health psych ch 11 living with chronic illness

what are chronic health conditions?

• 58% of the Canadian population has a chronic health condition (81% of older adults, 44% of adults 20+ years old)

• more common among women, lower SES, certain ethnic groups, and older adults

• 67% of all health care costs

• account for 88% of deaths in Canada

scoop of the issue

in Canada…

• 6.1 million with arthritis

• 2.1 million diagnosed with cancer

• 2 million with diabetes

• 740,000 with effects from a stroke

• thousands with history of heart attack or chest pain

• 25% have hypertension

what are chronic health conditions?

• chronic health conditions, chronic illness and chronic disease tend to be used interchangeably

• impact day-to-day physical, emotional, social and psychological functioning of the individual and their families

• self-management

self-management

involvement of patient in all aspects of chronic illness and its implications, including medical management, changes in social and vocational roles and coping strategies

what is quality of life?

the degree to which a person is able to maximize their physical, vocational, and social functioning, and psychological status

• self-reports

• comparing to general populations

• there are still imperfections

quality of life - previously

was measured based on how long you survived and signed of disease

quality of life - now

• is complex; physical, psychological, social components

• patients often experience psychological distress

why study quality of life?

1. documentation for interventions

2. identify what problems may emerge with certain chronic conditions

3. assess impact of treatments on QoL

4. compare therapies

5. inform decision makers

responses to chronic illness

• denial

• anxiety

• depression

• positive responses

denial

• a defense mechanism involving the inability to recognize or deal with external threatening events; believed to be an early stage of a chronic or terminal illness

• patients may act as if the illness will go away or is short-term

• can mask fear

• may interfere with treatment participation

anxiety

• more common in those with stroke, heart disease and cancer than general population

• chronic illness can be overwhelming

• can interfere with adaptive functioning

• interfere with assessment and treatment

depression

• common and debilitating

• can occur at any point

• likelihood of having clinical level of depression is highest for those with chronic fatigue syndrome and fibromyalgia

• exacerbates risk for many chronic illness

• complicates participation in treatment, medical decision-making, and makes assessment challenging

positive responses

• many people experience hope and optimism

• benefit finding: acknowledgement of the positive effects of illness in ones life

• perceive more control

• beneficial to recovery and QoL

how is the self changed ny chronic disease?

• the self is one of the central concepts in psychology

• self-concept

• self-esteem

• body image

• social identity

• goals and self-image

self-concept

an integrated set of beliefs about ones personal qualities and attributes

self-esteem

a global evaluation of ones qualities and attributes

body image

• the perception and evaluation of ones own body, ones physical functioning, and ones appearance

• component of physical self

• can impact participation in treatment

social identity

• rebuilding social self is important for readjustment

• patients personal goals and ambitions are also impacted by chronic illness (private self)

goals and self-image

• achievement in activities and personal goals impact self-esteem

• achieving self

5 strategies of dealing with chronic illness

1. social support/direct problem solving

2. distancing

3. positive focusing

4. cognitive escape/avoidant

5. behavioural escape/avoidant

how do people cope with chronic illness?

• avoidant coping strategy

  • increased psychological distress

  • can exacerbate illness

• active coping strategy

  • lower psychological distress

  • better adjustment

• illness duration

patient beliefs about chronic illness

beliefs about the nature of the illness

• inappropriately adapt acute model

beliefs about the cause of the illness

• adapt theories of where their illness came from

• self-blame

• blaming others can be maladaptive

beliefs about the controllability of the illness

• perceive a sense of control

physical problems associated with chronic illness

• emerge as a consequence of treatment, from previous injury, or the chronic illness itself

• worsen with age/over time

physical rehabilitation

a program of activities for the chronically ill geared toward helping them:

• use their bodies as much as possible

• sense changes in the environment/themselves and make appropriate physical accommodations

• learn new physical management skills

• learn treatment regimen

• learn how to control the expenditure of energy

helping physical problems associated with chronic illness

developing a comprehensive rehabilitation program

• need to consider all illness and treatment factors

• looks different for all illness

• need to consider factors that contribute to recurrence and exacerbate the condition

program adherence

• often high levels of non-adherence

• appropriate education

vocational issues with chronic illness

• many face discrimination

  • time (1996) suggests that those with cancer are 5x more likely to experience discrimination than other workers

• financial impact

• example: arthritis

  • fatigue is the most common limiting symptom

  • accommodations at work may affect job satisfaction, salary and ability to make advancements

  • interpersonal difficulties with coworkers

  • emotional challenges

social issues in chronic illness

negative responses from others

• friends, family, and acquaintances might have trouble adjusting too

impact on family

• increased dependency on family, changing roles within the family

caregiving role

• caring for someone with a chronic illness is irregular

• caregivers are at risk for distress

impact on sexuality

• often decreases

gender

• women tend to have a higher burden than men

children with chronic illness

• high levels of depression

• behavioural problems

  • rebelling and withdrawal

• low self-esteem

• maladaptive coping

• exacerbated by stress

psychological intervention

• validation of their response

• patient education

• relaxation, stress management, and exercise

  • can improve impacts and adjustment to the illness

social intervention

• social supports

  • greater life satisfaction

  • important for adjustment

• support groups: a group of people who meet regularly and usually have a common problem or concern

• family support is especially important

  • promotes adherence to treatment