Rona Moss-Morris

The illness perception questionnaire: A new method for assessing the cognitive representation of illness

Abstract The Illness Perception Questionnaire (IPQ) is a new method for assessing cognitive representations of illness. The IPQ is a theoretically derived measure comprising five scales that provides information about the five components that have been found to underlie the cognitive representation of illness. The five scales assess identity - the symptoms the patient associates with the illness, cause - personal ideas about aetiology, time-line - the perceived duration of the illness, consequences - expected effects and outcome and cure control - how one controls or recovers from the illness. The IPQ has a specific number of core items but allows the user to add items for particular patient groups or health threats. Data is presented supporting the reliability and validity of the IPQ scales in different chronic illness populations.

Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study

Objectives To compare pregnancy outcomes between women who stopped smoking in early pregnancy and those who either did not smoke in pregnancy or continued to smoke. Design Prospective cohort study. Setting Auckland, New Zealand and Adelaide, Australia. Participants 2504 nulliparous women participating in the Screening for Pregnancy Endpoints (SCOPE) study grouped by maternal smoking status at 15 (±1) week’s gestation. Main outcome measures Spontaneous preterm birth and small for gestational age infants (birth weight <10th customised centile). We compared odds of these outcomes between stopped smokers and non-smokers, and between current smokers and stopped smokers, using logistic regression, adjusting for demographic and clinical risk factors. Results 80% (n=1992) of women were non-smokers, 10% (n=261) had stopped smoking, and 10% (n=251) were current smokers. We noted no differences in rates of spontaneous preterm birth (4%, n=88 v 4%, n=10; adjusted odds ratio 1.03, 95% confidence interval l0.49 to 2.18; P=0.66) or small for gestational age infants (10%, n=195 v 10%, n=27; 1.06, 0.67 to 1.68; P=0.8) between non-smokers and stopped smokers. Current smokers had higher rates of spontaneous preterm birth (10%, n=25 v 4%, n=10; 3.21, 1.42 to 7.23; P=0.006) and small for gestational age infants (17%, n=42 v 10%, n=27; 1.76, 1.03 to 3.02; P=0.03) than stopped smokers. Conclusion In women who stopped smoking before 15 weeks’ gestation, rates of spontaneous preterm birth and small for gestational age infants did not differ from those in non-smokers, indicating that these severe adverse effects of smoking may be reversible if smoking is stopped early in pregnancy.

A Randomized Controlled Trial of Cognitive Behavior Therapy for Multiple Sclerosis Fatigue

Background: The purpose of this study was to assess the efficacy of cognitive behavior therapy (CBT) as a treatment for multiple sclerosis (MS) fatigue. Methods: A randomized controlled design was used where 72 patients with MS fatigue were randomly assigned to eight weekly sessions of CBT or relaxation training (RT). RT was designed to control for therapist time and attention. Participants were assessed before and after treatment, and at 3 and 6 months posttreatment. The primary outcome was the Fatigue Scale. Secondary outcomes included measures of stress, mood, and fatigue-related impairment. Results: Analysis was by intention-to-treat. A group by time interaction showed that the CBT group reported significantly greater reductions in fatigue across the 8 months compared with the RT group (p < .02). Calculated effect sizes for fatigue from baseline to the end of treatment were 3.03 [95% confidence interval, 2.22–3.68] for the CBT group and 1.83 [95% confidence interval, 1.26–2.34] for the RT group. Results also indicted that both groups showed clinically significant decreases in fatigue defined as fatigue levels equivalent or less than those reported by a nonfatigued healthy comparison group. There were no significant interactions between group and any of the secondary outcome variables, with both groups showing improvements over time on all measures. Interpretation: Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT. Even 6 months after treatment, both treatment groups reported levels of fatigue equivalent to those of the healthy comparison group. MS = multiple sclerosis; CBT = cognitive behavior therapy; RT = relaxation training; RCT = randomized controlled trial; EDSS = expanded disability status scale; HADS = the hospital anxiety and depression scale.

