Psychological determinants of the attitude towards vascular interventions in patients with lower limb ischaemia.

BACKGROUND: Critical lower limb ischaemia is associated with a 20% annual risk of amputation and death. It is necessary to activate patients' personal resources which comprise mental dispositions needed to effectively cope with the disease. The objective of the study was to evaluate the correlation between the attitude toward the vascular reconstruction and self-efficacy (SE), health locus of control (HLoC) and own life quality (QOL) assessment in patients with critical lower limb ischaemia. PARTICIPANTS AND PROCEDURE: The study involved 64 patients with critical lower limb ischaemia (Rutherford 4 and 5), 26 women and 38 men. Four scales were applied during primary admission: the Generalized Self-Efficacy Scale; the Satisfaction with Life Scale; the Multidimensional Health Locus of Control Scale; and the visual scale revealing attitude to vascular reconstruction. RESULTS: The attitude to the vascular reconstruction was positive (M = 8.50). The lowest grades were given by those hospitalised several times during follow-up (M = 8.30); women expressed low grades (M = 7.71). An overall positive correlation was found between the positive attitude to the surgery and self-efficacy (p = .012), internal HLoC (p = .041) and external locus (p = .026). In the patients who died within six months from baseline assessment, no correlations were found. In subjects with no readmission, a correlation was found between positive attitude to surgery and the external personal HLoC (p = .023). In patients with subsequent readmissions, a correlation was found between the originally positive attitude to the surgery and poor self-efficacy (p = .009). CONCLUSIONS: Patients with weak mental dispositions cannot cope with difficult situations and show a tendency to experience strong emotions, concentrating on their deficiencies, resulting in decreased motivation and feeble engagement in treatment. Poor mental disposition influences the final outcome of the vascular reconstruction.

Psychological Determinants of Attitude to Surgery in Internal Carotid Artery Stenosis Patients.

The basic way to prevent cerebral stroke in symptomatic 70-99% stenosis of internal carotid artery (ICA) is an open or endovascular surgical procedure. Psychological research done so far among ICA stenosis patients focused on cognitive functioning changes. The objective was to assess attitude to surgery in relation to self-efficacy, life quality perception, and health locus of control in ICA stenosis patients. MATERIALS AND METHODS: The study involved 53 asymptomatic ICA stenosis patients, aged from 53 to 81. Four scales were applied: Generalized Self-Efficacy Scale (GSES); Satisfaction With Life Scale (SWLS); Multidimensional Health Locus of Control Scale (MHLC); and a simple scale to examine the attitude to surgery, where "-10" stands for the maximally negative attitude, "0"-neutral, and "+10"-maximally positive. The obtained results were put to statistical analysis. RESULTS: It was found that women and men assessed their attitude to the surgery as positive (M = 7.92; SD = 3.094), though the men estimated it slightly higher (M = 8.03; SD = 3.02) than the women (M = 7.67; SD = 3.37). The mean value of self-efficacy was high (M = 32.53; SD = 6.231), and slightly higher for the men (M = 32.79; SD = 5.576) compared to the women (M = 31.87; SD = 7.836). The patients generally tended to manifest the external personal health locus of control (M = 28.62; SD = 3.17). The runner-up was internal health locus of control (M = 26.02; SD = 3.775), and the next one-external impersonal aspect (chance/luck) (M = 23.57; SD = 4.457). The mean assessment of the patients' own life quality proved to be above average (M = 23.60) but varied (SD = 5.95). The women perceived the quality of their lives as better (M = 24.33; SD = 6.422) than the men (M = 23.32; SD = 5.818). Very strong positive correlations were found between self-efficacy and life quality assessment (p < 0.001) and between the internal and external personal aspects of health locus of control (p < 0.007) in the women, and positive correlations were found between the attitude to surgery and internal health locus of control (p < 0.021) in the men. CONCLUSIONS: When breaking the news of a need to have a surgical intervention due to ICA stenosis, the physician should strongly refer to the value of human life and health. The message should arise from external (in the case of women) or internal (in the case of men) motivation to undergo surgery, and enhance the patient's conviction that the disease should be considered a challenge which must be taken to reverse their unfavorable situation and improve life quality.

Neuroticism Level and Life Satisfaction in Women Undergoing Breast Augmentation Surgery (a Preliminary Report).

