Factors Affecting the Relationship Between Stress and Anxiety in Critically Ill Patients: A Partial Least Squares Structural Equation Modeling Approach

This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients’ mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients’ illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels.

How I see is how I feel. Identification of illness perception schema and its association with adaptation outcomes in multiple sclerosis – a 5-year prospective study

The aim of the study was to assess the role of illness perception in adaptation to chronic disease among patients with relapsing-remitting multiple sclerosis (RRMS). The differences between the obtained configurations of the illness perception components during four measurements and the model of predictions of the values of adaptation indicators, i.e. depression, anxiety and quality of life during subsequent measurements, were analyzed. Illness representation was assessed at baseline via the Illness Representation Questionnaire–Revised. The adaptation indicators–anxiety, depression (measured by HADS) and quality of life (measured by MSIS-29) were measured at baseline and three more times over a five-year period. The k-means cluster analysis (with two-way and repeated measures ANOVA) was conducted in a group of 90 patients (48.89% women and 51.11% men). Subsequently, the mean values of depression, anxiety, physical and psychological quality of life were compared between the clusters using the Kruskall-Wallis test. Finally, a cross-lagged panel modeled for HADS and MSIS-29 subscales in each measurement occasion (T1-T4). Three different illness perception clusters (Anxious, Realistic and Fatalistic Illness Perception named AIP, RIP and FIP) were composed which differentiated the depression, anxiety, quality of life level and age. FIP showed the lowest adaptation outcomes with small differences between AIP and RIP. It was also significantly characterized by the highest age. The positive adaptation indicators were related to the RIP cluster. The model presented rather satisfactory fit (χ2(48) = 81.05; CFI = .968; TLI = .925; SRMR = .050) with slightly inflated RMSEA = .087 (90%CI .053-.120). Based on initial measurements of individual characteristics, it was possible to predict the functioning of patients after several years. For patients with AIP, the covariance of anxiety and depression was significant, for patients with RIP–depression and anxiety, and for patients with FIP–depression. In addition, each of the variables was a predictor of subsequent measurements in particular time intervals, illustrating the dynamics of changes. Results highlight that illness perceptions formed at the beginning of RRMS are important for the process of adaptation to the disease. Moreover, they showed the differences between the adaptation outcomes supporting the idea that a cognitive representation might be important for the level of psychological functioning.

Do patients’ resilience and subjective illness representation predict the outcome of a routine inpatient treatment program of major depressive disorder?

Adopting a personalized medicine approach beyond genetic/epigenetic profiling within psychiatric diagnostic and treatment is challenging. For the first time, we studied the influence of two patient resources (resilience and illness representation) on the success of an inpatient treatment of major depressive disorder (MDD). Using a 5-week observational real-world-study, the treatment- success was measured by the difference between the subjective depression- severity (according to the German short form of Beck’s Depression-Inventory) at baseline (i.e., days four to six post-admission) and study- endpoint. In the intention-to-treat sample (n = 60, 47.3 ± 12.8 years old; 58% females), the patients’ illness representation [measured by the “Krankheitskonzeptskala” (KK)] did not predict their treatment- success. The KK-dimension ‘trust-in-doctors’ was associated with resilience but not with the treatment-success. Albeit, the patients’ resilience (determined by Resilience- Scale, 11-item-version (RS-11)) negatively predicted their positive treatment- success (b = − 0.09, p = 0.017, f2 = 0.11). This influence of resilience on treatment- success was completely mediated by the baseline-depression- severity. This means, patients with low resilience reported high baseline-depression- levels which predicted a significant positive treatment- success. And, patients with high resilience reported low baseline-depression-levels which predicted no relevant or even negative inpatient treatment-success. The latter “high-resilience”- group (n = 27) was especially interesting. Remarkably, these patients appeared to have experienced within the first four-to-six inpatient treatment-days an “early sudden gain” against their considerable MDD- burden that initially had led to their admission. Thus, a stronger resilience might serve as a proxy of the development of an early MDD-relief as well as of lower baseline-depression- levels. Further studies are warranted to support the value of a patient’s resilience to predict his treatment response and inpatient treatment duration.

Self-Efficacy Effects of Maccabi Telcare Center Diabetes Mellitus Intervention: Do Men and Women Benefit Equally?

Background and PurposeA growing body of evidence points to physiological and psychological gender differences in the manifestation and treatment of type 2 diabetes mellitus. This study is part of a large-scale, prospective trial investigating the effects of Maccabi Telecare Center (MTC) interventions on self-efficacy. Here, we focus on the effects of gender on diabetes self-efficacy related to depressive symptom severity and illness representation.MethodsA prospective open-label study investigating the effect of tele-based intervention on diabetes self-efficacy. Participants completed the following questionnaires: Diabetes Management Self-Efficacy Scale (DMSES) (self-efficacy), Patient Health Questionnaire 9 (PHQ-9) (depression), and Illness Perception Questionnaire-Revised (IPQ-R) (illness representation). Data were collected at three time points: Baseline (T1), 3–4 months (T2), and 8–9 months (T3).ResultsAlthough men and women exhibited similar baseline self-efficacy levels, men scored significantly higher than women over time, at T2 (p < .05) and T3 (p < .05). Consistent gender differences were observed throughout the study in depression and illness representations: women scored higher than men on PHQ-9 (3.94 vs. 5.57, p < .001), and perceived their diabetes consequences as more severe than men (p < .001). A linear regression analyses indicated that MTC intervention, age, baseline self-efficacy, and depression at T3 explained 39.8% of the variance of selfefficacy at the conclusion of the study for both genders, although more strongly for men.Implications for PracticeThis study indicates that the effects of a treatment intervention for individuals with type 2 diabetes mellitus are gender specific. Thus, gender-tailored interventions may be advised to further improve outcomes for women with type 2 diabetes mellitus.

