Quality of life of adolescents with asthma: the role of personality, coping strategies, and symptom reporting

Objective

The aim of this study was to test which personality traits were related to quality of life (QOL) of adolescents with asthma, and whether relations between personality and QOL were mediated by coping strategies and symptom reporting.

Methods

A sample of 405 12 to 16-year-olds with asthma completed questionnaires on personality, coping, symptom reporting, and QOL (overall QOL and positive effects QOL). The direct relations between personality traits and QOL, as well as mediation pathways were tested with structural equation modeling.

Results

Adolescents high on extraversion and low on neuroticism had better overall QOL, while adolescents high on agreeableness had better positive-effects QOL. The coping strategy restricted lifestyle fully mediated the relation between extraversion and overall QOL, the relation between neuroticism and overall QOL was fully mediated by symptom reporting and the coping strategy worrying about asthma. The coping strategies positive reappraisal and hiding asthma fully mediated the relation between agreeableness and positive-effects QOL.

Conclusion

The results show that personality is related to QOL in adolescents with asthma. These relations were fully mediated by coping and symptom reporting. This study sheds light on the underlying mechanism why personality is associated with QOL. The results of this study will help to understand what determines QOL in patients with chronic illness in general and adolescents with asthma specifically. Furthermore, the results will help to design interventions that could facilitate minimizing the negative effects of having asthma on the QOL of these adolescents.     

Family environment,coping, and mental health in adolescents attending therapeutic day schools

Objective

This study examined associations among family environment, coping, and emotional and conduct problems in adolescents attending therapeutic day schools due to mental health problems.

Methods

Adolescents (N = 417; 30.2% female) ages 13–20 (M = 15.25) reported on their family environment (affective involvement and functioning), coping (emotion-focused support-seeking, cognitive restructuring, avoidant actions), and emotional and conduct problems.

Results

Poorer family environment was associated with less emotion-focused support-seeking and cognitive restructuring, and more emotional and conduct problems. Emotional problems were negatively associated with cognitive restructuring, and conduct problems were negatively associated with all coping strategies. Cognitive restructuring accounted for the relationship between family environment and emotional problems. Cognitive restructuring and emotion-focused support-seeking each partially accounted for the relationship between family functioning and conduct problems, but not the relationship between family affective involvement and conduct problems.

Conclusions

Findings implicate the role of coping in the relationship between family environment and adolescent mental health.     

The link between asthma and smoking explained by depressive feelings and self-efficacy

Objective

Adolescents with asthma consistently smoke at higher or similar rates as non-asthmatic peers, although smoking might involve more health risks. This study examined possible mechanisms (i.e. depressive feelings and self-efficacy to refrain from smoking) explaining the association between asthma and smoking initiation.

Methods

An indirect path from asthma to self-efficacy through depressive feelings was examined in two independent samples. Sample 1 consisted of 4531 adolescents (mean age 12.8) and sample 2 consisted of 1289 children (late childhood, mean age 10.1). Data were gathered from maternal and self-report. In the adolescent sample, whether the relationship between depressive feelings at baseline and smoking initiation two years post-baseline runs via self-efficacy was also examined.

Results

Higher amounts of depressive feelings decreased adolescents' self-efficacy to refrain from smoking, which subsequently increased the risk to initiate smoking. A diagnosis of asthma was also associated with higher levels of depressive feelings which in turn decreased self-efficacy. A marginal significant indirect effect was found in the childhood sample.

Conclusion

Smoking prevention efforts should start as early as mid to late childhood. The results indicate that focus should be placed on preventing depressive feelings with the aim of increasing children's self-efficacy to refrain from smoking. This is especially important for children and adolescents with asthma.     

Effect of Type D personality on medication adherence in early adolescents with asthma

Objective

Medication adherence for daily preventive asthma medication is especially low during adolescence. In the present study, we aimed to test whether Type D personality (both as a category and with its constituent components (negative affectivity: NA and social inhibition: SI) separately and in interaction) predicts medication adherence of early adolescents with asthma.

Methods

In a prospective study, 188 early adolescents with asthma who were prescribed daily preventive asthma medication completed questionnaires on Type D personality, medication adherence, socio-demographic and clinical information, and depressive symptoms in the Spring/Summer of 2011 (T1) and again 12 months later (T2). Multiple regression analyses, controlling for demographic and clinical information and for depressive symptoms, were conducted to test whether Type D personality (either as a categorical or dimensional construct) predicted changes in medication adherence over time.

