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PSY333H1 (15)
Chapter 11

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University of Toronto St. George
Nevena Simic

PSY333 – Chapter 11 Living with Chronic Illness  Nearly 3 million Canadians over the age of 12 have asthma, with the rates highest amongst children and teens o There has been a four-fold rate of increase in asthma among children in the past 20 years with 20% of boys and 15% of girls (8-11 years) o Exposure to environmental and air pollutants believed to play a role  Chronic illness may involve a disease process (e.g., heart disease) or not (e.g. sports injury)  At any given time, 58% of the Canadian population and 81% of the community-dwelling senior population has a chronic condition  Care for people with chronic illnesses accounts for 67% of all the health care costs incurred in Canada  More than 63% of deaths globally were due to chronic disease in 2008, amounting to an estimated 36 million people  although the largest number of these deaths occurred in low and middle-income countries, the prevalence rates were highest among developed countries like Canada  The estimated total direct and indirect health care costs of chronic diseases in Canada are ~$10 billion for diabetes, almost $18 billion for cancer, over $20 billion for arthritis, over $26 billion for CVD, hypertension and stroke  Self management refers to 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  For years quality of life was measured solely in terms of length of survival and signs of presence of disease with no consideration of the psychosocial consequences of illness and treatment  Self-reports of health status have been found to predict morbidity and mortality beyond medical and psychosocial factors  it’s an important aspect of quality of life  Those with a chronic illness are more likely to suffer from depression, anxiety and distress  can increase mortality o Stress exacerbates the symptoms and course of many chronic illnesses  Quality of life has several components, specifically physical functioning, psychological status, social functioning, and disease- or treatment-related symptomatology  QOL is now assessed with emphasis placed on how much the disease and its treatment interferes with the activities of daily living (e.g. eating, sleeping) o For patients with more advanced diseases, QOL focuses on functional aspects of daily living such as bathing, dressing, using the toilet  One way of understanding how QOL affects people with a chronic disease is to examine how the QOL of people living with a chronic disease or condition compares to that of a general population (population norms would have to be established and used as a standard) o The same norms can be used to compare QOL across countries PSY333 – Chapter 11  QOL may fluctuate depending on the characteristics of the illness, acute changes in symptoms and age-related changed in health over time  Culture and age can also play a role in how a chronic illness impacts QOL  Why study quality of life? o Documentation of exactly how illness affects vocational, social and personal activities provides a basis for interventions designed to improve quality of life o QOL can help pinpoint which problems are likely to emerge for patients with diseases and help anticipate the interventions required o Assess the impact of treatment on quality of life o QOL information can be used to compare therapies o QOL information can inform decision makers about care that will maximize long-term survival with the highest quality of life possible  Most people live with multiple chronic conditions, however, many programs only target one o In Canada, of those who live with a chronic illness, 1/3 has more than one chronic health condition o Those who live with multiple chronic conditions may require specialized treatment and management strategies to address their QOL deficits  it’s possible that one treatment for one illness may aggravate the other chronic illness  Immediately after a chronic disease is diagnosed, patients can be in a state of crisis marked by physical, social, and psychological disequilibrium o Eventually, the crisis phase of chronic illness passes, and patients begin to develop a sense of how chronic illness will alter their lives  Denial s a defense mechanism by which people avoid the implications of an illness o Patients may act as if the illness were not severe, as if it will shortly go away, or as if it will have few long-term impacts o Denial may serve as a protection function and can sometimes lead to fewer signs of dysfunction, better recovery etc  Following the diagnosis of a chronic illness, anxiety is common o Many patients become overwhelmed by the potential changes in their lives and, in some cases, by the prospect of death o Every twinge of chest pain may raise concern of another heart attack o Anxiety is especially high when people are waiting for test results, receiving diagnoses, awaiting invasive medical procedures and anticipating or experiencing adverse side effects of treatment o Anxiety can interfere with good functioning, produce its own symptoms (interfering with diagnosis) and compromise QOL  Up to 1/3 of all medical patients with chronic disease report at least moderate symptoms of depression, and up to ¼ suffer from severe depression o Among Canadians living with chronic illness, the likelihood of having clinical depression is highest for people with chronic fatigue PSY333 – Chapter 11 syndrome and fibromyalgia, and lower for people with diabetes, heart disease, hypertension, and thyroid disease  people with particular health conditions are at a greater risk of depression o Depression exacerbates the risk and course of several chronic disorders, most notably coronary heart disease; depression complicates treatment adherence and medical decision making o Depression is sometimes a delayed reaction to chronic illness because it often takes time for patients to understand the full implications of their condition; once the acute stage of chronic illness has ended, the full implications of the disorder may begin to sink in o Depression over illness and treatment has been linked to suicide among those with a chronic illness o Many of the symptoms of depression overlap with symptoms of chronic illness or side effects of medication and may be improperly viewed as symptoms correlated with illness and not those of depression o Depression increases with the severity of the illness and is typically led on by the experiences of pain and disability  Psychologists refer to the self-concept as a stable set of beliefs about one’s qualities and attributes; self-esteem refers to the general evaluation of the self-concept—namely, whether one feels good or bad about personal qualities and attributes  The self concept is a composite of self-evaluations regarding many aspects of one’s life, which include body image, achievement social functioning, and the private self  Body image is the perception and evaluation of one’s physical functioning and appearance  body image plummets during illness o First, a poor body image is related to low self-esteem and an increase likelihood of depression and anxiety o Second, body image may influence how adherent a person is to the course of treatment and how willing he or she is to adopt a comanagement role o Finally, body image is important because it cane be improved through psychological and education interventions  two exceptions are patients with facial disfiguration or with extensive burns o There appear to be 2 reasons that facial disfigurements produce chronic alterations in body image: first, the face is often associated with personality, and when the face is deformed, both patients themselves and others reacting to them may see the individual’s whole nature as tainted; second, facial disfigurements cannot be masked o Body image can be improved by stressing other aspects of appearance
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