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Does being involved by doctors satisfy patients' fundamental psychological needs? A study on a large European sample
Abstract
The present work was aimed at investigating whether the patients' involvement by their healthcare providers may satisfy patients' fundamental psychological needs (i.e. self-esteem, belonging, control, meaningful existence), which in turn, can impact their psychological well-being. Based on the European Quality of Life Survey data, the sample included 10,427 European adults who, in the last 12 months, visited GP/family doctors and hospital/medical specialists. Among them, 51.3% declared to have a chronic disease. Results showed that the experience of being involved by GP/family doctors and hospital/medical specialists had a positive effect on psychological well-being and that this effect was mediated by the satisfaction of all four needs. Moreover, the results of the moderated mediation model showed that the indirect effect of the involvement by GP/family doctors and hospital/medical specialists on psychological well-being through belonging was moderated by the presence or absence of a chronic condition. The study provides a novel contribution in investigating the positive effects of the patient's involvement, emphasizing its importance for patient's needs satisfaction, and its role appears particularly beneficial for the ones living with a chronic condition.
... seek health care services more frequently because they develop psychological and physical problems in response to prolonged ostracism (e.g., Rudert et al., 2021). (2) In what we term the "coping" account, using health care services more frequently may also be a coping mechanism for dealing with ostracism (e.g., Mazzoni et al., 2022). (3) The reverse association might also hold: What we refer to as the "stigmatization" account holds that individuals with illnesses get ostracized more often (e.g., Reinhard et al., 2020). ...
... Therefore, and in line with the notion that not all doctor visits are purely illness-related but driven by psychosocial needs (Barsky, 1981), one may speculate that ostracized individuals visit doctors to replenish psychological needs threatened by ostracism. In line with this idea, seeing a general practitioner (GP) benefits patients' well-being, specifically through the satisfaction of the four needs threatened by ostracism (Mazzoni et al., 2022). This further aligns with early theorizing that doctor-patient relationships become therapeutic through a sense of connection (Suchman, 1988). ...
... Importantly, by controlling for medical diagnoses, the present analyses offer one way of disentangling the coping and the sickness account and thus are the first to offer insight into the reasons why ostracized individuals visit doctors more frequently 3 years later: as a way of coping. Our findings thus align with previous work suggesting that seeing a doctor may afford the psychological needs that are typically threatened by ostracism (i.e., belonging, control, self-esteem, and meaningful existence, Mazzoni et al., 2022;Williams, 2009). Importantly, this does not reflect that ostracized individuals who seek medical advice are malingerers; rather, visiting a doctor fulfills a pressing social need. ...
Background: Individuals generally see doctors to get physically well, with potential benefits but also costs. We investigate ostracism (feeling ignored and excluded) as one possible factor for frequently seeing doctors. Aims: We test three different conceptual accounts: (1) Ostracism may impact health through stress and social pain processes (i.e., sickness account). (2) Seeing doctors may satisfy psychological needs that are typically threatened by ostracism, constituting a way of coping (i.e., coping account). (3) In the reverse direction, individuals who see doctors more frequently may be ostracized out of health stigmatization (i.e., stigmatization account). Method. Ostracism experiences, number of doctor visits, and medical diagnoses were assessed in a longitudinal, nationally representative panel survey of German adults (N = 2,001, two waves). Results: In cross-lagged panel analyses, ostracism predicts more frequent doctor visits 3 years later, even when controlling for medical diagnoses, suggesting doctor visits as a way of coping with ostracism. Number of medical diagnoses, but not doctor visits, longitudinally predict ostracism reports, potentially as an expression of health stigmatization. Limitations: The present results have been accrued in one context (Germany). We used retrospective recall of doctor visits, although we do not expect systematic recall biases based on ostracism experiences that could have altered the results. Conclusion: Ostracism leads to more frequent health care utilization. We conclude that seeing doctors more frequently may be a response to ostracism and call for efforts to develop ostracism-specific treatments and interventions.
... Für den Einzelnen beeinträchtigen Statusängste das subjektive (Delhey & Dragolov, 2014;Delhey & Steckermeier, 2016Schneickert et al., 2019;Steckermeier, 2021) und mentale Wohlbefinden (Layte, 2012;Mazzoni et al., 2022). Mit Blick auf die Gesellschaft stellen Statusängste vor allem eine Gefahr für die Demokratie dar, denn sie mindern das Institutionenvertrauen und die Demokratiezufriedenheit (Schneickert et al., 2019). ...