Results

Adherence was significantly lower at T2 than at T1 and this decrease was predicted by the categorical construct of Type D personality. Analyses of the two separate dimensions NA and SI and their interaction showed that higher scores on NA at T1 predicted more decrease in adherence over time. Neither SI nor the interaction between NA and SI predicted changes in adherence.

Conclusion

This is the first study to test the relationship between Type D personality and medication adherence in adolescents. Although categorical Type D personality predicts mediation adherence of adolescent with asthma over time, dimensional analyses suggest that this is due to negative affectivity only, and not to the combination of negative affectivity and social inhibition.     

Bully victimization and emotional problems in adolescents: Moderation by specific cognitive coping strategies?

Objective

Relationships between bully victimization and symptoms of depression/anxiety were examined. In addition, it was studied whether this relationship was moderated by specific cognitive coping strategies.

Methods

Participants were 582 secondary school students who filled out online self-report questionnaires on bully victimization, cognitive coping, and depression/anxiety. (Moderated) Multiple Regression analysis was performed.

Results

Strong relationships were found between bully victimization and symptoms of depression and anxiety. On top of that, two cognitive coping strategies moderated the relationship between bullying and depression, i.e. rumination (strengthening) and positive refocusing (reducing). Cognitive coping strategies that moderated the effect of bullying on anxiety symptoms were rumination, catastrophizing (strengthening) and positive reappraisal (reducing).

Conclusion

The results provide possible targets for intervention: when helping adolescents who have been bullied, maladaptive cognitive coping strategies could be assessed and challenged, while more adaptive strategies could be acquired.     

Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis

Objective

Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care.

Methods

Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated.

Results

Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r = ± 0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also.

Conclusions

Associations between cognitive illness representations and poor emotional health were in the expected direction — negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.     

Associations of psychological thriving with coping efficacy,expectations for future growth,and depressive symptoms over time in people with arthritis

Objective

Psychological thriving reflects a trajectory of growth over time as opposed to scaling back expectations. Whether thriving is a product, precursor, or process of coping with arthritis-related limitations is unclear. We examined associations between thriving, coping efficacy, and expectations for future growth in individuals with arthritis, and the relations of thriving to depressive symptoms and retrospective perceptions of personal growth over a six-month period.

Methods

A sample of 423 people with arthritis completed measures of thriving, coping efficacy, depressive symptoms, and expectations for future growth; 168 individuals completed a six-month follow-up survey. Structural equation modeling analyses compared three possible models of psychological thriving, controlling for disease-related variables. Hierarchical regression analyses of the cross-lagged associations of thriving with retrospective perceptions of positive personal change and depressive symptoms were also conducted.

Results

Structural equation analyses suggest that the process model in which thriving and coping efficacy jointly predicted expectations for future growth best fit the data. Baseline thriving was also associated with retrospective perceptions of personal growth at follow-up and fewer depressive symptoms at baseline and follow-up, after controlling for disease-related variables.

Conclusion

Overall, these findings suggest that psychological thriving is synergistically related to coping efficacy, and to expectations for future growth and less depression, in people with arthritis. Importantly, our findings support the notion that psychological thriving is more than scaling back expectations, and that thriving may be an important quality to cultivate to address the burden of depression in people with arthritis.     

Illness perceptions and emotional well-being in men treated for localized prostate cancer

Objective

Emotional adjustment to cancer survivorship may be influenced by how patients interpret treatment side effects and other cancer-related experiences. The current study examined cognitive representations of illness, as conceptualized by the Self-Regulatory Model (SRM), in men treated for localized prostate cancer (PC). More severe PC perceptions were hypothesized to predict poorer emotional well being, particularly among men experiencing greater post-treatment sexual dysfunction or general life stress.

Methods

The Perceived Stress Scale, Expanded Prostate Cancer Index Composite, Illness Perception Questionnaire-Revised, and Functional Assessment of Cancer Therapy were administered to 214 men within 18 months of completing treatment for early stage PC.

Results

Perceptions that PC was less comprehensible, was less likely to be controlled by treatment, and was more likely caused by one's own personality and behaviors remained associated with poorer emotional well being after adjusting for relevant medical and demographic factors. Life stress moderated the relationship between perceived consequences of PC and emotional well-being, such that more severe perceptions of negative consequences predicted poorer emotional well-being only for men experiencing higher life stress. Degree of sexual dysfunction did not moderate any relationships between cancer perceptions and emotional well-being.