A randomized controlled graded exercise trial for chronic fatigue syndrome: Outcomes and mechanisms of change

The aim of this study was to investigate the potential mechanisms underlying the efficacy of graded exercise therapy for chronic fatigue syndrome (CFS). Forty-nine CFS patients were randomized to a 12-week graded exercise programme or to standard medical care. At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group. A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect. Graded exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms.

A review of psychological correlates of adjustment in patients with multiple sclerosis

Multiple Sclerosis (MS) is a chronic neurological disease which poses significant psychological adjustment challenges. The purpose of this systematic review was to identify factors that are related to adjustment in people with MS and may be modifiable through psychological intervention. It aimed to gain an overview of the strength of evidence for relationships between psychological factors and adjustment and identify limitations to existing studies and directions for future research. Seventy two studies met inclusion criteria and were included in the review and a narrative synthesis was conducted. A wide range of psychological factors have been studied in relation to adjustment outcomes. The strongest and most consistent finding was that perceived stress and certain emotion-focussed coping strategies are related to worse adjustment in MS. Uncertainty was fairly robustly associated with worse adjustment. There was also more tentative evidence available for relationships between adjustment outcomes and a range of other factors including social support and interactions with others, cognitive errors and biases, illness and symptom cognitions, control perceptions, positive psychology factors, and health behaviours. Implications for therapeutic interventions are discussed and a preliminary model of adjustment to MS is outlined. In light of the shortcomings of extant studies, suggestions for future research are offered.

The impact of catastrophic beliefs on functioning in chronic fatigue syndrome

This study investigated the association between catastrophic beliefs and disability in the context of Chronic fatigue syndrome (CFS). A sample of 282 CFS sufferers were asked about the consequences of pushing themselves beyond their present physical state. Responses were coded into catastrophic or non-catastrophic categories. While not differing on the length of illness or psychological adjustment, subjects demonstrating catastrophic responses evidenced significantly higher levels of fatigue and were more disabled in terms of their ability to work both in their normal occupation and around the house. Catastrophizers also showed greater disability in terms of their sleep and rest, social communication, and recreational activities. The role of catastrophic beliefs and personal perceptions of CFS in maintaining the illness is discussed.

Social support and cancer progression: A systematic review

OBJECTIVE The variability in the conceptualization and categorization of social support has resulted in mixed findings regarding its role in cancer progression. This systematic review identifies and summarizes the evidence for the significance of two important indices of social support in progression of different cancers. METHOD We used systematic and replicable methods to search, select, and evaluate findings. RESULTS Thirty-one longitudinal prospective findings (in 26 papers) which were selected for inclusion categorized social support into structural and functional support. The types of cancer included in these studies fell into three major categories: breast cancer (16), other cancer (10), and mixed cancers (5). Results suggest that the evidence for the relationship between social support and cancer progression is sufficiently strong for breast cancer as shown by five out of seven methodologically sound studies but consistently unconvincing for other types of cancer or in studies which combined different types of cancer. Structural support indices were found to be more frequently associated with disease progression than the indices of functional support in breast cancer. Disease-related variables such as severity, treatment, nodal status, and site of metastasis were found to be significant predictors of cancer progression, and it is suggested that these variables must be considered when conducting studies on the role of psychosocial factors in cancer-related outcomes including progression. CONCLUSION Methodological limitations of the studies and counterintuitive findings are discussed, and further conclusive research, particularly randomized controlled trials of social support interventions, is warranted to support the findings of this systematic review.