Dieser Beitrag befasst sich damit, wo die Deutschen sich selbst in der Gesellschaft verorten und wie sie die gesellschaftliche Ungleichheit wahrnehmen. Dabei konzentrieren wir uns auf die subjektive Statuseinstufung und Statusängste als selbstbezogene Wahrnehmungen sowie auf Vorstellungen von der sozialen Schichtung als gesellschaftsbezogene Wahrnehmung. Drei Leitfragen gliedern die Darstellung: Wie sieht die Ungleichheitswahrnehmung in Deutschland aktuell und über die Zeit aus? Welche Individualmerkmale strukturieren die Wahrnehmungen? Wo steht Deutschland im internationalen Vergleich?
... Status anxiety has been shown to impair subjective (Delhey & Dragolov, 2014; and mental wellbeing of individuals (Layte & Maître, 2009;Layte, 2012;Vasile, 2020;Mazzoni et al., 2021). At higher levels of status anxiety, people are less happy (Delhey & Steckermeier, 2016), and less satisfied with their life in general (Steckermeier, 2021;Delhey & Steckermeier, 2016;Schneickert et al., 2019), and with their family life (Böhnke & Cifuentes, 2018). ...
** Private Full Text available. Please write a message via ResearchGate or Mail ** In the wake of the bestseller The Spirit Level: Why Equality is Better for Everyone by Richard Wilkinson and Kate Pickett, status anxiety is now a significant topic in well-being research. A central concern for human beings, status anxiety is conventionally defined as the fear or impression of not counting much in the eyes of others. According to theories of human needs, status anxiety implies a lack of need satisfaction that undermines one’s subjective quality of life. Our research overview positions the concept of status anxiety sociologically and presents pertinent empirical findings. It covers individual- and country-level determinants of status anxiety, as well as the consequences of status anxiety for individual well-being and society as a whole. We conclude with some suggestions for future research, of which the geographical expansion beyond the European cultural zone seems the most urgent.
Objectives: Healthcare providers have multiple ways to influence patients' behavior while they address health issues of the population. The study examined the direct impact of healthcare providers' communication style, health education, clinical time, cultural competence, and perceived trust on the health behaviour of Chinese patients. Methods: The data for this research was collected from patients, in general, to conduct the findings and provide policy implications. A sample of 282 respondents participated in this questionnaire survey-based research. This research used SPSS 29 to analyze the data. Results: The study concluded that healthcare providers' communication style, health education, clinical time, cultural competence, and perceived trust strongly and positively influence Chinese patients' health behaviour. The study has novelty as the tested relationship by this research was a new contribution to the body of knowledge. Conclusion: The findings of this research are also significant for policy implications in Chinese healthcare centers to improve the behaviour of patients for advancing their approaches to develop their attitude strategically toward healthcare. The findings of this research also address the theoretical gaps in the literature as it contributed to novel discoveries in the literature. The study also has limitations, which are reported along with future directions.
Health locus of control (HLOC) may influence people’s behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC’s relations with people’s control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale – form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people’s control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient’s HLOC could help tailoring the decision-making process within the clinical context.
Psychiatric disorders commonly co-exist with the diagnosis of chronic kidney disease (CKD). Research on depression and CKD has increased to a great extent. Multiple studies have demonstrated that depression is more prevalent in CKD and that end-stage renal disease is a robust risk factor for adverse outcomes such as hospitalization and mortality, yet these are often underdiagnosed or untreated. This review provides a selective overview on the prevalence rates of depression and anxiety in patients with CKD and across renal replacement therapies, the factors most consistently associated with symptoms of distress and their clinical implications. Finally, treatment and management strategies from relevant literature are appraised and discussed.