Conclusion

Within 18 months of completing treatment for localized PC, more severe perceived consequences of PC were associated with poorer emotional well-being, particularly among men experiencing greater life stress. Interventions that target distortions in illness perceptions may enhance emotional adjustment among the most distressed PC survivors.     

Asthma and odors: The role of risk perception in asthma exacerbation

Objective

Fragrances and strong odors have been characterized as putative triggers that may exacerbate asthma symptoms and many asthmatics readily avoid odors and fragranced products. However, the mechanism by which exposure to pure, non-irritating odorants can elicit an adverse reaction in asthmatic patients is still unclear and may involve both physiological and psychological processes. The aim of this study was to investigate how beliefs about an odor's relationship to asthmatic symptoms could affect the physiological and psychological responses of asthmatics.

Methods

Asthmatics classified as ‘moderate-persistent’, according to NIH criteria, were exposed for 15 min to a fragrance which was described either as eliciting or alleviating asthma symptoms. During exposure, participants were asked to rate odor intensity, perceived irritation and subjective annoyance while physiological parameters such as electrocardiogram, respiratory rate, and end tidal carbon dioxide (etCO₂) were recorded. Before, immediately after, and at 2 and 24 h post-exposure, participants were required to subjectively assess their asthma symptom status using a standardized questionnaire. We also measured asthma status at each of those time points using objective parameters of broncho-constriction (spirometry) and measures of airway inflammation (exhaled nitric oxide, FeNO).

Results

Predictably, manipulations of perceived risk altered both the quality ratings of the fragrance as well as the reported levels of asthma symptoms. Perceived risk also modulated the inflammatory airway response.

Conclusions

Expectations elicited by smelling a perceived harmful odor may affect airway physiology and impact asthma exacerbations.     

Illness perceptions among carer-survivor dyads are related to psychological distress among Oesophageal cancer survivors

Objective

To examine the extent to which the illness perceptions of Oesophageal cancer survivors and the illness perceptions of their carers explain the survivors' levels of psychological distress (in terms of anxiety and depression symptoms) relative to demographic and biomedical variables and patients' coping strategies.

Method

Everyone registered with the Oesophageal Patients' Association in the UK was mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, and the Hospital Anxiety and Depression Scale. Patients were asked to pass a modified version of the Illness Perception Questionnaire-Revised to someone they identified as a carer. Complete responses were received from 317 dyads.

Results

Regression models indicated that the variables measured could explain 56% of the variance in anxiety and 54% of the variance in depression. Patients' illness perceptions explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological well-being. Some of the carers' illness perceptions made a significant contribution to the explanation of the patients' levels of psychological distress, and in some instances, carer perceptions were found to moderate the relationship between patients' perceptions and psychological distress.

Conclusion

The findings suggest that cognition-based interventions could potentially be most effective in minimizing emotional distress among survivors of Oesophageal cancer. This study also shows that these interventions could usefully be delivered at the level of the patient-carer dyad.     

Impact du niveau d’activité physique sur l’alexithymie et le coping dans une population de plus de 40 ans atteinte de sclérose en plaques : une étude pilote

Introduction

The aim of this study was to evaluate the impact of physical activity on alexithymia and coping strategies among people with multiple sclerosis aged over 40. The hypotheses were that physical activity should have a protective effect on alexithymia, and more particularly, on “emotional identification” and could influence coping strategies because it can be considered as a distractive coping strategy.

Methods

Thirty-seven patients aged 40 years or older were asked to complete a form including an identification sheet and standardized questionnaires: the Bermond-Vorst Alexithymia Questionnaire (version B), the Coping with Health Injuries and Problem Questionnaire, the Fatigue Impact Scale, and the Hospital Anxiety and Depression Scale.

Results

The participants with a high or moderate level of physical activity used “information research” as a coping strategy better than those who had a lower level of physical activity. They also analyzed their emotions better. The results revealed an association between these variables and anxiety, depression and fatigue.

Discussion

This study provides insight for future research about the impact of physical activity on multiple sclerosis.     

Illness perceptions,mood and quality of life: A systematic review of coronary heart disease patients

Objective

To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations.

Methods

Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check.

Results

21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction.

Conclusion

The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.     

Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes

Background

Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally.

Purpose

This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control.

Methods

Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents’ medical charts.

Results

The adolescents’ use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life.

Conclusions

The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent’s diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes.

     

Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients

Objective

Patients' beliefs about their disease have been associated with emotional adjustment and outcomes in several severe illnesses. The aim of the present study was to investigate whether illness perceptions before pulmonary rehabilitation influence exercise capacity and quality of life after rehabilitation in patients suffering from chronic obstructive pulmonary disease (COPD).

