kossakowska ps6

The role of illness perceptions in benefit finding among chronically ill people

Marlena Kossakowska, Ph.D.

University of Social Sciences and Humanities, Sopot, PolandPositive Psychology Center, University of Pennsylvania, Philadelphia, USA

Introduction

* Benefit finding (Tennen, Affleck, 2005) is a meaning making

construct that has been shown to be related to positive growth among chronically ill individuals. Personal growth is understood in terms of one’s psychological and social development, including exposure to life difficulties and challenges, and is related to good mental health and well-being (Ryff, Singer, 1998). According to the Model of Personal Growth in Chronic Illness the individual illness perception plays significant role in benefit finding. * Illness perceptions are the subjective cognitive representations of illness (Weinman et al. 1996), including the following components: identity, cause, time-line, consequences and cure/control.

Theoretical assumptions

ILLNESS

PERCEPTIONS

Coping

Personal GrowthCommon-Sense Model of Self-Regulation of

Health and Illness

(Leventhal, Brissette, Leventhal,

2003)

Transactional Model of Stress

and Coping (Lazarus,

Folkman, 1984)

Benefit -finding benefit-reminding

(Tennen, Affleck, 2005)Meaning in life

Self-esteem

Personal Growth

Initiative

Intensity of Positive

Emotions in daily life

Aims

1. How many benefits do patients find from their illness?

2. What are the predictors of benefit findings in chronic illness?

3. What is a placement of illness perception in benefit finding prediction among chronically ill people?

Method: participants, n=410

n Female/MaleAge

Mean (SD)Illness duration

Hashimoto’s D. 40 0/40 30.98 (10.61) 3.01 (3.82)

Ischemic Hearts D. 30 15/15 62.90 (8.75) 2,13 (4.76)

Multiple Sclerosis 135 87/48 46, 14(12.62) 13,44 (12.10)

Cancer 62 42/20 52.63 (10.91) 3.44 (3.35)

Diabetes type 2 17 7/10 53.53 (15.59) 8.07 (7.91)

Psoriasis 44 30/14 32.47 (10.62) 14.28 (10.62)

Celiac D. 9 9/0 33.00 (9.72) 12.44 (15.4)

Rheumatoid arthritis 5 5/0 33.00 (10.20) 6.4 (5.18)

HIV/AIDS 60 18/42 43.02(8.44) 5.9 (8.21)

others 8 6/2 57.75 (9.48) 5.01 (2.1)

Overall 410 260/150 45.00 (14.40) 9.00 (10.47)

Method: Tools

1/ Illness Perception Questionnaire (Brief IPQ): Broadbent, Petrie, Weinman, Main, 20062/ COPE - Coping Orientations to Problems Experienced (Carver, Scheier, Weintraub, 1989) in Polish adaptation (Wrzesniewski, 1998)3/ MLQ - Meaning in Life Questionnaire (Steger, et al., 2006) in Polish validation of Kossakowska, Kwiatek, Stefaniak (2013)4/ SES - Self Esteem Scale (Rosenberg, 1965) in Polish version (Łaguna, Lachowicz-Tabaczek, Dzwonkowska, 2007)5/Positive Emotions Scale (Kossakowska,2014)6/ PGIS Personal Growth Initiative Scale (Robitschek, 1998) in Polish version: Kossakowska, Konkel, Robitschek (2014).7/ SL: The Silver Lining Questionnaire (Sodergren, Hyland, 2004) in Polish adaptation (Kossakowska,2014)

Method 1

Method 2

Methods 3-6

• MLQ. Meaning in life was measured by MLQ (Steger, et al., 2006) in Polish validation of Kossakowska, Kwiatek, Stefaniak (2013). This questionnaire consists of two subscales: presence of (α=.86), and search for (α=.72), meaning in life.

• PES. The intensity of positive emotions experiencing in daily life across the life span was assessed by the original scale created especially for this research in Polish circumstances by Kossakowska (2012). It was named Positive Emotions Scale and consists of 3 subscales: Love, Joy and Hope. PES has only Polish version. The individual is asked to assess the intensity of the following emotions using 6-point Likert’s scale (from 1- in a very little extend to 6- in very intensive extend): longing, sensitivity, desire, sentiment (LOVE, α=.86), exhilaration, enthusiasm, pleasure, happiness, cheerfulness (JOY, α=.87) and hope (HOPE).

• PGIS. The PGIS is a self-report instrument that yields a single scale score for personal growth initiative. Personal growth initiative (PGI) is a person's active and intentional involvement in changing and developing as a person(α=.86).

Method 7

Aim 1: How many benefits do patients find from their illness?

Benefits:OVERALL

N (%)

APPRECIATION

N (%)

RELATIONS

N (%)

PHILOSOPHY

N (%)

INFLUENCE

N (%)

STRENGHTS

N (%)

NO BENEFITS 23 (5.6) 112 (27.3) 77 (18.8) 200 (48.80) 222 (54.15) 81 (19.76)

AT LEAST 1

BENEFIT387 (94.4) 298 (72.7) 333 (81.2) 210 (51.20) 188 (45.85) 329 (80.24)

overall 410 410 410 410 410 410

94 % of participants declare one or more psychosocial benefits from their illness

Aim 2: What are the predictors of benefit findings in chronic illness?