Background
Over the last 10 years, patient engagement in health research has emerged as the next evolution in healthcare research. However, limited evidence about the clear role and scope of patient engagement in health research and a lack of evidence about its impact have influenced the uptake, implementation and ongoing evolution of patient engagement. The present study aims to conduct a scoping review to identify methods for and outcomes of patient engagement in health research. Methods
An adaptation of the scoping review methodology originally described by Arksey and O’Malley and updated by Levac, Colquhoun and O’Brien was applied. Sources from a formal database search and relevant documents from a grey literature search were compiled into data extraction tables. Articles were synthesised into key themes according to the (1) methods and (2) outcomes of patient engagement in health research. ResultsThe total yield for the scoping review was 55 records from across Canada, the United Kingdom and the United States. While evidence about the methods used to engage patients in health research is increasing, stronger evidence of specific patient and healthcare system outcomes is required. This necessitates further mobilisation of research that explores outcomes and that validates specific tools to evaluate engagement. Additionally, theoretical frameworks that can better inform and sustain patient engagement across the lifecycle of health research are lacking. Conclusion
Further increasing the volume and reach of evidence about patient engagement in health research will support the paradigmatic shift needed to normalise the patient’s role in research beyond ‘subject’ or ‘participant’, so as to ultimately improve patient health outcomes and better address healthcare reform in Canada.
From ostracism on the playground to romantic rejection, bullying at work, and social disregard for the aged, individuals are at constant risk of experiencing instances of social exclusion, including ostracism, rejection, dehumanization, and discrimination. These phenomena have a powerful impact as testified by their immediate influence on people’s thoughts, emotions, and behaviors. Social Exclusion: Psychological Approaches to Understanding and Reducing Its Impact investigates different psychological approaches, across multiple psychological subdisciplines, to understanding the causes and consequences of social exclusion and possible ways to reduce or buffer against its negative effects.
The purpose of this volume is threefold. First, it lays the groundwork for the understanding of social exclusion research; reviewing the different instances of social exclusion in everyday life and methods to experimentally investigate them. Second, this volume brings together different psychological approaches to the topic of social exclusion. Leading scholars from around the world contribute perspectives from social psychology, social neuroscience, developmental psychology, educational psychology, work and organizational psychology, clinical psychology, and social gerontology to provide a comprehensive overview of social exclusion research in different psychological subdisciplines. Taken together, these chapters are conducive to the important development of new and more integrative research models on social exclusion. Finally, this volume discusses psychological strategies such as emotion regulation, psychological resources, and brain mechanisms that can reduce or buffer against the negative consequences of social exclusion. From school shootings to domestic violence, from cognitive impairment to suicide attempts, the negative impact of social exclusion has been widely documented. Thus, from an applied perspective, knowing potential ways to mitigate the negative effects of social exclusion can have a significant positive influence on people’s—and society’s—well-being. Overall, this book provides the reader with the knowledge to understand the impact of social exclusion and with tools to address it across many different contexts. Importantly, Social Exclusion: Psychological Approaches to Understanding and Reducing Its Impact aims to bridge the gap between the approaches of different psychological subdisciplines to this topic, working towards a comprehensive, integrative model of social exclusion.
The 5-item World Health Organization Well-Being Index (WHO-5) is among the most widely used questionnaires assessing subjective psychological well-being. Since its first publication in 1998, the WHO-5 has been translated into more than 30 languages and has been used in research studies all over the world. We now provide a systematic review of the literature on the WHO-5.
We conducted a systematic search for literature on the WHO-5 in PubMed and PsycINFO in accordance with the PRISMA guidelines. In our review of the identified articles, we focused particularly on the following aspects: (1) the clinimetric validity of the WHO-5; (2) the responsiveness/sensitivity of the WHO-5 in controlled clinical trials; (3) the potential of the WHO-5 as a screening tool for depression, and (4) the applicability of the WHO-5 across study fields.
A total of 213 articles met the predefined criteria for inclusion in the review. The review demonstrated that the WHO-5 has high clinimetric validity, can be used as an outcome measure balancing the wanted and unwanted effects of treatments, is a sensitive and specific screening tool for depression and its applicability across study fields is very high.
The WHO-5 is a short questionnaire consisting of 5 simple and non-invasive questions, which tap into the subjective well-being of the respondents. The scale has adequate validity both as a screening tool for depression and as an outcome measure in clinical trials and has been applied successfully across a wide range of study fields. © 2015 S. Karger AG, Basel.
During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains – physical, psychological, and social functioning – that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL.
[«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)]
Background
Although the fashion for the “personalised” or “stratified” approach to medicine is valuable in exploiting the omic signatures of the individual patient, too little attention has been paid to the influence of psychological and cognitive factors in the care process. The aim of this paper is to highlight the importance of those individual psycho-cognitive components in affecting how people act to prevent, cope and react to illness, decide about different therapeutic options, interact with health care providers, and adhere to treatment.
