Ruth Curtis

The impact of illness representations and disease activity on adjustment in women with rheumatoid arthritis: A longitudinal study

This longitudinal study examined the extent to which illness representations and disease indicators predict physical and psychological outcomes in patients with rheumatoid arthritis. Baseline data was collected on 75 women attending an out-patient clinic in the west of Ireland. Data was available for a final study sample of 52 at two-year follow-up. Disease status was assessed by physician ratings of joint involvement and laboratory indices of erythrocyte sedimentation rate and c-reactive protein. The Illness Perception Questionnaire and the Arthritis Impact Measurement Scale were administered during a semi-structured interview held at yearly intervals over a three-year period. In hierarchical regression analyses the illness representations accounted for 17–33% of the variance in measures of physical function, pain, depression and anxiety. All relationships were in the expected direction. Disease status explained 10–15% of the variance in illness related aspects of physical function and pain and predicted pain over time. Illness perceptions outweighed the impact of medical disease status on concurrent physical and psychological adjustment. Interventions based on understanding and modifying illness representations may prove useful in facilitating patient well-being.

The influence of disease severity, perceived stress, social support and coping in patients with chronic illness: a 1 year follow up

This study examined the extent to which psychological stress, social support and clinical disease indicators predict physical, social and psychological wellbeing in patients with rheumatoid arthritis. Participants were 59 women recruited at an outpatient clinic. Data were available for 52 of the sample at 1-year follow-up. A range of psychological measures was administered and disease status was assessed by physician ratings of joint involvement and blood assays of inflammatory indices. Findings from correlational and hierarchical regression analyses reveal a number of statistically significant relationships (p < 0.01), for example higher perceived stress and lower social support were associated with poor emotional adjustment. Partial correlations showed that while social support did not mediate the relationship between psychological stress and adjustment, the use of venting emotions as a coping strategy was a mediator of the association between stress and negative affect. Results demonstrated that disease status predicted illness related functioning but did not predict emotional or social adjustment. Perceived stress was a better predictor than disease of concurrent positive and negative emotionality with explained variance ranging from 14% - 55%. Coping also predicted variance on these affective domains (10 - 19%). In longitudinal analyses, perceived stress accounted for variability in negative affect 1 year later and coping predicted positive affect over this time. Level of social support explained variance on social activity in cross-sectional and longitudinal analysis (10 - 14%). Results suggest that a cognitive behavioural intervention to facilitate patient adjustment could usefully include management of stress and its appraisal, the fostering of adaptive coping strategies and utilization of social support resources. In improving patient adjustment to rheumatoid arthritis it is envisaged that reliance on physicians for emotional rather than disease related problems will diminish.

Global stress predicts both positive and negative emotional adjustment at diagnosis and post-surgery in women with breast cancer

Individual differences in stress appraisal, coping, optimism and social support have contributed to variability in adjustment to breast cancer, but less is known about their relative influence particularly at diagnosis. The purpose of this study was to compare the predictive role of these variables on both positive and negative adjustment in a sample of recently diagnosed women.

Designing health communication: Testing the explanations for the impact of communication medium on effectiveness

Objective. The written format has been found consistently to be the most effective medium for communicating relatively complex information (e.g. Furnham, Gunter, & Green, 1990). Looking at the communication of health information, Corston and Colman (1997) accounted for media differences by referring to the facts that reading a written presentation is self-paced (the self-pacing theory) and that a written presentation contains fewer distracting characteristics than either audio-visual or auditory-only presentations (the distraction theory). The present study sought to test these theories. Method. Female students (N = 175) between the ages of 16 and 18 from two secondary schools were exposed to a fictitious health warning and completed a questionnaire immediately afterwards, measuring communication effectiveness via recall. Participants were divided into seven treatment condition groups which varied in the medium of presentation (two written, three audio-visual and three auditory-only) and distraction level inherent to the design of the communication. Results. In line with previous literature, the written format was the most effective way to communicate a piece of health-related information (p < .01). No evidence was provided for the ‘self-pacing theory’. Substantial support, however, was found for the ‘distraction theory’. Conclusions. In general, minimally distracting communication proved maximally effective. A simple distraction effect, however, was not found within the audio-visual medium. Here the presentation where the viewers see a reader conveying the message (the ‘talking head’ condition) proved most effective, even though it was not the least distracting. Being able to see someone reading the message appears to convey a special communication advantage on the presentation.

Cognitive-behavioural stress management enhances adjustment in women with breast cancer.

