Week 10 Flashcards
What are the four main features of chronic illness?
Long term: often lifelong (e.g. diabetes, asthsma)
Treatment: is not often curative and rather designed to manage symptoms and/or prevent progression of illness e.g. blood thinning medication to prevent heart attack/stroke
Lifestyle changes are required: physical activity and diet modification; avoidance of risky situations; use of mobility aids in the case of disabling illness
Functioning often affected
What are the two Australian bodies that estimate population prevalences?
Australian Bureau of Statistics (ABS) and Australian Institute of Health + Wellbeing (AIHW)
What are the ten main categories of chronic and acute disease?
- Arthritis
- Asthma
- Back pain/related
- Cancer
- Cardiovascular disease
- Chronic obstructive pulmonary disease
- Diabetes
- Chronic kidney disease
- Mental/behavioural condition
- Osteoporosis
All conditions up to 47% of Australian population
Responsible for 51% of hospital admissions
89% of deaths connected with these conditions
20% of the population has 2+ chronic health conditions - common and costly
What does a DALY measure?
Disability-Adjusted Life Years
Refers to years of healthy life lost to illness.
Comprised of YLL to death and YLL to disability.
Measures the impact of health problem on a population
1 DALY = 1 year of healthy life lost
In 2015, 4.8million DALYs lost to the burden of disease
QALY = Quality Adjusted Life Years
What role can health psychology play in chronic disease?
Prevention: understanding of the risk factors and promotion of healthy behaviours that reduce risk
Intervention: promote self-management of illness through, for example, adherence to medication schedules, lifestyle modifications
What are some of the limitations of the biomedical model of illness?
Too narrow to explain lifestyle related illnesses such as obesity, metabolic disease
Cannot account for medically unexplained symptoms or syndromes
Individuals experience of illness and symptoms is influenced by more than just biology
George Engels 1997 biopsychosocial model considered what three elements?
Biological
Psychological
Social (social + cultural contexts)
What are the biopsychosocial elements involved in Chronic Obstructive Pulmonary Disease (COPD)
Biological: lung inflammation; chronic infections; medical treatments such as inhalers, steroids etc
Psychological: substance use; uncertainty; identity changes; stress influenced symptoms; participation in self-management
Social: stigma; work environment; effect on family/spouse; difficulty remaining active
Define adjustment to chronic illness.
An organism returns to equilibrium after facing a disruption > makes changes to fit with new environment
What domains measure adjustment?
Quality of life
Emotional wellbeing
Life satisfaction
Self-esteem
Role functioning (work/social)
Why is adjustment important in terms of chronic illness?
Adjusting well helps to maintain role functioning and emotional wellbeing. When someone does not adjust well, this can add to the stress of the illness course and progression and reduce QOL (think DALYs)
Why do we have theories of adjustment to illness?
It helps us to have measurable constructs as we can predict and understand how people do/will adjust
What are some of the challenges of theories of adjustment to illness?
It’s a complex process with many multifaceted influences.
Adjustment is generally not a linear process.
Illnesses are highly variable i.e. amputation vs. epilepsy
Models cannot really explain enough variance in adjustment outcomes
Describe the assumptions of Mobs & Schaefer’s Crisis Theory (1984)
Major life crises and transition disrupt social and psychological equilibrium
Return to equilibrium can be either a healthy adaptation or a maladaptive response
Illness or injury constitute a crisis
Describe the two key elements of Mobs & Schaefer’s Crisis Theory (1984)
Adaptation and Coping skills.
Part 1: The model posits that a cognitive appraisal of the illness seriousness is the first phase.
Part 2: The model suggests that Adaptive Tasks can be divided into two categories; illness related (dealing with pain, procedures, hospitals) and general tasks (maintaining and emotional balance, preserving self-image and mastery, sustaining relationships, preparing for an uncertain future).
Part 3: Relates to coping skills (understanding the illness, confronting related problems, managing emotions)
A strength of the model is that each of these elements are clinically useful and can assess adaptation.
According to Moss & Schaefer, what three factors influence an individual’s ability to adapt?
- Nature of the person (demographic and personal characteristics)
- Aspects of the illness (course, outcome)
- Context (physical and social environment)
What are some of the issues with Moss & Schaefer’s Crisis Theory Model?
No clear measurable outcomes; how do we measure adaptiveness?
No clear empirical base; how were these categories decided?
Has not been empirically applied to chronic illness literature
Describe Lazarus & Folkman’s Model of Transactional Stress (1984)
Highlights the importance of appraising and coping in stress/threat situations.
Three main steps:
1. Primary and secondary appraisal
2. Coping strategies
3. Reappraisal
Overlaps with other theories i.e. CBT ad has a good evidence base to suggest that appraisal is central to coping and coping clearly affects adjustment.
Describe the key features of Moss-Morris’s Unified Theory (2013).
Combines aspects of Moss & Schaefer and Lazarus & Folkman models
Define adjustment as an outcome and a process
Acknowledges illness as an ongoing stressor
Good treatment utility
Limitations:
Complex, lacks parsimony and challenging to measure and build an empirical basis.
What are some of the psychological impacts of chronic illness?
Most of the research focuses on depression and anxiety
Depression: depressed mood most days; loss of interest and pleasure; often accompanied by fatigue and sleep disturbance, appetite change, cognitive difficulties
Anxiety: excessive fear and behavioural disturbance; focus of fear depends on the disorder i.e. SAD/GAD
What is the relationship between illness and psychiatric comorbidity?
Bidirectional.
Chronic illness is a risk factor for developing anxiety/depression
Pre-existing anxiety and depression are a risk factor for developing illness > have existing anxiety and depression can lead to worse illness outcomes
How does chronic illness affect mental health?
Fatigue: commonly reported in anxiety and depression; can be a side-effect of many medications i.e. chemotherapy; cardinal symptom of some illnesses e.g. heart disease, iron deficiency
Shaky hands: associated with anxiety, anxious distress; very frequent medication side effects (steroids, heart meds); cardinal symptom of some illnesses (Parkinson’s, tremor, hyperthyroidism)
What are some of the biological influences of psychological disorders affecting health?
Neural pathways that can modulate pain and distress
Chronic activation of stress-response may affect a range of bodily systems e.g. immune, digestive, musculoskeletal
Emerging evidence of the importance of sleep for health
What are some of the psychosocial influences of psychological disorders affecting health?
Comorbidity of substance use problems (alcohol, smoking)
Depression and anxiety often associated with poorer self-care behaviours (exercise, diet, adherence to medications)
How can psychological treatment help chronic illness?
Promote adjustment (psychological distress; role functioning; self-management)
Illness management e.g. sleep deprivation = epilepsy seizures
One element of a holistic approach to care
Improve QOL and reduce burden/cost of illness
What do structured programs for chronic illness include?
Education relevant to the illness (diet/lifestyle modifications)
Physical therapy
Information on supports and resources
Psychological resources/strategies
What are some of the advantages on online approaches for adjusting to chronic illness?
Can be multidisciplinary
Financial advantages
Easier for people with mobility issues to access
Easier for people in rural/remote locations to access
Avoid lengthy wait-times
Can be delivered by appropriately qualified professionals
