Evangelos C. Karademas

Family, School and Health in Children and Adolescents Findings from the 2006 HBSC Study in Greece

The association between family, school and subjective health was examined in a large representative sample of Greek children and adolescents (N = 3034). We hypothesized that (a) family and school factors are associated with health, even after controlling for gender and economic status; (b) family and school factors are directly related to satisfaction with life and health complaints, but indirectly to self-rated health. According to the findings, family and school factors were related to subjective health, even though this relation was weakening with age. Family and school factors were associated with self-rated health through health complaints and life satisfaction.

Illness Acceptance, Hospitalization Stress and Subjective Health in a Sample of Chronic Patients Admitted to Hospital

The aim of this study was to examine the effects of illness acceptance on the subjective health of hospitalized chronic medical patients. Participants were 128 patients with a previous diagnosis of chronic coronary artery disease, cancer, or chronic renal disease, who were admitted to a public hospital. Illness acceptance was associated with higher levels of subjective health. It was negatively related to psychological symptoms and positively to self-rated health, even after controlling for demographic variables, type of disease, years since diagnosis, health-related quality of life and hospitalization stress. Furthermore, acceptance mediated the effects of hospitalization stress on subjective health measures.

The Impact of Emotion Regulation and Illness-focused Coping Strategies on the Relation of Illness-related Negative Emotions to Subjective Health

In this study we examined whether emotion regulation and illness-focused coping strategies mediate and/ or moderate the relation of illness-related negative emotions to patients’ subjective health. One hundred and thirty-five cardiac patients participated in the study. Illness-focused coping strategies were found to mediate the relation of emotions to physical functioning, whereas emotion regulation strategies mediated the relation to psychological well-being. Moreover, an emotion regulation strategy (i.e. emotion suppression) and two illness-focused coping strategies (instrumental coping and adherence) moderated the two relationships. These findings suggest that both emotion regulation and illness-focused coping strategies are integral parts of the illness-related negative emotions—health relationship.

Cardiac patient–spouse dissimilarities in illness perception: Associations with patient self-rated health and coping strategies

The study examined the illness perception dissimilarities between chronic cardiac patients and their spouses, as well as the associations of perception dissimilarities with patients’ overall self-rated health (SRH) and illness-related coping strategies. Seventy-three patients (65 males, 8 females) with an old myocardial infarction and subsequent cardiovascular problems, and their spouses completed the Revised Illness Perceptions Questionnaire. Patients also completed a coping measure (the Coping with Health Injuries and Problems Scale) and a question regarding SRH. Significant differences, with spouses scoring higher than patients, were found in perceptions regarding illness chronicity, personal control and the emotional impact of the illness. The correlations of dissimilarity scores to SRH and coping were sporadic and weak. Additionally, after controlling for patients’ own perceptions, the effects of dissimilarity scores almost disappeared. However, when three different groups were constructed reflecting whether both partners scored high, low, or in an opposing way on each IPQ-R subscale, the overall matching in several illness perceptions was associated with certain coping strategies, even after controlling for the effects of the patients’ own perceptions. With respect to SRH, no significant effects were found.

Illness Cognitions as a Pathway Between Religiousness and Subjective Health in Chronic Cardiac Patients

The aim of this study was to examine the role of illness cognitions as a possible pathway between religiousness and subjective health in chronic illness. A sample of 135 chronic cardiac patients completed questionnaires about intrinsic religiousness, frequency of church service attendance, basic illness cognitions (i.e., helplessness, illness acceptance, perceived benefits), and physical and emotional well-being. According to the results, religiousness was significantly associated with subjective health. However, this relationship was indirect, with helplessness and illness acceptance serving as mediators between intrinsic religiousness and health. This finding is significant for understanding the complex relation of religiousness to chronic patients’ well-being.

Psychological symptoms of breast cancer survivors: a comparison with matched healthy controls and the association with cancer-related stress and coping.

Abstract The first aim of this study was to examine the psychological health of long-term breast cancer survivors who had undergone a mastectomy and were disease-free since treatment, in comparison with a matched healthy control group. A second aim was to examine the association between symptoms and cancer-related stress and coping. A total of 103 Greek breast cancer survivors, who had undergone a mastectomy more than 3 years ago and were free of any metastasis or relapse, participated in the study. The comparison group consisted of 100 women matched for age, education and marital status. Survivors scored significantly higher only in depressive symptomatology. Cancer-related stress and certain coping strategies were associated with psychological symptoms, even after controlling for demographic variables and time since mastectomy. Stress and focusing on the positive played a significant role in predicting depressive symptomatology.

