Predictors of psychosocial adjustment in people with physical disease


Kocaman N., Kutlu Y. , Özkan M., Özkan S.

JOURNAL OF CLINICAL NURSING, cilt.16, ss.6-16, 2007 (SCI İndekslerine Giren Dergi) identifier identifier identifier

Özet

Aims. The purpose of this paper was to examine the demographic, medical and psychosocial variables that result in the deterioration of psychosocial adjustment in patients with physical disease, the meaning their illness has for them and their coping style.

 

Keywords:

  • adjustment;
  • depression;
  • nurses;
  • nursing;
  • psychiatry;
  • psychosocial care

Aims.  The purpose of this paper was to examine the demographic, medical and psychosocial variables that result in the deterioration of psychosocial adjustment in patients with physical disease, the meaning their illness has for them and their coping style.

Methods.  The study was carried out in inpatient clinics of the Istanbul Faculty of Medicine (n = 198). The following evaluation instruments were used: a semi-structured questionnaire, the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), the Meaning of Illness Questionnaire (MIQ), the Hospital Anxiety–Depression Scale, the Multivariate Perceived Social Support Questionnaire and the Ways of Coping Inventory (WCI). Variables to be related with psychosocial adjustment were analysed by using Forward Logistic Regression.

Results.  The mean age of patients was 36·9 (SD 12·9) (18–65), 55% of which were women, the average PAIS-SR score was 1·02 (SD 0·41) (0·7–2·26); 47% of the patients had poor adjustment scores. Univariate analysis showed that psychosocial adjustment was affected by having children (p = 0·02), anxiety, depression, locus of control, perceived social support (p < 0·001), information level about their illness and its treatment (p = 0·01), the subscales of WCI [escape-avoidance (p < 0·001), distancing (p = 0·002), planned problem solving (p < 0·001), positive re-appraisal (p = 0·02)]. The psychosocial adjustment of patients with respiratory or infectious illnesses or bone-muscle-skeletal disorders was even less (p = 0·03). All 33 items of the MIQ were found to have a significant impact on psychosocial adjustment (p < 0·001). According to the regression analysis, the best predictors of psychosocial adjustment were: depression (p < 0·001) and the meaning of illness for patient (p < 0·01).

Conclusions.  Having a physical illness is an important stress factor. In providing assistance, a number of factors should be taken into consideration, including how the patient perceives his illness, the impact the illness has on the patient's life, and a determination of the degree of depression being experienced by the patient.

Relevance to clinical practice.  The study indicated some predictors in the assesment of psychosocial adjustment and care of patients with physical illness. In daily clinical practice, among the patients with physical illness, those with a negative perception of their illness and those who define depression should be given special attention for psychosocial support.