(final) Chronic illness

44% of adults (20+) have at least 1 of 10 common chronic conditions

Hypertension: 25%

Osteoarthritis: 14%

Mood / Anxiety Disorders: 13%

Osteoporosis: 12%

Diabetes: 11%

Asthma: 11%

COPD: 10%

Ischemic Heart Disease: 8%

Cancer: 8%

Dementia: 7%

How likely are we to develop chronic condition

Most of us are likely to develop at least one chronic condition that may lead to our death.

Chronic conditions account for ⅔ of Canada’s health spending.

Chronic conditions are more common among lower-income Canadians, women, and seniors

The Initial Response to chronic illness

Shock → an acute stress reaction

Anxiety, anger

Lower sense of control

Secondary appraisal

Emotion-focused coping

Some have denial

Crisis Theory

Describes factors that influence how people adjust/cope after first learning they have a chronic illness.

Illness-related factors, background/personal factors, physical/social factors

→ coping process: Appraisal (perceived meaning of the illness), adaptive tasks, coping skills

→ adjustment (poor adjustment is linked to self-blame, catastrophizing)

People who are ill must address 2 types of adaptive tasks:

Tasks related to the illness or treatment (3)

Coping with the symptoms/disability of illness.

Adjusting to hospital environment, procedures, treatments.

Developing good relationships with practitioners.

People who are ill must address 2 types of adaptive tasks: Tasks related to general psychosocial functioning (4)

Controlling negative feelings, having positive outlook.

Maintaining satisfactory self‐image, sense of competence.

Preserving good relationships with family/friends.

Preparing for an uncertain future

Coping Strategies for Chronic Health Problems

Denying or minimizing the seriousness (can be beneficial early on).

Seeking info

Learn to self-administered care to gain control.

Setting realistic, limited goals.

Get support

Be prepared for unexpected/stressful events

Gaining a manageable perspective, often by finding a sense of "purpose" or "meaning"

Major life-long adaptive tasks for successful adjustment (3)

Directly continuously manage disease (ex. taking meds regularly, maintain healthy lifestyle)

Minimizing physical limitations & disability (ex. use aid device)

Preserve as much positive functioning as possible (ex. socially engage)

Most useful coping strategies for cancer patients

Social support/direct problem solving (talk to someone abt it)

Distancing (shift focus on illness to smth else): Reduce stress (BUT Passive escape: Decrease psych well-being)

Positive focus (“I learned smth”)

Cognitive and behavioral avoidance (distraction, drinking)

Maladaptive coping for cancer patients

Rumination (exacerbates symptoms)

Interpersonal withdrawal

Avoidant coping (denial) → more distress, exacerbates symptoms (less adherence)

Denial in cancer patients (3 kinds)

Denial of diagnosis (very common)

Denial of impact (outcomes) — MOST common form of denial: Lower lifespan

Denial of emotions

Impacts on psychological functioning, not physical or social functioning depend on the form of denial

Ppl who blame themselves for their chronic illness have…

Higher depression and distress

Lower QoL

Impact of Depression on chronic illness

Helplessness, hopelessness

May be delayed as patients try to understand implications of condition; physically debilitating; direct impact on symptoms.

Shorter survival time for cancer

How can depression complicate medical evaluations?

It could have arisen due to a hospital stay or the treatment process.

Does decreasing depression help with cancer survivability?

Yes, by interventions like good hospice care, even a year earlier

Why do Cancer patients experience challenges in relationships?

Physical difficulty, feel awkward, embarrassed, stigmatized

Other people avoid them due to feelings of vulnerability, worrying they might say the wrong thing, or break down emotionally.

What factors lead to stigma for cancer patients?

Sense of self affected by the diagnosis

Perceived controllability and visibility of cancer

How much it interferes w daily functioning

Cancer stigma is correlated with

Problematic outcomes (depression)

Reduced cancer screening for cervical, breast, and colorectal cancer

Adaptation

Making changes to adjust constructively to life’s circumstances

Focus of coping shifting from crisis stage to dealing w more permanent changes

Successful adjustment → adaptive tasks that continue

Ex. Mastery of demands directly related to ongoing management of disease, minimize physical limitations, disability and preserving as much positive functioning as possible

Cancer survivorship

Long-term cancer survivors have higher rates of emotional distress, esp those of lower SES, single, and disabled

Evaluating Quality of Life (QoL)

Based on physical, psych, vocational, and social functioning; includes disease or treatment related symptoms

A person’s perceptions of their own health

Self-reported health (SRH) or subjective health

Emphasis on daily living

Quality of Life (QoL) is indicator of what?

