence this is a wake-up call for clinicians that a holistic and multi-sectoral approach to patient care should be adopted. The compartmentalization and disconnection in medical care services is a barrier to the promotion of holistic care. Treating physical illness is important as it should be; however, neglecting psychological well-being is a serious concern. Appropriate psychiatric liaison care is also of great importance. To improve safety in hospital environments would involve collaborations with the hospital management team. For the continuity of care after discharge, it requires much more collaborative efforts working with relevant stakeholders in patients’ recovery process, for example, family members, liaison hospital staff and follow-up services. It is ironic if expensive cares are given to patients to treat their physical illnesses, and then they choose to take their own lives because of the distress, pain or fear associated with physical illness or the treatment. Suicide prevention is everyone's business and certainly clinicians would be effective gatekeepers. No conflict of interest was declared.

DEPRESSION AND CHRONIC PHYSICAL ILLNESS ARE IN RECIPROCAL RELATIONSHIP WITH ONE ANOTHER: not only do many chronic illnesses cause higher rates of depression, but depression has been shown to antedate some chronic physical illnesses. Depression associated with physical illness is less well detected than depression occurring on its own, and various ways of improving both the detection and treatment of depression accompanying physical illness are described. This paper is in four parts, the first dealing with the evidence for depression having a special relationship with physical disorders, the second dealing with detection of depression in physically ill patients, the third with the treatment of depression, and the fourth describing the advantages of treating depression among physically ill patients.

Nursing care is a series of professional activities provided directly to clients with a holistic approach that encompasses physiological, psychological, social, and spiritual aspects. This approach is especially important for inpatients in the Intensive Care Unit, as disruptions in one dimension can affect other dimensions. This study aims to analyze the implementation of nursing care by nurses on the psychological, social, and spiritual aspects of inpatients in the Intensive Care Unit of Kediri Regency Hospital. This study used a quantitative method with a descriptive design. The sampling technique used was total sampling with respondents from all nurses in the Intensive Care Unit. Data collection was conducted through structured interviews using questionnaires in November–December 2024. Data analysis was conducted univariately and presented in the form of frequencies and percentages. The results showed that the implementation of nursing care in the psychological aspect was in the good category (100%). In the spiritual aspect, the implementation was in the good category at 42%, sufficient at 52%, and lacking at 6%. Meanwhile, the implementation of nursing care in the social aspect showed a good category at 84%, sufficient at 13%, and lacking at 3%. The conclusion of this study shows that the implementation of nursing care by nurses in the Intensive Care Unit has been running well in the psychological and social aspects, but still needs improvement in the spiritual aspect to realize holistic and quality nursing care.

The whole human education includes: physical, spiritual, intellectual, sosial, moral and sexual aspects. Genrrally, the whole human education is seen as fostering physical and spiritual aspects. Gravissimum Educationis says that Christian education is also the whole human education in which the implementation is based on the spirit of gospel and Jesus Christ. Through Christian education, the students are provided various knowledges and preverences of life so that, they can participate to realize the public welfrare and the ultimate goal of salvation.&#x0D; The development of a more and instant time has led to various aspects of life, including the process of education.The succes meaning of an education that should be emphasize the process, has sifted in meaning. The shifting meaning is evident from the efforts of the school or students who persue only academic values in a report of learning outcomes. In this regard, SMAK St. Augustinus Kediri, is one of Catholic educational institutions that must provide the whole and Christian human education. The issues that arise are: How is student's understanding on the wholeand Christian human education?How is the whole and Christian human education carried at SMAK St. Augustine Kediri? Based on the problems, the aim of this study is to describe students' understanding on the whole and Christian human at SMAK St. Augustinus Kediri and describe the implementation of thewhole and Christian human educationat SMAK St. Augustine Kediri.&#x0D; Through qualitative research, interviews were conducted to 10 respondents of grade XII SMAK St. Augustine Kediri. The conclusion of the study are: first, students understand the meaning of the whole human education. Second, students understand the meaning of Christian education. Third, wholeand Christian human education has almost been implemented at SMAK St. Augustinus Kediri, but there are still some things that need to be improved.

Compliance in adolescents with chronic diseases: a review

BackgroundPeople with comorbid mental and physical illness (PI) experience worse health, inadequate care and increased mortality relative to those without mental illness (MI). The role of gender in this relationship...