BACKGROUND: The aim of the present study was to verify the relationship between the level of neuroticism and selected aspects of life satisfaction in women undergoing breast augmentation surgery. METHODS: The study group included 109 women, aged 18-46 years, who completed the self-developed survey measuring selected psychological traits before and after (1 year) surgery. Four questions in this survey were related to the level of neuroticism and two pertained to the self-assessment of leading character traits and the level of life satisfaction. Three questions made up the lie scale. RESULTS: The studied women were constant in their truthfulness. No statistically significant difference in the level of neuroticism before and after surgery was noticed. However, an increase in the subjective life satisfaction after surgery was highly significant (p < 0.001). Statistically significant negative correlations of neuroticism level with the self-assessment of positive character traits (rs = - 0.236; p = 0.013) and life satisfaction (rs = - 0.277; p = 0.004) were found before surgery. Also, a significant positive correlation was observed between neuroticism and the change in life satisfaction 1 year after surgery (rs = 0.302; p = 0.001). CONCLUSIONS: Breast augmentation surgery did not affect neuroticism level, which proves that constitutional personality traits in women undergoing such operations are not significantly influenced by a surgical intervention. However, neuroticism may play the role of a modulator of the psychological changes in women after breast augmentation (e.g., an increased postsurgical life satisfaction). The preliminary results obtained in our study should be confirmed on a larger sample size in the future. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Personal resources and satisfaction with life in Marfan syndrome patients with aortic pathology and in abdominal aortic aneurysm patients.

INTRODUCTION: Whether or not the source of aortic pathology is Marfan syndrome (MFS) or other processes leading to development of abdominal aorta aneurysms (AAA), the awareness of pathology may lead to an emotional upset and low assessment of satisfaction with life. AIM: To assess, in regard to MFS patients with aortic pathology and to abdominal aortic aneurysm patients: 1) whether or not self-efficacy (SE) and health locus of control (HLoC) affect the patients' satisfaction with life; 2) whether the two groups of patients differ in terms of mental dispositions. MATERIAL AND METHODS: The study population consisted of 16 MFS patients with aortic pathology and 16 AAA patients, 9 men and 7 women in each group. The mean age of the MFS patients was 28.5 ±8.214, and of the AAA patients 64.25 ±7.019. The following scales were applied: Generalized Self-Efficacy Scale, Satisfaction With Life Scale, Multidimensional Health Locus of Control Scale. RESULTS: Abdominal aorta aneurysms patients compared to MFS patients gave a higher rating for SE (MD = 33.94 and MD = 29.56), internal health locus of control (MD = 25.00 and MD = 21.13), external personal HLoC (MD = 24.50 and MD = 19.25), external impersonal HLoC (MD = 23.06 and MD = 18.25), and satisfaction with life (M = 22.06 and M = 20.13). Internal and external HLoC were significantly lower in MFS patients compared to AAA patients. CONCLUSIONS: In patients with aortic diseases, special attention must be paid to the state of personal resources (PR). Interactions made by medical professionals should focus on enhancing PR supporting the patients' self-knowledge on their SE. This will help to improve their satisfaction with life and form a positive attitude to the illness.

Prevalence and factors leading to unemployment in MS (multiple sclerosis) patients undergoing immunomodulatory treatment in Poland.

Multiple Sclerosis (MS) is the most common, primary neurogenic cause of disability among young adults. We investigated demographic and clinical factors associated with unemployment on the example of 150 MS patients receiving immunomodulatory treatment in Poland. This study was based on clinical evaluation and collection of self-reported questionnaires, with an attention to self-motivation, severe fatigue and moderate disability. Patients who were unemployed (40% of all patients) had a mean disease duration of almost 5 years. Older (p<0.001), less educated (p = 0.007) and more severely disabled patients (p<0,001) were most likely to be unemployed. Moderate disability (OR = 11.089 95% CI: 4.11-34.201, p<0,001), severe fatigue (OR = 2.625 95% CI: 1.02-6.901, p = 0,046) and lower level of self-motivation (KNS) (OR = 0.947, 95% CI: 0.896-0.006, p = 0.042) were independently associated with unemployment.