Recovery/adjustment to chronic illness

Is subjective health consistent with objective health?

YES: SRH is associated with prevalence and onset of all diseases, and laboratory parameters of health

Some studies found no association with cancer

Self-reported/self-rated health (SRH) or Subjective health

Imp aspect of QoL

Use questionnaires/surveys

consistent with objective health

Is predictive of morbidity & mortality (more than objective measures and Satisfaction w Life Scale)

Predictive validity has increased over time

Is subjective health (SRH) predictive of mortality and morbidity?

YES

Even better than the actual physical health

Better than Satisfaction w Life Scale in mortality

Satisfaction with Life Scale (and what it predicts)

1 to 7

Ideal life, like conditions of life, life satisfaction, accomplishment, no regret

Predictive of morbidity (onset of chronic diseases), and mortality (less consistent than SRH)

What psychological interventions are used to manage chronic illness and disease?

Psychopharmacological

Patient & Family Education

Individual or Family Therapy

Stress Management / Relaxation

Support Groups

Why do ppl join Cancer Support Groups?

Common

Believe they can extend their lives

and they are much likely to live 1 year (but not 4 yrs) longer than ppl not in support group

Psychosocial benefits of support groups

Improved mood

Reduced uncertainty

Improved self-esteem

Enhanced coping skills

Improved QoL

Psyc factors that contribute to asthma

Stress, negative emotions, anxiety, catastrophizing → develop and worsening of asthma

High maladjustment and anxiety disorders

Social/Adherence Factors that contribute to asthma

Interpersonal conflict triggers asthma in children

Adherence to medication and avoidance of triggers (ex. smoking)

Good family support → decreased asthma-related inflammation

Psychosocial factors that contribute to epilepsy

Episodes, esp loss of consciousness → cognitive and motor impairments (limit jobs)

High anxiety and stress → increase chance/severity of seizures

Can benefit from relaxation, stress management, biofeedback

Stigma → worse adjustment, low optimism & social support

Rehab psyc goal for spinal cord injury

Gain as much physical function & independance as possible (Ex. bladder control)

Psyc factors that contribute to Spinal Cord Injury

Ppl w SCI experience depression and difficulties related to self-concept

Counselling can help w cope w permanent functional losses

Successful adaptation correlates w resilience, perseverance, tolerance, perceived competence

SCI from military are at higher risk for depression, PTSD

Social factors that contribute to Spinal Cord Injury

Face discrimination at work → limited support

Lower QoL, relationship/financial stability, emotional adjustment, sex satisfaction(helped thru edu and counselling)

Family overprotective → everyone stress out

Can benefit from Reinforcement methods (ex. Use devices to improve limb functioning, change the way they sit)

Psyc factors that contribute to Diabetes

Chronic stress and negative emotions worsen/cause diabetes

Heighten depression and lower self-efficary → less adherence to diet

Problem-focused coping → better emotional adjustment and coherance!

Social factors that contribute to Diabetes

Social support → adherence

Children w Type 1, transition of responsibility to self-care can cause family conflicts

Teen’s adherence → Self-esteem and QoL

Doctor vs patient goals differ (LT vs. day to day well being)

Psyc factors that contribute to Arthritis

Vicious cycle: pain → ↑ stress →↑ symptoms → ^ pain…

• Arthritis ^ risk of anxiety & depression (does not cause onset)

• Prior depression → v coping with pain

More Severe → interferes w/ daily activities + ^ helplessness & depression

Perceived control → better cope, adherence, adjustment

Helpless + catastrophizing → pain, depress

Social factors that contribute to Arthritis

Spouse’s mental well-being affects coping and adjustment

Client-centered→ better adjustment and less disturbance

More positive support → less pain, disability, depress, fatigue, better mood

Self-management program helps

Psyc outcome of Alzheimer’s

Can’t handle daily tasks and remember things → helplessness, depression

Caregivers of ppl w AD often have

Stress, lower self-efficacy, poorer health, depression

Interventions like cognitive restructuring, respite centres (nurses take care day and night to let caregivers rest) can help them