Methods
We reviewed the medical and psychological literature about the effect of cognitive and psychological dimensions on treatment efficacy, on patients' global satisfaction, and on treatment compliance.
Results
Psychological dimensions have been proved to impact on treatment efficacy, on patients' global satisfaction, and on compliance to treatment. However, there are substantial individual differences among patients; therefore, it is important that physicians recognise how to apply these general recommendations to each individual patient, alongside the omic information emerging from the molecular diagnostic laboratory.
Conclusion
The exam of the current literature allows one to derive several strategies which can help health professionals to improve the patients' understanding of their disease and involvement in the whole care process.
Researchers find that social and physical pain overlap in acute episodes. In this article, we hypothesize that social and physical pain overlap in chronic conditions as well. To support this hypothesis, we reviewed the literature and introduced the Integrated Chronic Pain Model (ICPM), which posits that chronic social and physical pain overlap in their psychological antecedents and consequences. Specifically, the ICPM proposes several common factors that play a role in the onset and maintenance of both social and physical chronic pain and indicates that both forms of pain persistently impair self-regulatory resources and threaten the same basic psychological needs.
Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions.
Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making.
To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article.
BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making.
IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.
Ostracism means being ignored and excluded by one or more others. Despite the absence of verbal derogation and physical assault, ostracism is painful: It threatens psychological needs (belonging, self-esteem, control, and meaningful existence); and it unleashes a variety of physiological, affective, cognitive, and behavioral responses. Here we review the empirical literature on ostracism within the framework of the temporal need-threat model.
Three experiments were conducted to test the hypothesis, derived from terror management theory, that reminding people of their mortality increases attraction to those who consensually validate their beliefs and decreases attraction to those who threaten their beliefs. In Study 1, subjects with a Christian religious background were asked to form impressions of Christian and Jewish target persons. Before doing so, mortality was made salient to half of the subjects. In support of predictions, mortality salience led to more positive evaluations of the in-group member (the Christian) and more negative evaluations of the out-group member (the Jew). In Study 2, mortality salience led to especially negative evaluations of an attitudinally dissimilar other, but only among subjects high in authoritarianism. In Study 3, mortality salience led to especially positive reactions to someone who directly praised subjects' cultural worldviews and especially negative reactions to someone who criticized them. The implications of these findings for understanding in-group favoritism, prejudice, and intolerance of deviance are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter discusses social behavior through self-evaluation maintenance (SEM) model. It describes several studies to provide a feel for the kind of research that has been completed in an attempt to explore the predictions of the model. The SEM model is composed of two dynamic processes. Both the reflection process and the comparison process have as component variables the closeness of another and the quality of that other's performance. These two variables interact in affecting self-evaluation but do so in quite opposite ways in each of the processes Model establishes the comprehensiveness of the research and the interactive quality of its predictions. Next, the SEM model is fit into the perspective of related work, including self-theories, social comparison theory, and Cialdini's BIRGing research. The chapter reviews the epistemological status of the model. It discusses some of the implications of the research for a variety of areas in psychology.
Throughout the past few thousand years, historical accounts, philosophical treatises, and works of fiction and poetry have often depicted humans as having a need to perceive themselves as good, and their actions as moral and justified. Within the last hundred years, a number of important figures in the development of modern psychology have also embraced this notion that people need self-esteem (e.g., Adler, 1930; Allport, 1937; Homey, 1937; James, 1890; Maslow, 1970; Murphy, 1947; Rank, 1959; Rogers, 1959; Sullivan, 1953). Of these, Karen Homey most thoroughly discussed the ways people try to attain and maintain a favorable self-image. The clinical writings of Horney, and other psychotherapists as well, document the ways in which people attempt to defend and enhance self-esteem; they also suggest that difficulty maintaining self-esteem, and maladaptive efforts to do so, may be central to a variety of mental health problems. In this chapter, we will first review the research supporting the existence of a need for self-esteem. Then we will present a theory that accounts for this need and specifies the role it plays in a variety of phenomena including self-presentation.
