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Comparisons Between Illness and Injury Outcomes: Potential Suppression Effects by Emotional Representations

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Abstract

Background

Based on recent findings that people perceive illness and injury as separate categories, we compared ill and injured participants with similar health conditions on illness perceptions and reported outcomes, e.g., functioning, distress, well-being.

Method

A cross-sectional study with 182 ill and 160 injured participants affected by ankle, knee, or neck conditions compared them on standard measures of illness perception and other reported outcomes (self-assessed health; physical, emotional, and social functioning; depression, anxiety, and somatization; satisfaction with life, self-esteem, and acceptance of disability).

Results

The groups did not differ on the measured outcomes, but injury elicited stronger emotional representations, and illness was perceived as more chronic. After controlling for the effects of emotional representations, the injured group presented better outcomes on all outcome measures, including self-assessed health, physical functioning, emotional functioning, social functioning, vitality, health beliefs, depression, somatization, total distress, and acceptance of disability.

Conclusion

Emotional representations may suppress the potential superior outcomes of injury compared with illness. The theoretical implications of these results for self-regulation theories are discussed, as well as clinical implications.

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Notes

  1. Maccabi Healthcare Services.

  2. The electronic self-report measure of function was only available in the clinics and was used as part of the clinical diagnosis of patients.

  3. Injured participants filled out additional items related specifically to injury as part of a study [22] for constructing the Injury Perception Questionnaire (InjPQ).

References

  1. Levine RM. Identity and illness: the effects of identity salience and frame of reference on evaluation of illness and injury. Brit J Health Psych. 1999;4:63–80.

    Google Scholar 

  2. Hagger MS, Orbell S. Illness representations and emotion in people with abnormal screening results. Psychology & Health. 2006;21(2):183–209.

    Google Scholar 

  3. Holmes TH, Rahe RH. Social Readjustment Rating Scale. J Psychosom Res. 1967;11(2):213 -&.

    CAS  PubMed  Google Scholar 

  4. Hentschel S, Eid M, Kutscher T. The influence of major life events and personality traits on the stability of affective well-being. J Happiness Stud. 2017;18(3):719–41.

    Google Scholar 

  5. Carleton RN, Park I, Asmundson GJG. The Illness/Injury Sensitivity Index: an examination of construct validity. Depress Anxiety. 2006;23(6):340–6.

    PubMed  Google Scholar 

  6. Shiloh S, Heruti I, Berkovitz T. Attitudes toward people with disabilities caused by illness or injury: beyond physical impairment. Int J Rehabil Res. 2011;34(4):321–9.

    PubMed  Google Scholar 

  7. Shiloh S, Heruti I, Leichtentritt R. A common-sense model of injury perceptions. J Health Psychol. 2016;21(8):1516–26.

    PubMed  Google Scholar 

  8. Leventhal H, Idler EL, Leventhal EA. The impact of chronin illness on the self-system. Self, social identity, and physical health: interdisciplinary explorations. Oxford: Oxford University Press; 1999. p. 185–207.

    Google Scholar 

  9. Orbell S, Phillips LA. Automatic processes and self-regulation of illness. Health Psychol Rev. 2018;13:1–28. https://doi.org/10.1080/17437199.2018.1503559.

    Article  Google Scholar 

  10. Oris L, Luyckx K, Rassart J, Goubert L, Goossens E, Apers S, et al. Illness identity in adults with a chronic illness. Journal of Clinical Psychology in Medical Settings. 2018;25(4):429–40.

    PubMed  Google Scholar 

  11. Agar E, Kennedy P, King NS. The role of negative cognitive appraisals in PTSD symptoms following spinal cord injuries. Behav Cogn Psychoth. 2006;34(4):437–52.

    Google Scholar 

  12. Shiloh S, Heruti I, Diamis A, Levy S, Avitsur R, Deutscher D, et al. The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes. Psychology & Health. 2018;33(12):1519–36.

    Google Scholar 

  13. Diefenbach MA, Leventhal H. The common-sense model of illness representation: theoretical and practical considerations. Journal of Social Distress and the Homeless. 1996;5(1):11–38.

    Google Scholar 

  14. Leventhal H. Common sense illness cognition: science and practice. International Journal of Psychology. 2012;47:433.

    Google Scholar 

  15. Leventhal H, Phillips LA, Burns E. The common-sense model of self-regulation (CSM): a dynamic framework for understanding illness self-management. Journal of Behavioral Medicine. 2016;39(6):935–46.

