Mediating Role of Anxiety and Depression in the Relationship between Posttraumatic Stress Symptoms and Illness Intrusiveness

BACKGROUND: Posttraumatic stress symptoms (PTSS) in patients with psychological trauma lead to poor health-related quality of life. Understanding of the relationships among PTSS, anxiety, depression, and illness intrusiveness will guide the development of efficient approaches to enhance subjective well-being in patients with psychological trauma. This study investigated whether anxiety and depression mediate the relationship between PTSS and illness intrusiveness in the hope of providing more comprehensive and effective trauma treatment. METHODS: Psychiatric outpatients who visited the trauma clinic of a university hospital (n = 260) participated in this study. Assessments were conducted for PTSS, anxiety, depression, and illness intrusiveness. Structural equation modeling and path analysis were performed to analyze the mediating effects of anxiety and depression on the relationship between PTSS and illness intrusiveness. RESULTS: PTSS had both direct and indirect exacerbating effects on illness intrusiveness. Anxiety exhibited the largest direct exacerbating effect on illness intrusiveness. The indirect effects of PTSS on illness intrusiveness through anxiety alone and through a depression-to-anxiety pathway were significant, but the indirect effect through depression alone was not. CONCLUSION: The findings demonstrate that anxiety, both independently and as part of an interrelated pathway with depression, partially mediates the relationship between PTSS and illness intrusiveness. Appropriate interventions and a comprehensive approach to alleviate anxiety and depression could mitigate the negative effects of PTSS on illness intrusiveness in patients with psychological trauma.

Perceived Illness Intrusiveness by the Characteristics of Primary Caregivers in Stroke Patients / 재활간호학회지

PURPOSE: This study was implemented to investigate perceived illness intrusiveness in stroke patients by the characteristics of primary caregivers. METHOD: Retrospective cross-sectional survey design was used. The subjects were 225 stroke patients and their primary caregivers. Demographic variables, relationship variables, burden, depression and support were measured as primary caregivers' characteristics. Data were analyzed with SPSS win 14+. T-test, ANOVA and correlation test were used depending on variables. RESULT: Demographic variables such as age, gender, relation with patients, and living status were not related significantly with illness intrusiveness. But primary caregivers' burden, depression and support were related significantly with perceived illness intrusiveness of stroke patients. That is, burden, depression and quantitative support of primary caregivers were significantly positively correlated with perceived illness intrusiveness of stroke patients. On the other hand, qualitative support was negatively correlated with perceived illness intrusiveness. CONCLUSION: Primary caregivers' characteristics such as burden, depression and support were found to be correlated with stroke patients perception such as illness intrusiveness. So, it is recommended that nursing intervention targeting burden, depression and support of primary caregivers must be developed to reduce illness intrusiveness of stroke patients.

Illness Intrusiveness by Symptoms in Patients with Rheumatoid Arthritis / 성인간호학회지

PURPOSE: Illness intrusiveness (illness induced lifestyle disruption) by symptoms was investigated in 439 patients with rheumatoid arthritis. METHOD: The cross-sectional and retrospective survey design was used. Fatigue, disability, pain, and depression were considered as symptoms of rheumatoid arthritis. RESULT: Patients were reported to perceive more illness intrusiveness than other chronic disease patients such as end stage renal disease, bipolar disorder, and peritoneal dialysis patients. They were especially intrusive into work, health, and active recreation domains. Stepwise regression analysis identified four variables counting for 26% of illness intrusiveness variances: fatigue, disability, marital status, and depression. All of the symptoms except pain were found to significantly predict illness intrusiveness. Fatigue explained 16% of illness intrusiveness variances. CONCLUSION: Fatigue and depression usually overlooked by health professionals must be carefully assessed and managed to reduce perceived illness for rheumatoid arthritis patients.