Anxiety disorders may cause substantial impairment in patient functioning and well-being. Little is known about the relationship between diabetes and anxiety. We estimated the prevalence of lifetime diagnosis of anxiety in adults aged > or = 18 years with and without diabetes in the USA.
We analysed data from the 2006 Behavioral Risk Factor Surveillance System (total, N = 201 575; 20 142 with diabetes; 39.4% men, 77.9% non-Hispanic Whites, 8.1% non-Hispanic Blacks and 7.7% Hispanics; mean age 52.4 years). Diabetes and lifetime diagnosis of anxiety were self-reported. A multivariable log-binomial model was used to estimate prevalence ratios (PR) and associated 95% confidence intervals (CI) of anxiety based on diabetes status.
The overall age-adjusted prevalence of lifetime diagnosis of anxiety was 19.5 and 10.9% in people with and without diabetes, respectively. After adjustment for educational level, marital status, employment status, current smoking, leisure-time physical activity and body mass index, people with diabetes had a 20% higher prevalence of lifetime diagnosis of anxiety than those without (PR 1.20; 95% CI 1.12, 1.30). There were no significant differences in the PR by gender (P = 0.06). However, the ratios differed significantly by age (P = 0.04) and by race/ethnicity (P < 0.01), indicating that people aged 18-29 years (PR 1.70; 95% CI 1.19, 2.43) and Hispanics (PR 1.69; 95% CI 1.33, 2.15) had a higher ratio than their counterparts.
Diabetes was significantly associated with anxiety in adults in this large population-based sample, particularly in Hispanics and young adults.
Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care.
In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters.
Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures.
Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with www.clinicaltrials.gov (NCT00217945 and NCT00149526).
The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices.
Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases.
Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education.
PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.
Three studies were conducted to assess the proposition that self-esteem serves an anxiety-buffering function. In Study 1, it was hypothesized that raising self-esteem would reduce anxiety in response to vivid images of death. In support of this hypothesis, Ss who received positive personality feedback reported less anxiety in response to a video about death than did neutral feedback Ss. In Studies 2 and 3, it was hypothesized that increasing self-esteem would reduce anxiety among individuals anticipating painful shock. Consistent with this hypothesis, both success and positive personality feedback reduced Ss' physiological arousal in response to subsequent threat of shock. Thus, converging evidence of an anxiety-buffering function of self-esteem was obtained.
The purpose of this article is to determine whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (a) whether a measure assesses support structure or function, and (b) the degree of specificity (vs. globality) of the scale. By structure we mean simply the existence of relationships, and by function we mean the extent to which one’s interpersonal relationships provide particular resources. Special attention is paid to methodological characteristics that are requisite for a fair comparison of the models. The review concludes that there is evidence consistent with both models. Evidence for a buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person’s degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications of these conclusions for theories of social support processes and for the design of preventive interventions are discussed.
A hypothesized need to form and maintain strong, stable interpersonal relationships is evaluated in light of the empirical literature. The need is for frequent, nonaversive interactions within an ongoing relational bond. Consistent with the belongingness hypothesis, people form social attachments readily under most conditions and resist the dissolution of existing bonds. Belongingness appears to have multiple and strong effects on emotional patterns and on cognitive processes. Lack of attachments is linked to a variety of ill effects on health, adjustment, and well-being. Other evidence, such as that concerning satiation, substitution, and behavioral consequences, is likewise consistent with the hypothesized motivation. Several seeming counterexamples turned out not to disconfirm the hypothesis. Existing evidence supports the hypothesis that the need to belong is a powerful, fundamental, and extremely pervasive motivation.
Advances in research and the delivery of health care have reduced mortality from disease and extended life expectancy in developed countries. We are living longer, but are we necessarily living better? Those who would have died from their condition may now survive but there is the emotional cost of long-term treatment and medical surveillance to consider (for example, the patient who has had a liver transplant must then continue immunosuppression treatment). Such patients must cope with a chronic condition and yet the emotional dimensions of these conditions are frequently overlooked when medical care is considered. Concepts such as the “sick role” and “illness behavior” have helped us understand the impact of disease and are familiar to most clinicians. Yet challenges still exist in the recognition and management of the psychological and social dimensions of chronic illness.
