Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis

https://doi.org/10.1016/j.ijnurstu.2019.01.015Get rights and content

Abstract

Aims

This paper aims to systematically review the illness perceptions of stroke patients and to examine the association between illness representation and psychological distress in empirical research studies.

Background

Patients’ perceptions of health threats determine their coping behavior. Several recent studies have focused on illness belief and distress in stroke patients. This information is suitable for a meta-analysis to further understand stroke patients’ illness perceptions.

Design

Systematic review and meta-analysis.

Method

An electronic literature search was conducted using the CINAHL, MEDLINE, PubMed, Cochrane library, and Google Scholar databases. Search strategies were title (stroke or cerebrovascular accident or CVA or cerebral vascular event or transient ischemic attack or TIA) and keyword (disease or illness) and keyword (perceptions or attitudes or opinion or experience or view or reflection or beliefs). The literature search covers the period of January 1990 to October 2018. Seven articles were included in the meta-analysis and Fisher’s z was calculated with correlation coefficient or regression coefficient values for eight illness representation dimensions and psychological distress. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 3.0 software.

Results

A total of 49 studies were reviewed, and seven studies with a total of 507 participants were eligible for the meta-analysis. For patients’ perceived anxiety and depression, six of seven studies, with 285 to 461 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that stroke patients’ perception of a strong illness identity, timeline-acute/chronic, timeline-cyclical, consequences, and emotional responses were significantly and positively related to anxiety and depression. The pooled z-value ranged from 0.189 to 0.460. Conversely, for protective-related factors, such as stroke patients’ perceived personal control, treatment control, and illness coherence, only perceived illness coherence was significantly negatively associated with depression (z-value, -0.122; 95% CI: -0.241, -0.002). For patients’ perceived overall distress, three of seven studies with 173 participants showed that there were significant and positive associations between identity, consequence, emotions, and distress (z-value ranges = 0.493–0.711) as well as a significant and negative association between illness coherence and overall distress (z-value, -0.226; 95% CI: -0.379, -0.073).

Conclusion

An association between illness representation and distress exists in stroke patients. Risk factors are the most significant in terms of this relationship, and protective factors do not have a protective health impact. Protection factors need to be promoted to reduce patient distress.

Section snippets

What is already known about the topic?

  • Patients’ perceptions of health threats determine their coping and behavior, based on patients’ illness representation.

  • Patients conceptualize their illness and how it influences their physical recovery, psychological well-being, and social functioning.

  • An early meta-analysis on chronic illness indicated that illness consequences, timelines, and identity had significant positive relationships with distress.

  • Research indicates that the control representation of patients with chronic illness is

What this paper adds

  • Meta analysis shows that stroke patients’ negative illness representation is positively related to psychological distress (depression and anxiety).

  • Of the stroke patients’ positive illness representation dimensions, only illness coherence was significantly related to depression and overall distress.

  • Stroke patients’ personal control and treatment control did not show a significant relationship with any distress outcome.

Literature search

An electronic literature search was conducted using the CINAHL, MEDLINE, PubMed, Cochrane library, and Google Scholar databases. Search strategies were title (stroke or cerebrovascular accident or CVA or cerebral vascular event or CVA or transient ischemic attack or TIA) and keyword (disease or illness) and keyword (perceptions or attitudes or opinion or experience or view or reflection or beliefs). The literature search covered the period of January1990 to October 2018.

The selection criteria

Results

As shown in Table 1, of the seven studies included, the total number of participants included in the meta-analysis was 507. The mean sample size of studies was 72.43 (SD = 47.59), ranging from 40 to 176.

Discussion

This study aimed to examine the relationships between the illness representation dimensions and psychological outcomes across available studies from the related health literature database. This is the first meta-analysis to provide evidence of the association between illness representation and distress in stroke patients. Meta-analysis techniques were used to correct the average relationships between illness representations dimensions and psychological outcomes across seven studies that

Limitations

We performed both a comprehensive systematic review and a meta-analysis. All seven empirical research studies, however, were either cross-sectional or follow-up research. Thus, in this study, there are some limitations that need to be addressed. First, the findings need to be confirmed, and any causal relationship between illness representation and stroke patients need to be further explored in a randomized controlled trial. Second, illness belief may be influenced by changes over time. Thus, a

Conclusions

The current evidence on the Common Sense Model, that a negative illness representation is positively related to psychological distress (depression and anxiety), was supported by this study. In regard to the positive illness representation dimensions that are negatively related to psychological distress (depression and anxiety) for stroke patients, only illness coherence was significantly related to depression and overall distress, whereas personal control and treatment control did not show a

Ethical approval

The study was approved by the institutional review board of Chung-Shan Medical University Hospital (CSMUH No: CS2-18011).

Funding

This research was funded by the Ministry of Science and Technology for funding this study (MOST 107-2314-B-040-002).

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

We thank the Ministry of Science and Technology for funding this study (MOST 107-2314-B-040-002).

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