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How you think about your health can have powerful impacts on how you experience your health. In a recent study with a group of cardiac patients, how people thought about their illness (termed “illness cognitions”) was found to have a direct impact on how people experience health and emotional wellbeing . These illness cognitions also affected health indirectly by influencing the types of behaviours people were engaged in to cope with cardiac problems. This study brings to our attention the relevance of psychology in relation to medical illnesses.
Cardiac problems are hugely common across the globe. Cardiovascular disease is the leading cause of death globally and has a significant impact as a chronic disease on quality of life, the economy and healthcare utilisation . Many causes of cardiac problems are preventable — for example by avoiding smoking, taking adequate exercise and maintaining a healthy diet and weight. From a biomedical perspective, treatment for cardiac problems has significantly improved survival rates through drug therapies and surgical approaches . This has caused the treatment focus switch from acute, or short-term, to chronic, or long-term. When living with a long-term health condition, the way people think about their illness becomes extremely important.
Two illness cognitions were focused on in the recent study. First, illness acceptance is an idea commonly talked about and is characterised by a focus on the positive aspects, realisation that the health condition is to be lived with, and an end to the search for a solution to remove the illness. Second, illness-related helplessness relates to feelings that an illness is uncontrollable and has severe consequences for everyday life. Researchers recruited 106 cardiac patients with a range of cardiac conditions. These patients completed questionnaires about their illness acceptance, illness helplessness and how they rated their own health. Six months later, the patients were again asked to complete questionnaires on illness acceptance, helplessness, subjective health and coping strategies they used to deal with their cardiac problems. The goal was to explore whether illness acceptance and helplessness could predict self-rated health. Coping behaviours were also studied. There are many different types of coping, such as soothing oneself, wishful thinking, emotional coping and reactions.
Using a complex statistical technique called “Structural Equation Modelling”, the researchers tested multiple relationships between different variables. The relationships between illness acceptance, illness helplessness, coping behaviours (of various types) and emotional well-being and physical functioning were tested. This method allows researchers to test the “path” between different variables: the degree to which one variable impacts another and whether this is direct or indirect through a third variable. The results showed both direct and indirect effects of illness acceptance and illness helplessness on the outcome variables of emotional well-being and physical functioning. Lower illness helplessness was related to better emotional well-being and better perceived physical health. This makes sense intuitively: feeling that nothing can be done about poor health is associated with feeling less happy and less able. Additionally, greater acceptance of illness was related directly to greater emotional and physical wellbeing.
Indirect effects were also seen. Greater helplessness was associated with more wishful thinking e.g. “If only I didn’t have this cardiac problem …”, as well as soothing strategies. These coping behaviours were associated with outcomes — more wishful thinking was related to poorer emotional wellbeing and more soothing coping was related to both poorer emotional and physical outcomes. Greater acceptance of illness was associated with less soothing coping and fewer emotional reactions, such as feeling angry. Again, these coping styles were related to the emotional and physical outcomes. This shows the complex nature of the relationships between thoughts, coping behaviours and emotional and physical outcomes.
Through this complex analysis, a simpler summary can be created with direct advice for healthcare: increasing acceptance and decreasing helplessness may improve health outcomes for people with cardiac problems. As with every study, these conclusions must be seen in relation to study limitations. Only subjective or self-reported outcomes of emotion and physical functioning were collected and there can be a large gap between what people report they can do and what they objectively are able to do. It is also vital to note that there were some types of coping that were unrelated to these illness cognitions — adherence to medical advice and “instrumental” coping (problem solving, e.g. locating information, self-management, etc.).
Cardiac disease is a physical illness, however the psychological elements are important to how the illness is experienced. Whilst taking medications, staying active, eating well, avoiding tobacco and alcohol are fundamentally important behaviours that a person should be engaged in, the way people with cardiac disease think is also important. Indeed, screening to identify people with cardiac disease who are showing helplessness and poor acceptance may be useful to select people at further risk. Additionally, interventions to promote healthy thinking as well as healthy behaviours may improve a person’s experience of living with cardiac disease.
- Karademas and Hondronikola. The impact of illness acceptance and helplessness to subjective health, and their stability over time: a prospective study in a sample of cardiac patients. Psychol Health Med. 2010 May;15(3):336-46.
- Beaglehole et al. Poverty and human development: the global implications of cardiovascular disease. Circulation. 2007 Oct 23;116(17):1871-3.
- Weisfeldt and Zieman. Advances in the prevention and treatment of cardiovascular disease. Health Aff (Millwood). 2007 Jan-Feb;26(1):25-37.