Throughout our lives, we rely on others and are relied on in turn. This is especially apparent in times of need, but also in ordinary daily goal pursuit. Among the people with whom we interact supportively, members of our families feature very prominently. Because the extent to which we are embedded in social networks and can rely on their help should we need it are consistent predictors of better health and longevity, it is not surprising that of the many forms of social exchange practiced with others, social support is the most frequently studied. This chapter provides a conceptual overview of social support and related constructs, discusses theories on how different forms of social support may be associated with health outcomes, and briefly reviews social support interventions in the area of coping with stress and disease. To account for the role of family processes, choice of social support theories reviewed in this chapter was guided not only by their impact on the field alone, but also by their assumptions on the role of specific support sources or providers, including members of our family.
Patient participation in health care is widely considered as crucial for the development of improved health systems and the refined management of chronic conditions. Against this background, however, there are divergent views and contradictions regarding its definition and actual content and scope. Moreover, there is no consensus as to the appropriate interventions, hence assessing their impact remains a challenge. The authors herein comment on the terms that are most commonly used for defining patient involvement in health care and underline the barriers identified in everyday clinical practice that may be responsible for failing to fully materialize its potential impact and/or endorsing it in real life.
Patient engagement is recognized as a crucial component of high-quality healthcare services. Among rheumatic diseases, systemic lupus erythematosus (SLE) appears particularly challenging for the engagement of patients in their own care. According to the patient health engagement (PHE) model, patient engagement is a dynamic phenomenon that proceeds through four experiential positions (blackout, arousal, adhesion and eudaimonic project). The aim of the present study was to describe the engagement process from the point of view and the experiences of SLE patients. Ten in-depth interviews and four focus groups were conducted with an international sample of SLE patients from different European countries. Transcripts were analysed through thematic content analysis. Findings showed that a fully engaged patient results from reframing emotional, cognitive and behavioural dimensions. The advances along the process depends on how the patient succeeds in each position. In conclusion, PHE represents an appropriate model by which to understand the engagement process of SLE patients. In order to meet patients' needs, healthcare providers and patient support groups should consider the specific position of SLE patients, providing adequate and tailored support.
Objective:
Patient engagement has been credited with contributing to improved outcomes and experiences of care. Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term have increased throughout the healthcare-related disciplines without a common definition. This study seeks to define the concept by identifying its attributes in the context of its use.
Methods:
A concept analysis of the scientific literature in the health disciplines was performed using the Rogers method.
Results:
The analysis revealed four defining attributes of patient engagement: personalization, access, commitment and therapeutic alliance. Patient engagement is defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care.
Conclusion:
Patient engagement is both process and behavior and is shaped by the relationship between the patient and provider and the environment in which healthcare delivery takes place.
Practice implications:
The definition and the identified attributes serve as a heuristic in designing patient engagement strategies and as a basis for future development of the patient engagement concept in healthcare.
During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains − physical, psychological, and social functioning − that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL.[«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)]
Introduction: The ability of health systems to respond to the legitimate expectations of the population regarding interpersonal and organizational aspects of healthcare - the so-called Health System Responsiveness - is considered a key competence of health systems. While various studies have assessed the responsiveness of ambulatory care, information on differences between care provided by general practitioners (GP) and specialists is still scarce. Methods: By means of a postal survey, 51 998 chronically ill persons (type 2 diabetes and/or coronary heart disease) insured by a statutory health insurance body (Techniker Krankenkasse) were surveyed regarding their experiences with GP and specialist care. An adapted version of the WHO Health System Responsiveness questionnaires was used for assessing data. Differences in the rating of specialist and GP care were analyzed using McNemar's test. Results: Responses from 13 685 patients were included in data analyses. Overall, ambulatory care was rated mostly as positive. Across all dimensions of health system responsiveness, GP care was rated statistically significantly as more positive than specialist care. Considerable differences were found in the evaluation of waiting times, involvement in decision-making and coordination of care. Conclusion: Overall, the surveyed persons were mostly satisfied with their GP and specialist care. However, some aspects of specialist care need to be optimized.
© Georg Thieme Verlag KG Stuttgart · New York.
Background and objectives:
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Previous studies showed that perceived social support has an important role in enhancing patient's quality of life (QOL). However, the precise mechanisms through which social support exerts such an effect are not completely understood. The aim of this paper is to test two alternative models explaining the relationship between social support (positive and problematic) and two dimensions of QOL: Health-Related (HR-QOL) and Non-Health Related (NHR-QOL).