The study explored the associations between characteristics (e.g., type of illness, years of illness, time spent on managing illness related activities, and the extent of physical impairment) of maternal chronic illness, household income, demands of illness experienced by the patients and their families, and their children’s academic achievement. One hundred and fifty mothers who were diagnosed with chronic physical illness (e.g., diabetes, cancer, multiple sclerosis, HIV/AIDS, etc.) participated in this study by completing a questionnaire asking their medical condition, experienced demands imposed by their illness, as well as their children’s grades in school. The results indicated that years of illness, extent of physical impairment, time spent on managing illness related activities, and household income were significantly associated with the demands imposed by the mothers’ physical illness. Household income was found to be the most robust predictor of children’s grades in the sample of chronically ill mothers. Implications and limitations of the present study will be discussed.

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.

Background There has been a reported rise in the number of people with chronic illness (also referred to as long-term disease) in the Western world. One hundred million people in the United States have at least one chronic condition and in the United Kingdom (UK) as many as 17.5 million adults may be living with chronic disease. New models of care have been developed which recognise the complexities of managing care where there is overlap between the wider community, the health care system and provider organisations, for example, the Chronic Care Model and the Expert Patient Programme. These new models herald a shift away from the idea of chronically ill patients as passive recipients of care towards active engagement, in partnership with health professionals, in managing their own care. Partnership, ideally, involves collaborative care and self-management education. This may support self-care alongside medical, preventative and health maintenance interventions. In this context the nature of the patient-practitioner consultation in promoting self-care takes on a new importance. Objective The overall objective of the review was to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Specifically the review sought to determine: What is the effectiveness of the patientpractitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how ‘effectiveness’ is defined in this context by patients and different practitioners? Inclusion Criteria Types of participants The review focussed on self-caring adults aged nineteen years and older living in the community, with a physical chronic illness, and not currently being treated as an in-patient. For example, people with diabetes, asthma, arthritis, coronary disease, lung disease, heart failure, epilepsy, kidney disease and inflammatory bowel disease. Since patients meet various professionals in a variety of community settings regarding their care, a practitioner in this review included doctors (physicians and General Practitioners), nurses, nurse specialists, dieticians, podiatrists and community health workers. Types of outcome measures A variety of outcomes measures was used to evaluate effective self-care management. These included physiological measurements such as: HbA1c, blood pressure, body weight, lipids; lifestyle measurements, for example physical activity; and self-care determinants such as knowledge, attitude; and self-care behaviours regarding, for example, diet and physical exercise, and medication. The outcome measures used to explore the meaningfulness of the patient-practitioner encounter, concerned patients’, physicians’ and nurses’ views and perceptions of selfcare management and support. Types of studies The review considered all types of quantitative and qualitative evidence regarding the patient-practitioner encounter where self-care in chronic illness was the focus. The quantitative studies reviewed included systematic reviews, randomised controlled trials (RCTs), quasi-experimental studies, and survey studies. Qualitative studies reviewed included interview designs, vignette technique, qualitative evaluation, grounded theory, and exploratory descriptive design. Search Strategy The search sought to find both published and unpublished studies between 1990 and 2005. The year 1990 was deemed appropriate since it precedes the development of the Chronic Care Model in which self-management support for people living with chronic illness is heralded as an important part of care-management. An initial search of CINAHL and MEDLINE databases was undertaken to identify appropriate search terms regarding self-care and chronic illness. A search strategy was then developed using all identified MeSH headings and key words and the following databases were searched: - Ovid CINAHL; Ovid MEDLINE (R); Ovid EMBASE; Ovid EBM Reviews (CDSR, ACP Journal Club, DARE, CCTR); ASSIA; SIGLE; TRUNCATED AT 600 WORDS.

Atrial fibrillation (AF) is the most commonly seen arrhythmia in clinical practice. At present, few studies have been conducted centering on depression and anxiety in AF patients. Our aim in this systematic review is to use the relevant literature to (1) describe the prevalence of depression and anxiety in AF patients, (2) assess the impact that depression and anxiety have on illness perception in patients with AF, (3) provide evidence to support a hypothetical connection between the pathophysiology of AF and depression and anxiety, (4) evaluate the benefit of treatment of AF on depression and anxiety, and (5) give insight on medically managing a patient with AF and concomitant depression and anxiety.

