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 |
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| Authors: | Joanna L. Hudson Chris Bundy Peter A. Coventry Chris Dickens |
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| Affiliation: | 1. Health Psychology Section, Psychology Department, Institute of Psychiatry, King''s College London, UK;2. NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK;3. Mental Health Research Group, Institute of Health Research, University of Exeter Medical School, UK;4. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK |
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| Abstract: | ObjectiveDepression 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.MethodsMedline, 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.ResultsNine 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.ConclusionsAssociations 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. |
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| Keywords: | BIPQ, Brief Illness Perception Questionnaire BMQ, Beliefs about Medicines Questionnaire CI, confidence interval CS-SRM, Common Sense Self-Regulation Model DIRQ, Diabetes Illness Representations Questionnaire DV, dependent variable FSN, fail safe N HbA1c, glycosylated haemoglobin IPQ, Illness Perception Questionnaire IPQ-R, Revised Illness Perception Questionnaire n, number NA, not applicable NE, non-estimable NR, not-reported NS, non-significant PMDI, Personal Models of Diabetes Interview S, step TC, treatment control |
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