Design:
Model A (mediation) hypothesized that positive support would reduce stress while problematic support would increase stress), and that this in turn would reduce QOL. Model B (moderation) hypothesized that the effect of support on QOL would be moderated by the experience of stress in that more stressed individuals would show stronger effects.
Methods:
Three hundred and forty-four Italian patients with SLE completed an on-line questionnaire.
Results:
Stress partially mediated the relationship between support and QOL dimensions (either HR-QOL and NHR-QOL) thus supporting model B. As hypothesized, positive support reduced stress, while problematic support increased stress.
Conclusions:
These findings help to explain the complex relationship between social support, stress, and QOL in patients with SLE.
This article reviews literature on adults' mental health outcomes during acute and long-term colorectal cancer (CRC) survivorship.
We identified articles that included at least one measure of psychological symptoms or mental quality of life or well-being through a search of databases (CINAHL, MEDLINE, PsycINFO, and PsycARTICLES). Articles were published between January 2004 and April 2015.
A significant proportion of CRC survivors experience clinically meaningful levels of anxiety and depressive symptoms or reduced mental well-being across the trajectory of the illness. Demographic, medical, and psychosocial predictors of mental health outcomes were identified. However, few studies were theory-driven, and gaps remain in our understanding of risk and protective factors with respect to mental health outcomes, especially during long-term CRC survivorship.
Theory-driven longitudinal research with larger samples is required to identify subgroups of CRC survivors with different trajectories of psychological adjustment. Such research would assess adjustment as a function of internal resources (e.g., personality and coping) and external resources (e.g., finances and social support) to inform future interventions for CRC survivors. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
The concept of "matching" is central to theories of social support, as researchers attempt to specify the links between the type of support, the source of support, and the type of stressor, and to identify their function in the support process. This study examines these links more closely by differentiating between spouse and friend support, and by considering different types of life problems (e.g., role and ambient strains). I hypothesized a continuum of support efficacy whereby spouses and friends can ameliorate the depressing effects of nonfamilial strains (e.g., work straints). Spouses were further hypothesized to buffer the relationship between ambient strains (bur not familial role strains) and depression, Friends were expected to serve as effective buffers to familial role strains, but not to ambient strains. Results show that perceived spouse support both alters initial perceptions of strains and ameliorates the depressive effects of all forms of life strains, while friend support has a more limited direct and indirect role. Researchers interested in the interactive role of support ties must be attuned to the distinction between intimates when examining the negative effects of role strains, but not necessarily of ambient strains.
Objective: Social support has been linked to beneficial effects on health directly (main effect) and as a buffer to stress. Most research, however, has examined these relationships using global and retrospective assessments of health and stress, which may be subject to recall biases. This study used ambulatory ecological momentary assessment (EMA) methods to test the main and stress-buffering effects of social support on the daily health and well-being of asthma and rheumatoid arthritis (RA) patients. Design: Community volunteers with asthma (n = 97) or RA (n = 31) responded to EMA prompts five times daily for one week. Main outcomes: Baseline perceived social support was obtained, and then, participants reported mood, stress and symptoms using EMA. Multilevel mixed-modelling examined whether social support predicted mood and symptoms directly or via stress-reducing effects. Results: Supporting a main effect, more perceived social support predicted decreased negative mood and stress severity. Supporting a stress-buffering effect, more perceived social support resulted in fewer reported symptoms when stress was present. Conclusion: Results suggest perceived social support directly relates to better ambulatory status and dynamically buffers individuals against the negative effects of stressors, and highlight the importance of studying social support across different temporal and contextual levels.
Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.
Ostracism—being excluded and ignored—thwarts satisfaction of four fundamental needs: belonging, self-esteem, control, and meaningful existence. The current study investigated whether training participants to focus their attention on the here-and-now (i.e., focused attention) reduces distress from an ostracism experience. Participants were first trained in either focused or unfocused attention, and then played Cyberball, an online ball-tossing game for which half the participants were included or ostracized. Participants reported their levels of need satisfaction during the game, and after a short delay. Whereas both training groups experienced the same degree of need-threat in the immediate measure, participants who were trained in focused attention showed more recovery for the delayed measure. We reason that focused attention would not reduce the distress during the ostracism experience, but it aided in recovery by preventing participants from reliving the ostracism experience after it concludes.
