The impact of beliefs about mental health problems and coping on outcome in Schizophrenia

Department of Clinical Psychology, The University of Liverpool, Liverpool, UK.
Psychological Medicine (Impact Factor: 5.94). 11/2004; 34(7):1165-76. DOI: 10.1017/S003329170400203X
Source: PubMed


Using the theoretical framework of the Self Regulation Model (SRM), many studies have demonstrated that beliefs individuals hold about their physical health problems are important in predicting health outcomes. This study tested the SRM in the context of a mental health problem, schizophrenia.
One hundred and twenty-four people with a diagnosis of schizophrenia were assessed on measures of symptom severity, beliefs about their mental health problems, coping and appraisal of outcome at two time points, 6 months apart.
Using multivariate analyses and controlling for severity of symptoms, beliefs about mental health were found to be significant predictors of outcome. Beliefs about greater negative consequences were the strongest and most consistent predictors of a poorer outcome in both cross-sectional and longitudinal analyses.
These results suggest that the SRM is a promising model for mental health problems and may highlight important areas for development in clinical, and especially psychosocial interventions.

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    • "Interest in the study of illness perceptions in patients with schizophrenia and related psychoses has encouraged research from diverse countries such as the United Kingdom (Freeman et al., 2013; Karatzias et al., 2007; Lobban et al., 2004, 2005; Shah et al., 2009; Theodore et al., 2012; Watson et al., 2006; Williams and Steer, 2011), Germany (Cavelti et al., 2012a), Turkey (Güner, 2014), and New Zealand (Sanders et al., 2011), with quantitative (e.g., Williams and Steer, 2011) as well as qualitative methods (e.g., Güner, 2014). Results have shown significant correlations between positive and negative psychotic symptoms (Cavelti et al., 2012a; Lobban et al., 2005), anxiety and depression (Cavelti et al., 2012a; Karatzias et al., 2007; Lobban et al., 2004, 2005; Watson et al., 2006), functioning (Lobban et al., 2004), engagement with treatment (Freeman et al., 2013; Shah et al., 2009; Williams and Steer, 2011), coping style, satisfaction with mental health (Lobban et al., 2004), self-esteem (Watson et al., 2006), and quality of life (Lobban et al., 2004; Theodore et al., 2012). Although at some point insight and illness perception might overlap, results suggest that they are two fairly different constructs thus, they would relate differently to outcome (Cavelti et al., 2012a; Watson et al., 2006). "
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    ABSTRACT: Background: Insight and illness perception are two concepts of interest in the study of factors related to clinical outcome in patients with psychosis. Insight implies a risk of emotional distress for the patient. Illness perceptions, regardless of their accuracy, might be favorable or not to illness. Literature provides evidence of significant correlates of these factors with clinical outcome, but they are rarely included in a single study. Objectives: 1) assessing insight and illness perception in a sample of Mexican patients who have experienced psychosis and, 2) analyzing how insight and illness perception relate to each other and how they relate to clinical status (i.e., positive, negative, and general psychopathology, depression, and anxiety). Methods: Sixty-one participants (55.7% females) were recruited from a public psychiatric hospital; insight and illness perceptions were assessed with the SUMD and the Brief-IPQ, respectively. Clinical status was assessed with the PANSS, CDS and BAI scales. Results: Participants showed good insight, favorable illness perceptions for the cognitive and comprehension dimensions, but unfavorable for the emotional dimension. Clinical status of sample was characterized by mild symptoms. Poor insight related to positive symptoms and general psychopathology. Cognitive and emotional perceptions of illness were significantly associated to most clinical status parameters, whereas comprehension showed no significant results. Conclusions: The study not only replicates the significant association on insight and illness perception with clinical outcome, but shows how their patterns of interactions are different, reinforcing the idea that they are two distinct factors worthy of being habitually acknowledged in research and clinical practice.
    Preview · Article · Mar 2015 · Schizophrenia Research: Cognition
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    • "There were two processes underlying this coping strategy. First, engaging in a conversation with others acts as a form of distraction that might help persons experiencing hallucinations to keep their minds focused and their attention distracted from the contents thereof [21, 22]. Second, engaging in conversation through verbalization on hallucinations could serve as a protective factor for psychological dysfunctioning [23]. "
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    ABSTRACT: Auditory hallucination is a positive symptom of schizophrenia and has significant impacts on the lives of individuals. People with auditory hallucination require considerable assistance from mental health professionals. Apart from medications, they may apply different lay methods to cope with their voice hearing. Results from qualitative interviews showed that people with schizophrenia in the Chinese sociocultural context of Hong Kong were coping with auditory hallucination in different ways, including (a) changing social contacts, (b) manipulating the voices, and (c) changing perception and meaning towards the voices. Implications for recovery from psychiatric illness of individuals with auditory hallucinations are discussed.
    Full-text · Article · Dec 2012 · The Scientific World Journal
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    • "The particular association between depression, rumination and awareness of social disability also corresponds with some of the specific appraisals of illness proposed as important in contributing to depression in schizophrenia. Appraisals of illnesses that have been associated with depressive symptoms include illness characteristics such as uncontrollability, chronicity and entrapment in illness, but also social consequences such as loss of social role, social humiliation, and stigma (Birchwood et al., 1993; Iqbal et al., 2000; Lobban et al., 2004, 2005; Lysaker, Roe and Yanos, 2007; Rooke and Birchwood, 1998; Watson et al., 2006). It may be that rumination leads to such thoughts about illness being repeatedly activated, increasing their impact upon mood. "
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    ABSTRACT: Background: Depressive symptoms are common in schizophrenia. Previous studies have observed that depressive symptoms are associated with both insight and negative appraisals of illness, suggesting that the way in which the person thinks about their illness may influence the occurrence of depressive responses. In affective disorders, one of the most well-established cognitive processes associated with depressive symptoms is rumination, a pattern of perseverative, self-focused negative thinking. Aims: This study examined whether rumination focused on mental illness was predictive of depressive symptoms during the subacute phase of schizophrenia. Method: Forty participants with a diagnosis of schizophrenia and in a stable phase of illness completed measures of rumination, depressive symptoms, awareness of illness, and positive and negative symptoms. Results: Depressive symptoms were correlated with rumination, including when controlling for positive and negative symptoms. The content of rumination frequently focused on mental illness and its causes and consequences, in particular social disability and disadvantage. Depressive symptoms were predicted by awareness of the social consequences of mental illness, an effect that was mediated by rumination. Conclusions: Results suggest that a process of perseveratively dwelling upon mental illness and its social consequences may be a factor contributing to depressive symptoms in people with chronic schizophrenia.
    Full-text · Article · Nov 2012 · Behavioural and Cognitive Psychotherapy
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