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

Distinct Illness Representation Profiles Are Associated With Anxiety in Women Testing Positive for Human Papillomavirus

Background Testing positive for human papillomavirus (HPV) at cervical cancer screening has been associated with heightened anxiety. To date, the cognitive determinants of heightened anxiety remain unclear, making it difficult to design effective interventions. Purpose This study investigated latent illness representation profiles in women testing positive for HPV with no abnormal cells (normal cytology) and explored associations between these profiles and anxiety. Methods Women aged 24–66 (n = 646) who had tested HPV-positive with normal cytology at routine HPV primary screening in England completed a cross-sectional survey shortly after receiving their result. Results Latent profile analysis identified three distinct profiles of illness representations (termed “adaptive,” “negative,” and “negative somatic”), which differed significantly in their patterns of illness perceptions. Hierarchal linear regression revealed that these latent illness representation profiles accounted for 21.8% of the variance in anxiety, after adjusting for demographic and clinical characteristics. When compared with adaptive representations (Profile 1), women with negative representations (Profile 2) and negative somatic representations (Profile 3) had significantly higher anxiety, with clinically meaningful between-group differences (mean difference [MD] = 17.26, confidence interval [CI]: 14.29–20.22 and MD = 13.20, CI: 9.45–16.96 on the S-STAI-6, respectively). Conclusion The latent illness representation profiles identified in this study provide support for the role of negative beliefs contributing to anxiety in women testing HPV-positive with normal cytology. Characteristics specific to subgroups of highly anxious women (Profiles 2 and 3) could be used by policymakers to target information in routine patient communications (e.g., test result letters) to reduce unnecessary burden. Future research should adopt longitudinal designs to understand the trajectory of illness representations from HPV diagnosis through to clearance versus persistence.

ILLNESS REPRESENTATION DENGAN KEPATUHAN MENGIKUTI ANJURAN PEMERINTAH DALAM RANGKA MEMUTUS MATA RANTAI CORONAVIRUS DISEASE 2019 (COVID-19)

Latar belakang dari penelitian ini yaitu kurangnya kesadaran individu terhadap kepatuhan terhadap pemutusan mata rantai covid-19 dapat mengakibatkan mengalami kenaikan jumlah pasien yang terpapar. Jika penanganan tidak maksimal dan masyarakat belum sepenuhnya mematuhi anjuran keras untuk stay at home (WFH) dan menjaga jarak sosial (social distancing), virus corona akan terus meluas. Penelitian ini bertujuan untuk mengetahui signifikansi hubungan antara illness representation dengan kepatuhan mengikuti anjuran pemerintah dalam rangka memutus rantai pandemi covid-19. Metode yang digunakan dalam penelitian ini adalah mixed method, dimana peneliti menggunakan metode penelitian kuantitatif dan metode kualitatif untuk mengukur responden. Responden dalam penelitian ini sebanyak 244 responden, yang diambil dengan menggunakan teknik purposive sampling. Ada dua skala yang digunakan untuk mengukur penelitian ini yaitu, skala kepatuhan dan skala IPQ-R. Teknik analisa data yang dipakai adalah teknik korelasi� purposive sampling dan observasi serta depth interview dengan pendekatan fenomenologis. Hasil dari penelitian ini adalah terdapat hubungan positif signifikan antara nilai r = 0,260 dan p<0,01, yang berarti bahwa adanya hubungan positif signifikan antara illness representation dengan kepatuhan� mengikuti anjuran pemerintah dalam rangka memutus mata rantai coronavirus disease 2019 (covid-19). Penelitian ini memiliki implikasi teoritis adalah sebagai pengembangan pengetahuan psikologis mengenai virus covid-19 dan pengembangan factor-faktor yang lain memengaruhi illness representation dan kepatuhan mengikuti anjuran pemerintah. Selain implikasi teoritis, implikasi praktis dalam penelitian ini adalah membantu mengedukasi masyarakat agar lebih mematuhi anjuran dari pemerintah terkait pemutusan mata rantai pandemic Covid-19.�

Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients’ illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients’ self-efficacy, promote patients’ resilience, and better function.

Illness Representation among Adolescents: A Qualitative Approach

There is a significant increase in the studies investigating illness representation through quantitative methods, which is due to a certain extent to the valid psychometric instruments that measure this construct. This phenomenon is especially intense among people who have a certain diagnosis. Not the same can be said about the existing research for the study of the representation that healthy people have about illness, in which the qualitative methods predominate. The purpose of this study is to outline how adolescents perceive the disease, given that they go through a period of change with significant implications for adult-related health behaviours. In this study, 132 adolescents aged between 11 and 18 were included (M =14.60; SD= 2.54). Because we wanted to obtain complex and accurate information, we chose to collect the data through three qualitative methods: drawing, the free association method, and the open-ended questionnaire. Based on the common-sense model, we were able to identify the most frequently cited causes of disease onset, which are the indicators of its occurrence, the effects adolescents perceive as occurring over time and how they think we can treat it. One of the most important dimensions represented through the three methods of data collection was that of emotions. This result draws attention to the importance that people attach to the emotional sphere when it comes to illness. Unfortunately, medical staff are well prepared for the assessment of biomedical aspects, but less so for understanding the psychosocial, social, and cultural dimensions of health and illness.