Regression Summary for Dependent Variable: Benefit Finding Overall (SLQ-24)

R= .30; R²= .10; Adjusted R²= .07; F(8,378)= 4.74; p<.001

N=387 Beta Std.Err. - of Beta B Std.Err. - of B t(378) p-level

Intercept 7.94 1.94 4.09 .00001

IPQ1:

Consequences .06 .06 .12 .12 .96

IPQ2:

Timeline-.17** .05 -.49 .15 -3.35 .001

IPQ3:

Personal Control.11* .06 .21 .11 1.99 .05

IPQ4:

Treatment Control.08 .06 .17 .11 1.49

IPQ5: Identity/Severity .14* .06 .31 .13 2.42 .05

IPQ6:

Concern-.09 .07 -.16 .14 -1.16

IPQ7:

Understanding.10 .05 .18 .10 1.84 .07

IPQ8:

Emotional Response-.05 .07 -.10 .14 -.68

The results of hierarchical regression analyses indicate that benefit finding is predicted directly by illness perceptions. The most significant predictors in benefit finding are: personal control (β=-.11), illness identity/severity (β=.14) and timeline (β=-.17) (R²= .07, F(8,378)=4.74; p< .001).

Aim 3: Placement of illness perception in benefit finding prediction

• Six independent forward multiple regression, sequentially add variables into model

• Significance level to enter, SLE: .20

Placement of illness perceptions in benefit finding prediction among chronically ill people, n=387

ILLNESS

PERCEPTIONS

TIMELINE β= -.14**

IDENTITY β=.08

CONCERN β= -.12*

UNDERSTANDING β= .07

PERSONAL CONTROL β= .06

Coping

PROBLEM β=.36****RELIGION β= .29****

ACCEPTANCE β=.11*

SHUMOR β= -.08

SUPPORT β= .05 Benefit -finding benefit-reminding

(total)

R²=.32 ****F(12, 376)=14.82

MLQ-S β=.18***

PGI β=.16**

Placement of illness perceptions in benefit finding: INNER STRENGTHS prediction among chronically ill people, n=329

ILLNESS

PERCEPTIONS

TIMELINE β= -.20*UNDERSTANDING

β= .12*IDENTITY β= .11*

Coping

PROBLEM β= .28****RELIGION β= .17**ACCEPTANCE β=.11

DENIAL β= -.07

Benefit -finding benefit-remindingINNER STRENGTHS

R²=.24 ****F(11,317)=9.34

PGI β=.17**

MLQ-S β=.17***

JOY β=.10

HOPE= .07

Placement of illness perceptions in benefit finding: PHILOSOPHY prediction among chronically ill people, n=210

ILLNESS

PERCEPTIONS

UNDERSTANDING β= .14*

IDENTITY β= .08

Coping

RELIGION β= .40****ACCEPTANCE β=.09EMOTIONS β= -.08PROBLEM β= .07


PHILOSOPHY

R²=.31 ****F(9,200)=9.81PGI β=.27****

MLQ-S β=.15*

LOVE β= -.11

Placement of illness perceptions in benefit finding: POSITIVE INFLUENCE prediction among chronically ill people, n=188

ILLNESS

PERCEPTIONS

IDENTITY β= .15*CONCERN β= -.10

PERSONAL CONTROL β=.10

CONSEQUENCES β=.11

Coping

RELIGION β= .22**ALCOHOL β=.10PROBLEM β= .10


POSITIVE INFLUENCE

R²=.22 ****F(11,176)=4.48

PGI β=.20**

MLQ-S β=.18**

SELF-ESTEEM β=.16*

MLQ-P= -.12

Placement of illness perceptions in benefit finding: POSITIVE RELATIONSHIPS prediction among chronically ill people, n=333

ILLNESS

PERCEPTIONS

CONCERN β= -.11*TIMELINE β= -.10*

Coping

ACCEPTANCE β=.25***PROBLEM β= .15*ALCOHOL β=-.09SUPPORT β= .10RELIGION β= .06


POSITIVE RELATIONSHIPS

R²=.14 ****F(9,323)=5.64

MLQ-S β=.10

SELF-ESTEEM β=.07

Placement of illness perceptions in benefit finding: APPRECIATION prediction among chronically ill people, n=298

ILLNESS

PERCEPTIONS

PERSONAL CONTROL β= .21***

TIMELINE β= -.12*

IDENTITY β=.13*

CONCERN β= -.17**

UNDERSTANDING β= .06

Coping

ACCEPTANCE β=.21***DENIAL β= -11*

RELIGION β= .11*


APPRECIATION

R²=.26 ****F(11,286)=9.14JOY β=.28****

MLQ-P β=.14*

MLQ-S β=.12*

Placement of illness perceptions in benefit finding’sprediction among chronically ill people

• Timeline is located at the 2nd, 4th, 5th or 6th position in BF prediction. The placement depends on the domain of BF.

• Identity/severity is located at the 5th or 7th position in BF prediction. The placement depends on the domain of BF.

• Concern is located at the 3th, 7th or 8th position in BF prediction. The placement depends on the domain of BF.

• Personal Control is the most important predictor (after intensity of Joy experienced in life) for Appreciation of Life only (2 step)

• Understanding is the most important predictor for Changes in Philosophy (4t step) and for Inner Strengths increasing (6th step) only

Conclusions

• People are willingly to find benefits from their illness

• Illness perceptions seem to be moderate but still important predictors for BFs. Their placement is more or less important. Choice of proper strategies (Problem Focused Coping) Religion, Acceptance) and selected psychological resources (meaning in life, PGI, self-esteem, intensity of positive emotions) are still more important than illness perceptions.

• In positive therapy of chronically ill people it is important to pay attention on cognitive and emotional representations of illness and on behavioral aspects of coping with illness in terms of coping strategies

This study was granted by Polish National Science Center No 2011/03/B/HS6/01117

Thank you!

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