OBJECTIVE This randomized controlled trial examines whether a briefer cognitive-behavioural (CBT) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer. It further aims to identify characteristics of those women most likely to benefit from the intervention. DESIGN AND METHOD A randomized controlled trial was conducted to assess the efficacy of a psychological intervention. Women (N = 355) who had undergone surgery for breast cancer 4 months earlier, the majority of whom were currently undergoing adjuvant therapy, completed questionnaires assessing global and cancer-specific stress, depression, anxiety, optimism and benefit finding. They were randomly assigned to a 5-week group cognitive-behavioural stress management (CBSM) programme plus standard care or standard care only. Reassessment occurred post-intervention and 12 months later. RESULTS Analyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls. These differences, however, were not maintained at 12 months. Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety. CONCLUSIONS A CBSM intervention, which was briefer than the norm (5 weeks vs. 9-20 weeks), had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress. Screening on this basis may facilitate optimal and cost-effective psychological treatment.

Experience of breast cancer: burden, benefit, or both?

Background: Transactional models of stress emphasize the role of appraisal of stress in adjustment to illness. The current qualitative study uses this framework to explore the subjective response to these stressors in women with breast cancer. Reappraisals or opportunities for growth from the experience are also examined. Objective: The objective of this study was to explore the experience of stress in Irish women with breast cancer using the Stress-Coping Model. Methods: The diaries of 30 women newly diagnosed with breast cancer were analyzed using thematic template analysis. A template of 5 themes based on elements of the Stress-Coping Model was defined prior to analysis. Results: Six top-level and 14 second-level themes were defined in the final template. Following initial diagnosis of breast cancer, women viewed it as either a threat or a challenge. After diagnosis, however, other stressful events included treatment effects, loss of womanhood, and illness disclosure. Women described coping strategies and social interactions that both increased and decreased their stress. In tandem with negative consequences of breast cancer, women also reported benefit from the experience. Conclusions: Women differed in their identification of stressful events and subsequent coping strategies. Their reports also illustrated the complex relationships between appraisal of the event, personal resources, and social interactions, which can result in both positive and negative outcomes. Implications for Practice: Appraisal of breast cancer can vary, and awareness of this by health professionals can facilitate adjustment. Women need advice in regard to disclosure of diagnosis to others and need more information on managing treatment effects.

Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer

Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5–25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8–31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.

Factors influencing adherence among Irish haemodialysis patients

OBJECTIVE Adherence to dietary and fluid restrictions among haemodialysis patients with end stage renal failure (ESRD) is a multi-factorial concept. This study seeks to assess the predictive value of demographic and psychological variables in non-adherence. METHODS A multi-centre cross sectional design assessed 50 haemodialysis patients on self reported adherence, attitudes towards dietary restrictions, quality of life, depression and anxiety. Adherence to fluid and dietary restrictions was measured objectively using potassium (K), phosphorus (PO4) and inter-dialytic weight gain (IDWG) parameters. RESULTS 62% of patients were non-adherent with at least one aspect of the treatment regime. Regression analysis revealed age as significantly associated with adherence, in particular IDWG, with younger patients displaying poorer adherence. CONCLUSION Younger patients may experience greater difficulty integrating complex treatment demands into their lifestyles, and non-adherence may be a consequence of the severe lifestyle limitations imposed by the haemodialysis treatment regime. PRACTICE IMPLICATIONS Individualised interventions may be more effective than traditional methods of adherence monitoring in reducing the non-adherent behaviour.

Quality and quantity of social support as differential predictors of cardiovascular reactivity

Social support is believed to be associated with positive health and, specifically, to be inversely related to risk factors for cardiovascular disease (such as cardiovascular reactivity). However, the theory has failed to generate substantial evidence in laboratory settings. The present study sought to clarify the relationships between social support and cardiovascular reactivity. Fifty female undergraduates were individually exposed to two computer-driven laboratory stressors while having their blood pressure and heart rate monitored. Assessments of social support and depression were derived using standardised questionnaires. Results indicate that: (a) perceived quantity of social support was associated with elevated – rather than diminished – cardiovascular reactivity; and (b) perceived quality of social support bore no significant relationship with reactivity . A negative association between depressed mood and support quality was also detected. These results imply that, in certain contexts, large netwo...

Stress, personality and illness: The move from generality to specificity in current research trends

This paper identifies a shift in emphasis from the general to the more specific view of interactions between stress and illness, personality and iIIness and the associated role played by social support. Within this framework it examines research with di verse stressors, psychophysiological reactions to them, proposed connecting pathways, protective and harmful aspects of personality dispositions and the effects of social support. It acknowledges the extraordinary advances made in this area to date and concludes that further progress within a biopsychosocial model will involve prospective research designs employing more sophisticated measures of the relevant psychological constructs, and immune parameters