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Chapter 8

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PSYC 328
Blaine Ditto

PSYC328 Chapter 8 Notes Using Health Services: • Not everyone who feels sick or is sick seeks medical care from a professional, and not everyone who seeks medical care is sick with a physical illness • Psychological, social, and cultural factors are involved in whether one chooses to seek medical care How Do We Recognize and Interpret Symptoms? • People’s awareness of their body is limited, allowing for many psychological and social factors to influence the recognition of symptoms and interpretation of illness • Recognizing and then interpreting symptoms as reflecting an illness are the necessary first steps before decisions to seek medical care can be made Recognition of a Symptom: • In the face of seemingly severe symptoms, some people continue normal activities, while others go to bed when they detect any minor bodily disturbance Individual Differences and Personality: • Some people are consistently more likely to notice a symptom than others • Hypochondriacs (4-5% of population) worry that normal bodily functions are signs of illness • Most frequent symptoms among patients converting distress to physical pain are: back pain, joint pain, pain in the extremi- ties, headache, abdominal symptoms such as bloating, food “allergies”, cardiovascular symptoms such as palpitations • Women are not more likely than men to report symptoms, but older people are • Neuroticism (personality dimension marked by negative emotions, self-consciousness, and concerns with bodily processes) affects perception of symptoms • Symptom perception hypothesis: people high in neuroticism or negative affectivity trait recognize and/or report symptoms more quickly • Neurotic people may exaggerate their symptoms or simply be more attentive to real ones • Depression linked to increased physical symptoms but only when recalled retrospectively • Anxiety increased reports only for concurrent or momentary physical symptoms • These differential association are consistent with the notion that encoding and retrieval processes are distinct for anxious and depressed individuals, with depression linked to better retrieval of past symptoms, whereas anxiety heightens encoding current symptoms Cultural Differences: • Reliable cultural differences in how quickly and what kind of symptoms are recognized • Reasons for these differences not fully understood • Cultural differences in emotional responses may be at the root of observed differences • Even symptoms from the same problem can be experienced differently • Japanese women less likely than American women to report menopause symptoms – differences may be due to socio-cultur- al differences in language/meaning and biological variations in experiencing symptom associated with different lifestyles Situational Factors: • Situational factors influence whether a person will recognize a symptom • Boring situations makes people more attentive to symptoms than an interesting situation • Medical student’s disease: students imagine they have the illnesses they study and symptoms consistent with the illness under study seem to emerge, but as they learn more about different diseases, their distress (not perception) from appar- ent symptoms tends to decrease – likely a normal process, not hypochondriasis Stress: • Stress can precipitate or aggravate experience of symptoms • People who are under stress may believe that they are more vulnerable to illness and so attend more closely to their bodies • Stress-related physiological symptoms can include accelerated heartbeat or breathing and people can interpret these as symptoms of illness • Symptoms people experience are real but their perception and interpretation of the meaning of the symptoms may be exag- gerated if they are under stress • Stress can trigger symptoms or flare-ups of existing health problems Mood: • Mood influences self-appraised health • People who are in a positive mood rates themselves as more healthy, report fewer illness-related memories, and report fewer symptoms (opposite for negative mood) • Even people who have diagnosed illnesses report fewer or less serious symptoms when they are in a positive mood Interpretation of Symptoms: • Interpretation of symptoms is heavily a psychological process • Understanding the contextual factors surrounding the symptom can often provide valuable clues about how it may be inter- preted • Individual, historical, cultural, and social factors all conspire to produce interpretations of the symptom experience Prior Experience: • Interpretation of symptoms is heavily influenced by prior experience • People with experience of medical condition estimate the prevalence of symptoms to be greater, and regard condition as less serious • A symptom’s meaning is also influenced by how common it is within a person’s range of acquaintances or culture • High prevalent risk factors and disorders are generally seen as less serious than rare or distinctive ones