Body image and depressive symptoms in person suffering from psoriasis. / Obraz wlasnego ciala oraz objawy depresyjne u osób chorych na luszczyce.

OBJECTIVES: The purpose of the research study was specifying the relationship between severity of psoriasis and body image and self-reported depressive symptoms, taking into account the differences between the sexes. METHODS: The research study involved 54 psoriasis patients, including 30 men and 24 women aged from 19 to 82. The level of depressive symptoms was assessed using the Beck Depression Inventory, and body image - using the Multidimensional Body-Self Relations Questionnaire. The disease severity was objectively assessed using the Psoriasis Area and Severity Index. RESULTS: The female psoriasis patients were more critical of their appearance than the men (p< 0.01), and at the same time they were more appearance-oriented (p< 0.05). The men rated their fitness level (p< 0.01) and care for good physical condition (p< 0.01) higher than the women. The women showed less satisfaction with their body parts than the men (p< 0.01) and more fear of obesity (p< 0.05) and overweight (p< 0.05). No statistically significant differences were found between men and women with regard to general evaluation of body image and self-reported depressive symptoms. Moreover, it was established that in the case of both women and men there was a correlation between lowered mood and psoriasis severity (R = 0.416), as well as body image (R = - 0.282). In relation to individual scales, there was a statistically significant relationship between self-reported depressive symptoms and appearance evaluation (R = - 0.519), health evaluation (R = - 0.585), satisfaction with body parts (R = - 0.462), as well as appearance orientation (R = 0.425). CONCLUSIONS: Distortion of body image is correlated with self-reported depressive symptoms in psoriasis patients.

Stigmatization feelings and depression symptoms in psoriasis patients. / Poczucie stygmatyzacji a objawy depresyjne u osób chorych na luszczyce.

OBJECTIVES: The objective of the study was to show the correlation between the feelings of stigmatization and depressive symptoms in psoriasis patients. The study has considered severity of feelings of stigmatization and depressive symptoms, as well as factors such as gender and skin lesions visibility. METHODS: The study involved 54 adult subjects suffering from psoriasis - 26 women and 28 men. The patients filled in the 33-item Feelings of Stigmatization Questionnaire and the Beck Depression Inventory. Moreover, the subjects were asked to mark the location of their psoriatic lesions on a schematic drawing. RESULTS: A correlation was found between feelings of stigmatization and depressive symptoms in the psoriasis patients. No differences between women and men were found with regard to depressive symptoms and feelings of stigmatization (except for the secretiveness aspect). It was found that location of skin lesions did not have an effect on occurrence of depressive symptoms and feelings of stigmatization (except for the shame and guilt aspect). CONCLUSIONS: It is still necessary to change the public attitude to patients with psoriasis. It is also very important to provide the patients with psychotherapeutic support aimed at enhancing their self-acceptance in order to overcome any feelings of stigmatization and to prevent them from depression.

Time perception and illness acceptance among remitting-relapsing multiple sclerosis patients under treatment.

OBJECTIVES: The aim of the study was to determine temporal orientation in patients diagnosed with RR-MS as compared with that of healthy individuals; to analyse self-evaluated acceptance levels in terms of physical and psychological condition and self-reliance; an attempt to identify factors of illness acceptance in patients with RR-MS including temporal perspective. METHODS: Acceptance of Illness Scale (AIS, adapted into Polish by Z. Juczynski), Zimbardo Time Perspective Inventory (ZTPI, adapted into Polish by M. Mazewski), and original interview aimed to assess socio-demographic data and self-evaluated physical as well as psychological condition and self-reliance of patients with MS (referred to the neurological testing according to the EDSS). RESULTS: Patients with RR-MS focus on fatalistic and hedonistic present more than healthy individuals. They also tend to reflect on their negative past experience. Acceptance of illness correlated positively with subjective assessment of physical and psychological condition as well as self-reliance, and negatively with objective disability score (measured with the use of EDSS) and a factor considering time of disease duration. CONCLUSIONS: Avoiding contemplation of negative past and concentrating on hedonistic future constitute significant predictors of illness acceptance. These results may be of importance in terms of holistic approach to treatment of RR-MS patients. In the initial stage of the disease progression, patients might benefit from psychological support due to change in temporal orientation.

Quality of Life and Optimism in Patients with Morphea.

