Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients

Simon R Knowles, Davina Tribbick, William R Connell, David Castle, Michael Salzberg, Michael A Kamm
Journal of Wound, Ostomy, and Continence Nursing 2014, 41 (6): 573-80

PURPOSE: We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual's illness perceptions as well as what coping strategies they engage in.

DESIGN: Descriptive, cross-sectional questionnaire-based study.

SUBJECTS AND SETTING: One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

METHODS: Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

RESULTS: Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

CONCLUSIONS: Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

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