    PubMed  Google Scholar 

  16. Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychology & Health. 2015;30(11):1361–85.

    Google Scholar 

  17. Hagger MS, Orbell S. A meta-analytic review of the common-sense model of illness representations. Psychology & Health. 2003;18(2):141–84.

    Google Scholar 

  18. Petrie KJ, Weinman J. Patients’ perceptions of their illness: the dynamo of volition in health care. Current Directions in Psychological Science. 2012;21(1):60–5.

    Google Scholar 

  19. Richardson EM, Schuz N, Sanderson K, Scott JL, Schuz B. Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis. Psycho-Oncology. 2017;26(6):724–37.

    PubMed  Google Scholar 

  20. Hagger MS, Chatzisarantis NLD, Griffin M, Thatcher J. Injury representations, coping, emotions, and functional outcomes in athletes with sports-related injuries: a test of self-regulation theory. Journal of Applied Social Psychology. 2005;35(11):2345–74.

    Google Scholar 

  21. Aitken LM, Chaboyer W, Kendall E, Burmeister E. Health status after traumatic injury. J Trauma Acute Care. 2012;72(6):1702–8.

    Google Scholar 

  22. Heruti I, Levy S, Avitsur R, Deutscher D, Gutvirtz M, Berkovitz T, et al. Development of the Injury Perceptions Questionnaire (InjPQ). Psychol Health. 2018;33(5):614–33.

    PubMed  Google Scholar 

  23. Lee BO, Chaboyer W, Wallis M. Illness representations in patients with traumatic injury: a longitudinal study. Journal of Clinical Nursing. 2010;19(3-4):556–63.

    PubMed  Google Scholar 

  24. Faugier J, Sargeant M. Sampling hard to reach populations. J Adv Nurs. 1997;26(4):790–7.

    CAS  PubMed  Google Scholar 

  25. Deutscher D, Hart DL, Dickstein R, Horn SD, Gutvirtz M. Implementing an integrated electronic outcomes and electronic health record process to create a foundation for clinical practice improvement. Phys Ther. 2008;88(2):270–85. https://doi.org/10.2522/ptj.20060280.

    Article  PubMed  Google Scholar 

  26. Deutscher D, Hart DL, Stratford PW, Dickstein R. Construct validation of a knee-specific functional status measure: a comparative study between the United States and Israel. Physical Therapy. 2011;91(7):1072–84.

    PubMed  Google Scholar 

  27. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16.

    Google Scholar 

  28. Ware JE, Sherbourne CD. The Mos 36-Item Short-Form Health Survey (Sf-36) .1. Conceptual-framework and item selection. Med Care. 1992;30(6):473–83.

    PubMed  Google Scholar 

  29. Derogatis LR, Melisaratos N. The brief symptom inventory - an introductory report. Psychol Med. 1983;13(3):595–605.

    CAS  PubMed  Google Scholar 

  30. Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49(1):71–5.

    CAS  PubMed  Google Scholar 

  31. Rosenberg M. The association between self-esteem and anxiety. J Psychiatr Res. 1962;1:135–52.

    CAS  PubMed  Google Scholar 

  32. Linkowski DC. Scale to measure acceptance of disability. Rehabil Couns Bull. 1971;14(4):236–44.

    Google Scholar 

  33. Buchi S, Sensky T. PRISM: Pictorial representation of illness and self measure - a brief nonverbal measure of illness impact and therapeutic aid in psychosomatic medicine. Psychosomatics. 1999;40(4):314–20.

    CAS  PubMed  Google Scholar 

  34. Klis S, Vingerhoets AJJM, de Wit M, Zandbelt N, Snoek FJ. Pictorial Representation of Illness and Self Measure Revised II (PRISM-RII) - a novel method to assess perceived burden of illness in diabetes patients. Health Qual Life Out. 2008;6:104.

    Google Scholar 

  35. MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000;1(4):173–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Carleton RN, Asmundson GJG, Taylor S. Fear of physical harm: factor structure and psychometric properties of the Injury/Illness Sensitivity Index. Journal of Psychopathology and Behavioral Assessment. 2005;27(4):235–41.

    Google Scholar 

  37. Brown RJ. Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model. Psychological Bulletin. 2004;130(5):793–812.

    PubMed  Google Scholar 

  38. Maguire R, Maguire P, Keane MT. Making sense of surprise: an investigation of the factors influencing surprise judgments. Journal of Experimental Psychology-Learning Memory and Cognition. 2011;37(1):176–86.