Methods

Ninety-six patients with COPD (GOLD III/IV) were approached on admission to rehabilitation and reassessed before discharge. Assessment included medical measures of FEV?% predicted, and exercise capacity (6 min walk test). Additionally, depressive symptoms (Hospital Anxiety and Depression scale), anxiety (COPD specific anxiety questionnaire) and quality of life (Short Form 36 health survey (SF-36)) were assessed. Illness beliefs were measured by the Revised Illness Perception Questionnaire (IPQ-R).

Results

Exercise capacity and psychological well-being (SF-36) of patients improved after rehabilitation programme, while physical functioning (SF-36) did not change. Additionally, patients showed significantly lower levels of depressive symptoms, COPD specific anxiety and negative perceptions of their illness after pulmonary rehabilitation compared to baseline. In the hierarchical multiple regression analyses, after controlling for socio-demographic data, psychological variables, illness severity and baseline scores of the corresponding variables, it was shown that illness perceptions before rehabilitation predicted exercise capacity and psychological well-being, both assessed at the end of treatment.

Conclusion

COPD patients' perceptions about their illness before rehabilitation influence exercise capacity and quality of life (psychological well-being) after treatment. Therefore it might be relevant to identify and change maladaptive illness perceptions in order to improve medical and psychological outcome in COPD.     

Coping profiles in bipolar disorder

Objective

As coping responses have the capacity to distinctly influence the illness course in affective disorders, they form targets for psychological intervention. Beneficial effects have been reported for interventions incorporating adaptive coping in bipolar disorder. Identification of differential coping preferences in bipolar disorder sub-types has etiological and clinical implications. As most studies to date have focused exclusively on bipolar I disorder, the current study examines coping profiles in those with a bipolar I or II disorder, contrasted with unipolar depressive and healthy controls.

Methods

Groups were derived on the basis of agreement between clinician and DSM-IV diagnoses. Participants (94 bipolar I, 114 bipolar II, 109 unipolar recurrent depression, 100 healthy controls) completed coping style measures including the Brief Cope, Responses to Positive Affect questionnaire, Response Styles Questionnaire, the Coping Inventory for Prodromes of Mania, and the Cognitive Emotion Regulation Questionnaire.

Results

Bipolar (I and II) participants were more likely than unipolar participants to ruminate about positive affect, and engage in risk taking when faced with negative affect. Medication status and current mood symptoms influenced risk-taking scores in the bipolar sub-sets, however rumination about positive affect appeared to represent a trait-like response in those with a bipolar II disorder. Behavioral coping strategies differentiated bipolar sub-types, with bipolar II participants being less likely to seek support when faced with stress, and less likely to engage in strategies to down-regulate hypomania.

Conclusion

Coping style differences were observed between bipolar sub-types. Further consideration of such differentiating characteristics should serve to direct the focus towards specific targets for clinical intervention, reflecting nuances integral to the differing conditions.     

The effect of seasonality on sleep-disordered breathing severity in children

Objective

Sleep-disordered breathing (SDB) is a common disorder associated with substantial morbidity that occurs in otherwise healthy children. Atopy, asthma, and viral upper respiratory tract infections are known risk factors for pediatric SDB that exhibit seasonal variability. The aim of our study was to investigate the effect of seasonality on SDB severity in children and adolescents referred for polysomnographic evaluation for suspected SDB and to examine the effect of atopy/asthma on this variability.

Methods

The medical records of all children and adolescents referred for a polysomnography (PSG) for suspected SDB between 2008 and 2010 were retrospectively assessed for seasonal patterns. The effect of atopy/asthma, age, and obesity on seasonal variability was investigated.

Results

A total of 2178 children and adolescents (65% boys) were included. The mean age of the cohort was 4.9 ± 3.5 years (range, 3 months–18 years). Eighteen percent of patients had a history of asthma/atopy. The mean obstructive apnea–hypopnea index (OAHI) in the winter was significantly higher compared to the summer (9.1 ± 9.6 vs 7.5 ± 7.0; P = .01; Cohen d = 0.19), particularly in children younger than the age of 5 years (10.2 ± 10.5 vs 7.9 ± 7.3; P = .008; Cohen d = 0.25). Asthma/atopy had no significant effect on seasonal variability.