The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

Aim: To determine whether a combination of mood and personality factors together with illness beliefs and behaviours predict the onset of irritable bowel syndrome (IBS) post gastroenteritis, as suggested by the cognitive behavioural model of IBS. Methods: Primary care patients with a positive test for Campylobacter gastroenteritis, and no previous history of IBS or serious bowel conditions were recruited into this prospective study (n = 620). Participants completed a questionnaire at the time of infection, which included standardised measures of mood, perceived stress, perfectionism, negative illness beliefs and illness behaviours. Participants completed follow-up questionnaires designed to determine whether they met the Rome criteria for IBS 3 and 6 months after initial infection. Results: A total of 49 participants met the criteria for IBS at both follow-up points. Logistic regressions indicated that those who developed IBS had significantly higher levels of perceived stress (1.10, 95% CI 1.02 to–1.15), anxiety (1.14, 95% CI 1.05 to 1.23), somatisation (1.17, 95% CI 1.02 to 1.35) and negative illness beliefs (1.14, 95% CI 1.03 to 1.27) at the time of infection than those who did not develop IBS. Patients with IBS were also significantly more likely to remain active in the face of their acute symptoms until they felt forced to rest (all-or-nothing behaviour) (1.09, 95% CI 1.03 to 1.16), and significantly less likely to initially rest in response to their acute illness (0.93, 95% CI 0.88 to 0.97). Depression and perfectionism were not associated with the onset of IBS. Conclusions: Results suggest that patients with high stress and anxiety levels are more prone to develop IBS after a bout of gastroenteritis. Additional risk factors include a tendency to interpret illness in a pessimistic fashion and to respond to symptoms in an all-or-nothing manner.

To "lump" or to "split" the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome?

Objectives: Recent academic debate has centered on whether functional somatic syndromes should be defined as separate entities or as one syndrome. The aim of this study was to investigate whether there may be significant differences in the etiology or precipitating factors associated with two common functional syndromes, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). Methods: We prospectively studied 592 patients with an acute episode of Campylobacter gastroenteritis and 243 with an acute episode of infectious mononucleosis who had no previous history of CFS or IBS. At the time of infection, patients completed a baseline questionnaire that measured their levels of distress using the Hospital Anxiety and Depression scale. At 3- and 6-month follow-up, they completed questionnaires to determine whether they met published diagnostic criteria for chronic fatigue (CF), CFS, and/or IBS. Results: The odds of developing IBS were significantly greater post-Campylobacter than post–infectious mononucleosis at both 3- (odds ratio, 3.45 [95% confidence interval (CI), 1.75–6.67]) and 6- (2.22 [95% CI, 1.11–6.67]) month follow-up. In contrast, the odds for developing CF/CFS were significantly greater after infectious mononucleosis than after Campylobacter at 3 (2.77 [95% CI, 1.08–7.11]) but not 6 (1.48 [95% CI, 0.62–3.55]) months postinfection. Anxiety and depression were the strongest predictors of CF/CFS, whereas the nature of the infection was the strongest predictor of IBS. Conclusions: These results support the argument to distinguish between postinfectious IBS and CFS. The nature of the precipitating infection appears to be important, and premorbid levels of distress appear to be more strongly associated with CFS than IBS, particularly levels of depression. CDC = Centers for Disease Control and Prevention; CFS = chronic fatigue syndrome; CF = chronic fatigue; CI = confidence interval; IBS = irritable bowel syndrome; IM = infectious mononucleosis; HADS = Hospital Anxiety and Depression Scale.

Worries about modernity predict symptom complaints after environmental pesticide spraying.

Objective: Concerns about environmental and technological changes affecting health have been shown to be associated with symptom reports in cross-sectional studies. We aimed to investigate how worries about modernity affecting health, negative affectivity, and prior symptom complaints influence health complaints after environmental spraying in a prospective study. Methods: Two hundred ninety-two residents of West Auckland completed questionnaires measuring recent symptoms, negative affect, and concerns about the effects of modernity on health before aerial spraying of their neighborhood with Foray 48B. After spraying, 181 residents (62%) returned a follow-up questionnaire measuring symptoms, spray-avoidance behavior, and the perceived effect of the spray program on health. Results: The number of symptoms reported after the spray was most closely related to the number of symptoms reported at baseline (&bgr; = 0.40, p = .0001). Higher levels of modern health worries (&bgr; = 0.23, p = .001) and baseline symptoms (&bgr; = 0.17, p < .05) were associated with a higher number of symptoms being attributed to the spray program. Modern health worries also predicted avoidance behavior during the spraying times (&bgr; = 0.32, p = .001) and the belief that the health of participants and the health of their children and pets was affected by the spray (all p < .01). Conclusion: Worries about aspects of modern life affecting health can strongly influence the attribution of symptoms and beliefs about health effects after environmental incidents. PANAS = Positive and Negative Affect Schedule.