    PubMed  Google Scholar 

  39. Mellers BA, Ritov I. How beliefs influence the relative magnitude of pleasure and pain. Journal of Behavioral Decision Making. 2010;23(4):369–82.

    Google Scholar 

  40. Tracy JL, Robins RW. Putting the self into self-conscious emotions: a theoretical model. Psychol Inq. 2004;15(2):103–25.

    Google Scholar 

  41. Gould RV, Brown SL, Bramwell R. Psychological adjustment to gynaecological cancer: patients’ illness representations, coping strategies and mood disturbance. Psychol Health. 2010;25(5):633–46. https://doi.org/10.1080/08870440902811163.

    Article  PubMed  Google Scholar 

  42. Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “common-sense” of chronic illness management. Annals of Behavioral Medicine. 2011;41(2):152–63.

    PubMed  Google Scholar 

  43. Leventhal H, Diefenbach M, Leventhal EA. Illness cognition - using common-sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research. 1992;16(2):143–63.

    Google Scholar 

  44. Dempster M, Howell D, McCorry NK. Illness perceptions and coping in physical health conditions: a meta-analysis. Journal of Psychosomatic Research. 2015;79(6):506–13.

    PubMed  Google Scholar 

  45. Hagger MS, Koch S, Chatzisarantis NLD, Orbell S. The common sense model of self-regulation: meta-analysis and test of a process model. Psychological Bulletin. 2017;143(11):1117–54.

    PubMed  Google Scholar 

  46. Kaplan RM. Behavior as the central outcome in health-care. American Psychologist. 1990;45(11):1211–20.

    CAS  PubMed  Google Scholar 

  47. Savulich G, Menon DK, Stamatakis EA, Pickard JD, Sahakian BJ. Personalised treatments for traumatic brain injury: cognitive, emotional and motivational targets. Psychological Medicine. 2018;48(9):1397–9.

    PubMed  Google Scholar 

  48. Li Y, Bressington D, Chien WT. Systematic review of psychosocial interventions for people with spinal cord injury during inpatient rehabilitation: implications for evidence-based practice. Worldviews on Evidence-Based Nursing. 2017;14(6):499–506.

    CAS  PubMed  Google Scholar 

  49. Giummarra MJ, Lennox A, Dali G, Costa B, Gabbe BJ. Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: a systematic review and meta-analysis. Clinical Psychology Review. 2018;62:11–36.

    PubMed  Google Scholar 

  50. Greenberg LS. Emotion-focused therapy. Clinical Psychology & Psychotherapy. 2004;11(1):3–16.

    Google Scholar 

  51. Broadbent E, Ellis CJ, Thomas J, Gamble G, Petrie KJ. Further development of an illness perception intervention for myocardial infarction patients: a randomized controlled trial. Journal of Psychosomatic Research. 2009;67(1):17–23.

    PubMed  Google Scholar 

  52. Cameron LD, Jago L. Emotion regulation interventions: a common-sense model approach. British Journal of Health Psychology. 2008;13:215–21.

    PubMed  Google Scholar 

  53. Junghans C, Feder G, Hemingway H, Timmis A, Jones M. Recruiting patients to medical research: double blind randomised trial of “opt-in” versus “opt-out” strategies. BMJ. 2005;331(7522):940. https://doi.org/10.1136/bmj.38583.625613.AE.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychology, Rabin Medical Center, Petach Tikva, Israel

    Irit Heruti

  2. The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel

    Sigal Levy

  3. Maccabi Healthcare Services, Tel Aviv-Yafo, Israel

    Daniel Deutscher, Moshe Gutvirtz & Tamar Berkovitz

  4. School of Psychological Sciences, Gordon Faculty of Social Sciences, Tel Aviv University, 69978, Tel Aviv, Israel

    Shoshana Shiloh

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  1. Irit Heruti
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  2. Sigal Levy
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  3. Daniel Deutscher
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  4. Moshe Gutvirtz
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  5. Tamar Berkovitz
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  6. Shoshana Shiloh
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Correspondence to Shoshana Shiloh.

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Heruti, I., Levy, S., Deutscher, D. et al. Comparisons Between Illness and Injury Outcomes: Potential Suppression Effects by Emotional Representations. Int.J. Behav. Med. 28, 393–400 (2021). https://doi.org/10.1007/s12529-020-09931-3

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