Conclusions

SDB severity alters in a season-dependent manner in children and adolescents referred for polysomnographic evaluation for suspected SDB. These alterations are more prominent in children younger than the age of 5 years. The presence of asthma/atopy does not contribute to this seasonal variability. These findings suggest that viral respiratory infections are most likely the major contributor for the seasonal variability observed in pediatric SDB; additionally, the time of the year when a child is evaluated for suspected SDB may affect the clinical management and outcome in borderline cases.     

Struggling in an emotional avoidance culture: A qualitative study of stress as a predisposing factor for somatoform disorders

Objective

To explore patterns of experienced stress and stress reactions before the onset of illness in the life history of patients with severe somatoform disorders to identify predisposing stress-mechanisms.

Methods

A systematic, thematic analysis was conducted on data collected from 24 semi-structured individual life history interviews.

Results

Generally, patients had experienced high psychosocial stress during childhood/youth. However, there was considerable variability. Characteristic of all patients were narrations of how communication with significant adults about problems, concerns, and emotions related to stress were experienced to be difficult. The patients described how this involved conflicts stemming from perceived absent, insufficient, or dismissive communication during interactions with significant adults. We conceptualized this empirically based core theme as “emotional avoidance culture.” Further, three related subthemes were identified: Generally, patients 1.) experienced difficulties communicating problems, concerns, and related complex feelings in close social relations; 2.) adapted their emotional reactions and communication to an emotional avoidance culture, suppressing their needs, vulnerability and feelings of sadness and anger that were not recognized by significant adults; and 3.) disconnected their stress reaction awareness from stressful bodily sensations by using avoidant behaviors e.g. by being highly active.

Conclusion

Patients adapted to an emotional avoidance culture characterized by difficult and conflicting communication of concerns and related emotions in social interactions with significant adults. Patients experienced low ability to identify and express stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact, which made them vulnerable to stressors. Generally, patients resolved stress by avoidant behaviors, prolonging their stress experience.     

Behavior problems and prevalence of asthma symptoms among Brazilian children

Objective

Asthma is the most common chronic disease in childhood and has been designated a public health problem due to the increase in its prevalence in recent decades, the amount of health service expenditure it absorbs and an absence of consensus about its etiology. The relationships among psychosocial factors and the occurrence, symptomatology, and severity of asthma have recently been considered. There is still controversy about the association between asthma and a child's mental health, since the pathways through which this relationship is established are complex and not well researched. This study aims to investigate whether behavior problems are associated with the prevalence of asthma symptoms in a large urban center in Latin America.

Methods

It is a cross-section study of 869 children between 6 and 12 years old, residents of Salvador, Brazil. The International Study of Allergy and Asthma in Childhood (ISAAC) instrument was used to evaluate prevalence of asthma symptoms. The Child Behavior Checklist (CBCL) was employed to evaluate behavioral problems.

Results

19.26% (n = 212) of the children presented symptoms of asthma. 35% were classified as having clinical behavioral problems. Poisson's robust regression model demonstrated a statistically significant association between the presence of behavioral problems and asthma symptoms occurrence (PR: 1.43; 95% CI: 1.10-1.85).

Conclusion

These results suggest an association between behavioral problems and pediatric asthma, and support the inclusion of mental health care in the provision of services for asthma morbidity.     

The role of goal cognitions,illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: A cohort study

Objective

Nonadherence to immunosuppressive medication (IM) after kidney transplantation is related to poorer patient and graft outcomes; therefore research into modifiable factors associated with nonadherence is a priority. In this prospective cohort study we investigated whether changes in goal cognitions, illness perceptions, and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation.

Methods

Interviews were conducted with patients in the out-patient clinic six weeks (T1: n = 113) and six months (T2: n = 106) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS© Interview). The Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and questions on goal cognitions were also administered at both time points.

Results

Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17% to 27%. Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time. Perceived necessity of immunosuppressive medication was high but significantly decreased over time. Concerns about the medicines were low. There were no significant changes in illness perceptions or concerns over time. An increase in perceived graft longevity (timeline) was related to higher likelihood of nonadherence six months post-transplant. Furthermore, younger adult patients were more likely to be nonadherent six months after transplantation.

Conclusion

The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.     

Longing for existential recognition: A qualitative study of everyday concerns for people with somatoform disorders

Objective

Patients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life.

Methods

A cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory.

Results

A major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) “existential misrecognition” covered the experience of being met with distrust and disrespect, 2) “uncertain existential recognition” covered experiences of unclear communication and a perception of not being totally recognized, and 3) “successful existential recognition” covered experiences of total respect and understanding. “Misrecognition” and “uncertain recognition” related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas “successful recognition” related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal.

Conclusion

Different modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.