Expectations: • Expectations play a role in experience and interpretation of symptoms • Simply expecting symptoms activates brain areas associated with the experience of them, and distracting yourself reduces activation Seriousness of the Symptoms: • Symptoms affecting highly valued body parts are seen as more serious and requiring more attention (ex. eyes, face) • A symptom will be regarded as more serious and will be more likely to prompt seeking of treatment if it limits mobility or if it affects a highly valued organ • Believing a symptom has a profound impact on one’s life can prompt seeking medical and/or taking medication • If a symptom causes pain, a person will seek treatment faster Cognitive Representations of Illness: Illness Schemas: • Illness representations (schemas): organized conceptions of illness influencing how people react to symptoms • Illness schemas are acquired through the media, personal experience, and family/friends who have had experience with par- ticular disorders • These schemes can range from sketchy and inaccurate to extensive, technical and complete • Their importance stems from the fact that they lend coherence to a person’s comprehension of the illness experience • Schemas influence preventative health behaviours, reactions to diagnoses and experience of symptoms, adherence to treat- ment, and expectations for future health • Five distinct components (info. about illness): identity (name of illness), consequences (symptoms, treatment, extent person believes illness will affect life), causes (factors believed to give rise to the illness), duration (expected length of time illness is expected to last), cure (belief of whether illness can be cured) • Characteristics of illness cognitions guide decisions about the types of actions needed to cope with illness • 3 models of illness: • Acute illness: caused by specific viral/bacterial agents, short duration; no long-term consequences (ex. Flu) • Chronic Illness: caused by several factors, long duration; severe consequences (ex. Heart disease) • Cyclic illness: alternating periods of many symptoms/no symptoms (ex. Herpes) • Disease model a person has can greatly influence behavior related to disease (ex. Diabetes can be seen acute or chronic de- pending on the person and thus people will treat their disorders differently) • The conception of disease an individual holds determines health behaviors in important ways The Lay Referral Network: • Lay referral network (LFN): informal network of family/friends who offer their own interpretations of symptoms well before medical treatment is sought • LFN preferred mode of treatment in many communities • 70% of people talk with people in LFN about whether to seek treatment for symptoms • LFNs often recommend home remedies and alternative forms of treatments • Alternative medication is so on the rise, the World Health Organization has taken steps to evaluate their efficacy • Natural health products (NPH): include vitamins, herbal remedies and teas, minerals, plants • 71% of Canadians have tried NPH and 31% use them daily • Only a fifth of Canadians consult alternative therapy providers (ex. chiropractor) in a year • Therapies mainly used to complement rather than replace traditional medicine, but health care providers are usually unaware of the supplemental treatments and this can cause risk of conflicting treatments The Internet: • Internet could be a LFN on its own • 4million Canadians seek health information online per day • 6/10 internet users have used the net to seek health information • Women 2x more likely than men use internet for health info, and households with children are much more likely to. Men 15-24 are least likely • Most common info searched is for specific diseases/conditions - Lifestyle information is 2 nd • 96% of surveyed physicians say internet will positively affect health What Predicts the Use of Health Services? • Wait times main reason for not getting care when needed in Canada, and cost in main barrier in USA • Presence of atypical or numerous symptoms, serious illness, or disability are common reasons people seek help, but individ- ual and social factors also play a role Age: • Age influences use of healthcare serves- very young, and elderly most frequent users • Young children develop many infectious diseases and more likely to experience unintentional injuries such as falls- children under 5 accounted for more ER visits than any other group • In late adulthood, chronic conditions and diseases start to develop • Advancing age (as isolated factor) associated with increased physician consultations Gender: • Women use healthcare system more than men • Pregnancy and childbirth account for much of gender difference but not all • Women have better homeostatic mechanisms- report pain earlier, experience temperature changes more rapidly, and detect new smells faster • As women age, use becomes closer to men • It is more socially acceptable for women to express feelings of pain • Economic factors- m
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