The Relationships of Illness Intrusiveness and Quality of Life in Chronic Liver Disease Patients / 성인간호학회지

PURPOSE: This study was performed to identify the illness intrusiveness, quality of life, and their relationships in patients with chronic liver disease. METHOD: Data was collected using scales of illness intrusiveness developed by Devins et al and Korean health related quality of life (KoQoLS) developed by Shim et al to measure the illness intrusiveness and quality of life from 141 chronic liver disease patients. RESULT: The total mean score of illness intrusiveness was 38.85+/-18.45. The domain of illness intrusiveness which showed the highest mean score was health (4.60+/-2.02), and the lowest mean score domain was relationship with spouse (2.04+/-1.69). The subcategory of KoQoLS which showed the highest mean score was bodily pain (6.96+/-2.98), and the lowest mean score subcategory was vitality (2.75+/-1.20). There were negative relationships between illness intrusiveness and KoQoLS in all subcategories. Abovel all, Illness intrusiveness had the strongest negative relationship with role limitation (r=-0.641) among the KoQoLS subcategories. CONCLUSION: Because the illness intrusiveness had negative influence on the quality of life in patients with chronic liver disease, further research will need to specify detailed illness intrusiveness and to explore influencing factors on quality of life in them.

Predicting Factors of Post-Stroke Depression / 성인간호학회지

Predicting factors of post-stroke depression were investigated. The subjects were 254 stroke patients who had been discharged and visited regularly the outpatient clinic for follow up care. The influencing factors were classified into five categories: demographic, disease-related, current state, social support, and illness intrusiveness. Sex, age, job, and educational level were defined as the demographic factor. The disease-related factors included stroke type, illness duration, attack frequency, and NIH score. ADL, cognitive function, and social activity were considered as the current state factors. The social support was measured as the perceived amount of social support. Illness intrusiveness means the perceived illness induced life style disruptions. Demographic, disease-related, current state, and social support were hypothesized to directly and indirectly affect post-stroke depression through illness intrusiveness. The illness intrusiveness was hypothesized to directly affect post-stroke depression. The hierarchial multiple regression was used to identify significant factors. The result showed that this model explained 43.3% of variance of post-stroke depression. And the prevalence of post-stroke depression was 38.8%. Among the demographic factors, job was identified as a main contributor to indirectly increase the post-stroke depression. Among the disease-related factors, stroke type, attack frequency, and NIH score were found to indirectly affect the post-stroke depression. Among the current state factors, ADL and social activity indirectly affected the post-stroke depression through illness intrusiveness. Social support and illness intrusiveness were identified to directly affect the post-stroke depression. This study has proved the factors likely to be implicated in the development of post-stroke depression. Based upon these results, it is recommended that the nurses who take care of post-stroke patients consider the risk factors such as social support, illness intrusiveness et al. Also programs which decrease the illness intrusiveness and increase the social support to reduce post-stoke depression recommended to be developed.

Readjustment and Social Support of the Post Hospitalized Stroke Patients / 간호학회지

An explanatory design was employed to identify the relationship of physical, emotional & social readjustment and social support of post hospitalized stroke patients and their caregiver. A convenient sample of 254 patients who given follow-up care at the outpatient department after discharge and 225 caregivers were recruited. Mental Status Questionnaire(MSQ), Social Support Inventory Stroke Survivors(SSISS), Illness intrusiveness(II), Instument Activity of Daily Living(IADL), Center of Epidnmilogic Studies-Depression(CES-D), social activity and caregiver burden were used for measurement in this study. Results showed patient's physical level measured by IADL and psychological level measured by depression were high. But social activity was low. Cognitive function, depression & social activity were not significantly different by the posthospitalized period, but IADL was. The source of professional support was mostly the physician at the outpatient department. The family support was found significantly related to patient's depression & social activity and caregiver's subjective related to patient's IADL & depression. ILLness intrusiveness as a mediating variable was a significantly predicting power on patient's IADL & depression. The path analysis was used to identify the variables to predict the physical, emotional, and social status of patients, the physical, emotional, and cognitive function, illness intursiveness and professional support significantly predicted the level of siveness and family support significantly predicted the level of depression ; and patient's age and family support significantly predicted the level of social activity of posthospitalized stroke patients. Based upon these results, the rehabilitation programs to reduce the illness intrusiveness and improve cognitive function were recommended for the readjustment of the stroke patients. This model of the readjustment of the posthospitalized stroke patients is recommended as the framework for care of the stroke patients.