Representations of control and psychological symptoms in couples dealing with cancer: a dyadic-regulation approach.

The aim of this study was to examine the relation between illness representations of personal and treatment control and psychological symptoms (i.e. symptoms of anxiety and depression) in 72 married couples dealing with a recently diagnosed cancer. Patients were first-diagnosed with early stage (45.83%) or metastatic cancer (54.17%). Dyadic responses were examined with the actor–partner interdependence model. Also, in order to examine whether patients and spouses’ representations of control moderate the relation of their partners’ corresponding representations to psychological symptoms, we used the relevant bootstrapping framework developed by Hayes and Matthes [(2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41, 924–936]. Patients’ symptoms of anxiety and depression were associated with both partners’ representations of control. Chi-square difference tests indicated that actor and partner effects were equal. Spouses’ symptoms of anxiety and depression were related only to their own representations. Moreover, spouses’ representations of personal control moderated the relation of patients’ corresponding representations to depressive symptoms, whereas patients’ representations of treatment control moderated the relation of their spouses’ corresponding representations to both anxiety and depression. Findings suggest that both partners’ representations of control are important for adaptation to illness. Moreover, they indicate that dyadic regulation may be equally important to self-regulation as far as adaptation to illness is concerned.

The Relationship of Patient and Spouse Personality to Cardiac Patients’ Health: Two Observational Studies of Mediation and Moderation

BackgroundLittle is known about the ways that personality is related to patient health, although there is some evidence that illness self-regulation as well as partner personality play a significant role.PurposeThe aim of the two present studies was to examine the intra-personal (i.e., through illness representations) and the inter-personal (i.e., partner) effects of personality on cardiac patients’ subjective health.MethodsOne hundred fifteen patients participated in study 1; 75 patients and their spouses participated in study 2.ResultsThe representations of illness consequences, personal control, and the attribution of illness to emotional causes mediated the relation of personality to health (first study). The relations of patients’ extraversion, agreeableness, and conscientiousness to their health were statistically significant at the higher levels (+1 SD) of spouse corresponding traits (second study).ConclusionPersonality affects patients’ health through illness representations (intrapersonal level), as well as by interacting with partner personality (interpersonal level).

Effects of exposure to the suffering of unknown persons on health-related cognitions, and the role of mood.

The purpose of the present study was to examine whether exposure to the suffering of unknown persons, as an inevitable part of life, influences cognitions about health. Our assumption was that exposure to suffering affects cognitions in a negative way, as well as this influence being exerted directly and through negative mood. Eighty-nine participants were randomly assigned to two groups. The experimental group was exposed to a series of photos presenting situations of human suffering, whereas the control group was exposed to a series of photos showing relaxing situations. Participants in the experimental group reported higher health anxiety and health value, and lower internal health locus of control, in comparison to the control group. No differences were found in self-rated health. Exposure to suffering affected cognitions directly and through decrease in positive mood. It seems that an ‘in vitro’ exposure to human suffering activates a cognitive and emotional reaction, which affects evaluations about self and personal well-being.

The relation of illness representations to the 'end-stage' appraisal of outcomes through health status, and the moderating role of optimism.

The aim of this study was to examine an important pathway suggested by the common sense model (CSM): the relation of illness representations to the ‘end-stage’ appraisal of outcomes through health status. A further aim was to examine the moderating role of optimism in this relationship. One hundred and six chronic cardiac patients completed questionnaires about illness representations and dispositional optimism at baseline, and health status and illness-related helplessness (as an indicator of the ‘end-stage’ appraisal of outcomes) at a follow-up interview, 6 months later. Indirect (mediation) as well as conditional indirect (moderated mediation) effects were examined using bootstrapped models. According to the results, the effect of illness representations on helplessness was mediated by at least one of the health measures used. Also, most of these indirect relations were conditional on the values of optimism. That is, optimism moderated the ‘illness representations–health status–“end-stage” appraisal of outcomes’ relationship, as the mediating effects were absent at higher levels of optimism. These findings can provide us with a more comprehensive picture of adaptation to illness, as well as of the ways the illness-related information is being processed by patients. Thus, they have significant implications for theory, research and practice.