Self-affirmation processes are being activated by information that threatens the perceived adequacy or integrity of the self and as running their course until this perception is restored through explanation, rationalization, and/or action. The purpose of these constant explanations (and rationalizations) is to maintain a phenomenal experience of the self-self-conceptions and images as adaptively and morally adequate—that is, as competent, good, coherent, unitary, stable, capable of free choice, capable of controlling important outcomes, and so on. The research reported in this chapter focuses on the way people cope with the implications of threat to their self-regard rather than on the way they cope with the threat itself. This chapter analyzes the way coping processes restore self-regard rather than the way they address the provoking threat itself.
Presents an animal model of how learned helplessness may manifest itself as depression and anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Baumeister and Tice's (this issue) social exclusion theory of anxiety proposes that a primary source of anxiety is perceived exclusion from important social groups. This article elaborates the basic propositions of social exclusion theory, then applies the theory to a broader analysis of affective reactions to exclusion. Specifically, the article examines the relationship between perceived social exclusion and social anxiety, jealousy, loneliness, and depression. The function of self-esteem and its role in moderating reactions to perceived exclusion are also discussed.
The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition.
The present study relies on questionnaire data from a diabetes and hypertension screening carried out on the entire adult population of a medium-sized Norwegian county (total number of participants = 74,977). Self-reported diabetic patients were compared with non-diabetics, and with patients with self-reported angina pectoris, previous cardiac infarction, and stroke. The psychological well-being of the known diabetic patients was found to be significantly poorer than that of those without diabetes, but better than that of those with angina and stroke. HbAl level was found to be significantly related to well-being, the low levels of HbAl (below 7.5%) scoring low on well-being and the high levels (above 15%) scoring high. Because of its special design, the present study allowed comparisons between diabetic patients undergoing treatment and newly detected patients who had not yet been treated. Treatment-related interpretations therefore could be rejected.
The direct and buffer effects of various aspects of social support and personal coping resources on depressive symptoms were examined. The study concerned a community-based sample of 1690 older persons aged 55-85 yrs, of whom 719 had no chronic disease, 612 had mild arthritis and 359 had severe arthritis. Persons with arthritis reported more depressive symptoms than persons with no chronic diseases. Irrespective of arthritis, the presence of a partner, having many close social relationships, feelings of mastery and a high self-esteem were found to have direct, favourable effects on psychological functioning. Mastery, having many diffuse social relationships, and receiving emotional support seem to mitigate the influence of arthritis on depressive symptoms, which is in conformity with the buffer hypothesis. Favourable effects of these variables on depressive symptomatology were only, or more strongly, found in persons suffering from severe arthritis.
To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes.
MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design.
A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%).
The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.
This study sought to examine the relationships between decisional role (preferred and assumed) at time of surgical treatment (baseline), congruence between assumed role at baseline and preferred role 3 years later (follow-up), and quality of life at follow-up. Two hundred and five women diagnosed with breast cancer completed the decisional role preference scale at baseline and follow-up, and the EORTC QLQ-C30 at follow-up. A statistically significant number of women had decisional role regret, with most of these women preferring greater involvement in treatment planning than was afforded them. Women who indicated at baseline that they were actively involved in choosing their surgical treatment had significantly higher overall quality of life at follow-up than women who indicated passive involvement. These actively involved women had significantly higher physical and social functioning and significantly less fatigue than women who assumed a passive role. Quality of life was significantly related to reports of experienced involvement in treatment decision making, but not to reports of preferred involvement, or congruence between preferred and experienced involvement.
Desire for control: Personality, social and clinical perspectives
- J M Burger
- Plenum
- C M Celano
- E E Beale
- S V Moore
- D J Wexler
- J C Huffman
Burger, J. M. (1992). Desire for control: Personality, social and clinical perspectives. Plenum.
Celano, C. M., Beale, E. E., Moore, S. V., Wexler, D. J., & Huffman, J. C. (2013). Positive
psychological characteristics in diabetes: A review. Current Diabetes Reports, 13(6), 917-929.
https://doi.org/10.1007/s11892-013-0430-8
European quality of life survey 2016: Technical and fieldwork report
Eurofound. (2018). European quality of life survey 2016: Technical and fieldwork report. On-line
working paper. https://www.eurofound.europa.eu/sites/default/files/wpef18016.pdf