Lecture 3
Health Psychology and
Physical Illnesses I (Part 1)
Dr. Antoinette Lee
The University of Hong Kong
Lecture Outline
Part 1:
 Psychological factors in Help-Seeking

Illness Cognitions and Representations

Coping with Chronic Illnesses
Part 2:
 Adherence to treatment
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Lecture Outline
Part 3:
 Coronary Heart Disease
 Psychological factors and CHD
 Psychological responses to CHD
 Psychological contributions to prevention
and management of CHD
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Health-Adjusted Life
Expectancy
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WHO’s concept of Health-Adjusted Life Expectancy (HALE)
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HALE (at birth), 2000 & 2002:
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Disability-adjusted life expectancy
Years of life in good health
Versus the concept of Life Expectancy which focuses on years of life in both
good and ill health
USA:
China:
HK:
65.7 / 67.2 (male) 68.8 / 71.3 (female)
60.9 / 63.1 (male) 63.3/ 65.2 (female)
70.3 (male) 75.7 (female) (for 2000 only, Law & Yip, 2003)
Life Expectancy (at birth), 2000 & 2002:
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USA:
China:
HK:
Antoinette M. Lee, HKU
74.3 / 74.6 (male) 79.7 / 79.8 (female)
69.6 / 69.6 (male) 73.3 / 72.7 (female)
77 / 77.2 (male) 82.2 / 82.7 (female)
Master in Behavioral Health
Health Psychology Module Spring 2005
Help-Seeking
Individual
factors
•Prior experience
•Expectations
•Seriousness of Sx
Recognition
of Symptom
Interpretation
of Symptom
Situational
factors
Illness
representations
Antoinette M. Lee, HKU
Lay referral
network
Master in Behavioral Health
Health Psychology Module Spring 2005
Help-seeking
Health
Behaviors
Factors Affecting Help-Seeking
Behaviour
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AGE- young children and the elderly population tend to seek help
most often
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GENDER- women seek help more often than men; physiological
differences and social norms influence help-seeking behaviour
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SOCIAL CLASS- in USA, those of lower SES use health services
less. Is the situation the same in Hong Kong???
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EMERGENCE of irregular symptoms, disability, or serious illness
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SOCIAL PSYCHOLOGICAL FACTORS- a person’s beliefs and
attitudes on symptoms
→ The role of illness cognitions
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Somatization

“the substitution of somatic preoccupation for
dysphoric affect in the form of complaints of physical
symptoms and even illness” (Kleinman, 1980, p.1)
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Cultural influences
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Are Chinese really somatizers?
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The role of doctor-patent relationship, interviewing skills,
and situational factors
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Illness Cognitions and
Representations
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Illness cognition:
 “a patient’s own implicit common sense beliefs about
their illness” (Leventhal et al. 1980, 1997)
 Knowledge about disease, meaning of illness, beliefs about
illness……..
Illness representations / schemas: organized conceptions of
illness
Acquired through personal experience, family and friends,
contacts with health care system, mass media
Provide patients with a framework or schema for
 Understanding their illness
 Coping with their illness
 Telling them what to look out for if they are becoming ill
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Illness Representations
Five dimensions of illness representations:
1.
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2.
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IDENTITY
Label given to the illness and the symptoms experienced
Beliefs about associated symptoms
Disease prototype
PERCEIVED CAUSE OF ILLNESS
Biological, psychological, behavioral
Cultural influences
Internal versus external locus of control
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Illness Representations
TIME LINE
3.
Beliefs about the duration of illness
•
Acute
•
Chronic
•
Cyclic
CONSEQUENCES
•
4.
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beliefs about the impact of illness on their life (physical, emotional,
social consequences)
beliefs about treatments that result
CURABILTY & CONTROLLABILITY
5.
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Can the illness be treated? How?
Extent to which the outcome is controllable by self or external
factors Who can control the outcome of the illness (patients
themselves, doctors, fate….) ?
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Self-Regulatory Model of
Illness Cognitions
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Developed by Leventhal et al. (1980, 1997) to explain
how illness cognitions affect coping strategies
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Basis for model:
 Humans develop problem solving techniques when
normal state is altered (i.e. when health turns for the
worse)
 Motivated to re-establish state of normality and
equilibrium
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Three processes (interpretation, coping, appraisal) that
interrelate in an on-going and dynamic manner
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Self-Regulatory Model
Representation of
health threat
- identity
- cause
- consequences
- time line
- cure/control
Stage 1: Interpretation
- symptom perception
- social message
-> deviation from norm
Stage 2:Coping
- approach coping
- avoidance coping
Emotional response
to health threat
- fear
- anxiety
- depression
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Stage3:Appraisal
- Was my coping
strategy effective?
Stage 1: Interpretation
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Initial confrontation with the illness

An individual may be aware of illness either from
symptom perception or social messages

Symptom perception , e.g. I have a pain in my chest

Social messages may take the form of doctor’s
diagnosis, lab test result, or messages from lay referral
system
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Stage 1: Interpretation
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Individual differences in symptom perception
e.g. attentional differences, neuroticism, mood,
expectations, situational factors
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Interpretation activates illness representation in
attempt to give meaning to the problem
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Stage 2: Coping
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Consideration and application of different coping
strategies
Coping with illness as well as emotional reactions to
illness
Can be broadly categorized into:
Approach coping
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E.g. Consulting a doctor, adhering to treatment,
rest, lifestyle change, seeking information, seeking
support from others
Avoidance coping

