PSYC 314 - CHAPTER 11 NOTES
•Chronic conditions are more common among lower income Canadians, women and seniors.
⁃Self management - involvement of the patient in all aspects of a chronic illness and its implications,
including medical management, changes in social and vocational roles and coping.
•People's perception of their own health is important for quality of life.
⁃Evaluation of their own health may come from the psychological distress that accompanies chronic illnesses.
⁃Stress exacerbates symptoms and chronic illnesses so managing stress is important for management of
•Qualify of Life - Physical functioning, psychological status, social functioning and disease related symptomatology.
⁃This varies depending on the extent to which a patient's normal life activities have been compromised by
disease and treatment.
•SF-36 (Short Form Health Survey) - Measures qualify of life with 8 different scales of profile. Concepts include
physical functioning, role physical, bodily pain, general health, role social, mental health, vitality, and social functioning.
⁃Canadians score higher than Americans and men had higher scores than women in Canada.
⁃Qualify of life can fluctuate depending on characteristics of the illness, acute changes in symptoms and age
related changes in health over time and culture can also play a role in how a chronic illness impacts quality of life.
Why study Quality of Life?
Documentation of exactly how illness affects social, personal and vocational activities provides basis for
Pinpoint which problems are likely to emerge.
Assess the impact of treatments on quality of life.
Inform decision makers about care that will maximize long-term survival with the highest quality of life possible.
o Many live with more than one chronic illness and they tend to have significantly poorer quality of life than
those who have just one.
Emotional responses to chronic illness listed in typical order
Denial – Defense mechanism by which people avoid implications of an illness.
o During the acute phase, denial can serve a protective function.
o During the rehabilitative phase of illness, denial may have adverse effects if it interferes with the ability to
take in necessary information that will be part of the patient’s treatment or self-management program.
Anxiety – common after diagnosis of chronic illness.
o It is a problem because it is intrinsically distressing but it can also interfere with good functioning. o Especially prevalent among people with asthma and pulmonary disorders; it compromises quality of life.
Depression – common and often debilitating reaction to chronic illness
o Sometimes a delayed reaction to chronic illness because it often takes time for patients to understand the
full implications of their conditions.
o Likelihood of having depression is highest for people with chronic fatigue syndrome and fibromyalgia.
o It has an impact on the symptoms experienced and on the overall prospects for rehabilitation ore recovery.
o Potent risk factor for death among the individuals with chronic illness
o Many of the physical signs of depression like fatigue, sleeplessness, or weight loss may be symptoms of
disease or side effects of treatment.
o It increases with the severity of the illness
How is “self” changed by chronic disease?
o Self-concept – stable set of beliefs about one’s qualities and attributes.
o Self-esteem – general evaluation of the self-concept like whether one feels good or bad about personal
o A chronic illness can produce drastic changes in self-concept and self-esteem.
o Body-image – perception and evaluation of one’s physical functioning and appearance.
Poor body image is related to low self-esteem and an increased likelihood of depression and anxiety.
Body image also influences how adherent a person is to the course of treatment and how willing she
or he is to adopt a comanagement role.
It can be improved through psychological and educational interventions
2 exceptions are patients with facial disfigurements or with extensive burns who may never
truly accept their altered appearances.
When illness threatens sexual functioning as it does for strike and paralysis, body image may be
Social self-efficacy can decrease effect of disfigurement on social isolation.
Achievement through vocational activities is also an important aspect of self-esteem and self-
Interactions with family and friends can be a critical source of self-esteem.
The private self may be severely strained by chronic illness. Many illnesses create the need to be
dependent on others; the resulting loss of independence poses threats to self.
Coping with chronic illness
Those with a chronic illness report fewer active coping methods like planning, problem solving, or confrontative
coping and more passive strategies like positive focus and escape/avoidant strategies.
Use of avoidant coping is associated with increased psychological distress and thereby may be a risk factor for
adverse responses to illness Active coping, in contrast has been found to predict good adjust