IntroductionHematological diseases represent a diverse disease group ranging from benign to life-threatening conditions, with hematological malignancies being a major cause of mortality in the population worldwide. Although most hematological diseases require ongoing medical care making these conditions even more difficult for patients to endure. Since these diseases can pose many challenges by causing symptoms and limitations in various aspects of daily life, health-related quality of life (HRQoL) is a crucial aspect of their healthcare. Different dimensions of health-related quality of life are influenced by several psychological factors, including illness perception, stigmatization, and optimism: a more positive illness perception, along with optimism and reduced stigmatization, can contribute to a better HRQoL among hematology patients.ObjectivesSince hematological diseases often cause serious life changes, the current study aimed to explore the direct and indirect effects of illness perception on health-related quality of life among hematology patients in Hungary, including stigmatization and optimism as possible contributors.MethodsIn this cross-sectional study, 96 hematology patients (mean age = 56.45 years; SD = 15.55 years; 43.8% female) completed a self-administered survey including the following instruments: EORTC Quality of Life Scale, Brief Illness Perception Questionnaire, Stigma Scale for Chronic Illness, Revised Life Orientation Test.ResultsBy creating two pathway models, illness perception had significant indirect effects on physical functioning (β = -.205, p < .05) through role and cognitive functioning while emotional functioning had significant indirect effects on social functioning (β = .369, p < .01) through illness perception and stigmatization, both effects moderated by optimism. After controlling for other factors, both illness perception and emotional functioning directly influenced physical and social functioning, respectively.ConclusionsOur study supports previous research on the direct and indirect effects of illness perception on HRQoL. Based on our data, more optimistic illness perceptions and greater emotional functioning improve hematology patients’ health-related quality of life by facilitating an unbiased understanding of the disease. Optimism serves as a potential moderating mechanism by positively altering indirect effects. Healthcare professionals need to optimize patients’ illness perception to improve physical and social functioning.Disclosure of InterestH. Kiss Grant / Research support from: This work was supported by the New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund, #ÚNKP-22-4-SZTE-301., V. Müller: None Declared, K. Dani: None Declared, B. Pikó: None Declared

More people with an intellectual disability are now living to older age and there is a paucity of information about this group of people. Mental illness is 2-3 times more prevalent in people with an intellectual disability than in the general community; however, this often goes undiagnosed and undetected. Additional issues complicate assessment if the person is also ageing. Little is known about the prevalence and nature of mental illness in this group of older people. Instruments used to assist in the diagnosis of mental illness in the general community are not suitable for use with individuals who have an intellectual disability. The Developmental Behavioural Checklist for Adults (DBC-A) (Mohr, Tonge & Einfeld, 2005) is a well established screen for psychopathology; however, it has no standardised norms and has not been specifically validated for older adults. Lack of knowledge and inadequate assessment processes can result in inappropriate service delivery and therefore reduced quality of life for older people with an intellectual disability and their carers. The general aim of the research was to contribute knowledge about older people with an intellectual disability and more specifically to investigate their mental health. In addition, the validity of the DBC-A for use with older adults was examined. An epidemiological study of adults aged 55 years and older, who lived in representative areas in South Australia, and who were registered with intellectual disability service agencies, were surveyed. Familiar informants completed a questionnaire booklet (see Appendix A). The Adaptive Behaviour Dementia Questionnaire (ABDQ) (Prasher, Farooq & Holder, 2004) and, for a subset of the participants, the Dementia Screening Questionnaire for Individuals with Intellectual Disability (DSQIID) (Deb, Hare, Bhaumik et al., 2007a) were also completed (see Appendices F and G). There was a participation rate of 91.7% and participants’ ages ranged from 55-86 years, the majority being males (56.6%), except in the oldest cohort. Those aged 55-64 years appears to differ from those who are older and younger. They have more severe intellectual impairments, more chronic health conditions, they are less likely to be engaged in activities, and have fewer relationships. Those older than 65 years are more similar to older people without an intellectual disability except that more live in nursing homes or larger congregate care settings. Standardised normative data was established for the DBC-A for older people. The DBC-A profile showed age-associated decline in psychopathology; however, the intensity of behaviours was higher in older people with more severe cognitive impairment. Significant psychopathology was found in 16% of older adults. There were no gender differences but those with a moderate level of intellectual disability had the highest rates. Being younger, having fewer hours in activity, living in large congregate care and significant life events were all risk factors. Rates of dementia of between 5-7% were found using the ABDQ, DSQIID and respondent report. A dementia screen using items from the DBC-A (DBC-A Dem) identified almost double that number. There was no association between age and dementia status in this study, which differs from other research, as does the lack of relationship between having Down syndrome and dementia status. The results of this study confirm a picture of differential mortality and the presence of a healthy survivor cohort who have fewer chronic health problems and are more likely to have a mild level of intellectual disability. Although there is an age-related decline in the prevalence of mental illness, rates are still one and a half times more than older people who do not have an intellectual disability. With minor amendments, the DBC-A is a valid screening instrument for use with older people with an intellectual disability. It can record changes in a wide range of emotional and behaviour disturbances including those that may affect older people, including dementia. When used with other DBCs for children and adolescents (Einfeld & Tonge, 1995) it provides a simple and familiar way to record psychopathology throughout the lifespan. This offers clinicians, researchers and service providers a means to monitor and maintain the mental health and well-being of older people with an intellectual disability.