E.g. Denial, wishful thinking
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Stage 3: Appraisal
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Evaluating if the coping efforts are effective
If not effective, reconsider coping strategies
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness and The Self-Regulatory
Model of Illness Cognitions
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The model is useful in understanding and/or
predicting:
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Emotional reactions to illness
Coping with illness
Adherence with treatment and lifestyle changes
Outcomes of illness
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness
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Characteristics:
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Long in duration
Long-term consequences
Usually involves multiple causes, including health habits
Cannot be fully cured; can only be managed
As many as 50% of population has some chronic
condition
Cancer, heart diseases, diabetes, hypertension,
arthritis, stroke………
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Challenges
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Change in perception of self
Worries concerning the illness and one’s life
Treatment
Disruption in life and need for lifestyle change
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Life plans
Health habits
Physical management
Monitoring of bodily changes (e.g. early signs of problems)
Vocational
Social
Financial
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness

Emotional reactions to chronic illness
Shock and Denial
 Anxiety
 Depression
 1/3 of medical inpatients with chronic illness report
moderate symptoms of depression
 1/4 report severe depression
 Usually (but not necessarily) occur in later phases
 Adverse impact on outcome
 May lead to suicide
 Difficulty in assessment
Antoinette M. Lee, HKU
Master in Behavioral Health

Health Psychology Module Spring 2005
Chronic Illness
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Factors affecting chance of depression
among chronically ill patients:
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Severity of illness
Pain and disability
Other negative life events
Social support
Age (Schnittker, 2004)
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness

Schnittker, 2004’s study:
 Impact of seven illnesses (high blood pressure, diabetes,
cancer, chronic obstructed pulmonary disease, heart conditions,
stroke, and arthritis) and three forms of disability (mobility,
strength, activities of daily living) on depressive symptoms
 The role of age in moderating the illness, disability, depression
relationship
 Main findings:
 Age is associated with accelerated increase in depressive
symptoms
 However:
 (1) Impact of illness on depressive symptoms decrease with
age
 90% decrease in size of illness effect from 51 to 100 years
of age for diabetes and high blood pressure; 59%
decrease for arthritis
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness

(2) Impact of disability on depressive symptoms
decrease with age
 Effect of ADL on depressive symptoms decrease by
46% from 51 to 100 years of age; effect of mobility
disability and strength disability decrease by 28%
and 43% respectively from 51 to 100 years of age
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness
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Illness as crisis
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Unexpected appearance of illness
Unclear and ambiguous information about
illness and the course of illness
Need to make quick decisions (on treatment,
telling others, taking time off work)
Little experience with illness (limited past
history)
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness
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What about positive reactions?
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Escaped death, second chance
Healthy lifestyle change
Improved close relationship
Change in life priorities
Greater appreciation of health and life
Renewed meaning in life
Greater knowledge about health
Improved empathy
Stronger faith, spirituality
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Chronic Illness and The Self-Regulatory
Model of Illness Cognitions

The model is useful in understanding and/or
predicting:




Emotional reactions to illness
Coping with illness
Adherence with treatment and lifestyle changes
Outcomes of illness
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Coping Strategies for Chronic
Illness

Similar to coping strategies for other stressful
events in life except that chronically ill patients use
less active coping methods:
Social support and direct problem-solving
 “I talked to someone to find our more about the situation”
 Distancing
 I didn’t let it get to me”
 Positive focus
 “I came out of the experience better than I went in”
 Cognitive escape / avoidance
 “I wished that the situation would go away”
 Behavioral escape / avoidance
the situation
by
eating,
Antoinette M.Lee,“Avoiding
HKU
Master in
Behavioral
Health drinking, sleeping etc”

Health Psychology Module Spring 2005
Chronic Illness and The Self-Regulatory
Model of Illness Cognitions

The Self-Regulatory Model has been found to be
useful in understanding and/or predicting:
Adherence with treatment and lifestyle changes
 Brewer et al. (2002): belief that illness has serious
consequences was related to medication adherence, and
belief that illness is stable, asymptomatic, and with serious
consequences was related to actual cholesterol control
among patients with hypercholesterolaemia
 Horne and Weinman (2002): Among patients with asthma,
those who doubt the necessity of medication, have greater
concerns about the negative consequences of medication
had poorer adherence
Antoinette M. Lee, HKU
Master in Behavioral Health

Health Psychology Module Spring 2005
Chronic Illness and The Self-Regulatory
Model of Illness Cognitions
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Outcomes of illness
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Johnston et al. (1999): perceived control predicted
recovery among stroke patients at one and six months
after discharge from hospital
Petrie et al. (1996): Longitudinal study of 143 first-time
MI patients aged 65 or below for 12 months following
admission to hospital
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Belief that the illness had less serious consequences and
would last a shorter time (at baseline) predicted return to
work at six weeks
Belief that the illness could be controlled or cured predicted
attendance at rehabilitation classes
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
Part 2: Non-Adherence

Notes on non-adherence will be provided
during class after the group presentation
Antoinette M. Lee, HKU
Master in Behavioral Health
Health Psychology Module Spring 2005
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Chronic Illness - Centre on Behavioral Health