Despite extensive knowledge about quality of life of people suffering from dermatological diseases, data on patients with morphea are scarce. The aim of our study was to compare the quality of life of healthy controls and morphea patients, as well as to determine the correlation of this variable with the level of dispositional optimism. The study included 47 patients with morphea and 47 healthy controls, matched for gender and age. Cantril's Ladder and Life Orientation Test-Revised were used to assess the levels of life satisfaction and dispositional optimism, respectively. LoSSI was used for the objective assessment. The anticipated level of life quality and the level of dispositional optimism were statistically significantly lower in morphea patients (p = 0.032 and p = 0.014, respectively) when compared to controls. There were no differences in the assessment of current (p = 0.168) and past (p = 0.318) levels of life quality. Also, we proved that type of morphea did not differentiate the current (p = 0.175), past (p = 0.620) and future (p = 0.356) assessment of the quality of life. In the group of morphea patients there was a statistically significant correlation between the level of dispositional optimism and current (p = 0.002, r = 0.43), as well as anticipated (p < 0.001, r = 0.57) levels of life quality. Current level of life quality of healthy controls and morphea patients is comparable, whereas the latter anticipate their future life situation to be significantly worse than the former. Higher level of life satisfaction correlates with higher level of optimism.

Reasons underlying the consent to endovascular treatment, displayed by patients diagnosed with asymptomatic internal carotid artery stenosis.

BACKGROUND: Endovascular treatment of internal carotid artery stenosis (ICAS) has gained popularity in recent years. Offering CAS, which is a controversial treatment in asymptomatic disease, may provoke patient distrust of the diagnosis and intervention benefit. The aim of this study was to prove that asymptomatic ICAS patients tend to show an emotional attitude to their illness, and therefore their decisions regarding carotid artery stenting are externally motivated and assessed emotionally. MATERIAL AND METHODS: This study was conducted by a questionnaire consisting of 18 half-open questions (obtained from 25 consecutive patients) in categories of self-image, attitude to illness, and decision-making regarding CAS. Descriptive analysis was performed. RESULTS: Reaction: "Nothing to worry about - every illness can be cured" evidenced the rational attitude to the disease. Attitude towards oneself after receiving the unexpected information about the disease did not change. Most patients pursued a second opinion before the intervention. Most patients showed internal motivation (78.7%). Rational assessment of the decision on CAS relied on consulting and insights into the disease and the intervention-related risk compared to risk of "doing nothing" CONCLUSIONS: In decision-making about CAS by asymptomatic patients, the emotional attitude to disease and negative expectations pertaining to postoperative health lead to an internally-motivated and rationally assessed decision. At least 2 conversations with the patient should be scheduled. The primary purpose of the second visit should be dissipating any doubts and repeating the arguments for the intervention. Patients should be provided with an appropriate amount of information to reduce their fear of neurological complications and mental disturbances. Conversation should be concentrated on life-quality improvement instead of controversies about the intervention.

Physical attractiveness and self-assessment before and after breast augmentation.

BACKGROUND: This study verifies selected opinions on breast cosmetic surgery in the population of Polish women. MATERIALS AND METHODS: A total of 78 women aged 20 to 48 years were surveyed between 2008 and 2010 before and after breast augmentation surgery using a questionnaire. The χ and Wilcoxon signed rank tests were used for statistical analysis. Most were married and single women aged approximately 30 years and residents of large cities. RESULTS: The significance of professional success in the hierarchy of values and the level of self-assessment increased after surgery (P = 0.0000 and 0.0213, respectively). The distribution of responses concerning the expectations of surgery and the evaluation of their fulfillment changed significantly (P = 0.0031). In general, the satisfaction with one's life after surgery also increased (P = 0.0000). CONCLUSIONS: A well-thought-out decision on breast cosmetic surgery positively affects at least several spheres of psychosocial functioning and fulfills most women's expectations.

Disease-induced level of shame in patients with acne, psoriasis and syphilis.

INTRODUCTION: A prolonged feeling of shame leads to particularly negative consequences and it accompanies, as well as triggers, any kind of stigma. AIM: AS EMPIRICAL WORKS ON SHAME DUE TO STIGMATIZING DISEASES ARE SCARCE, THE AUTHORS AIMED TO INVESTIGATE THE FOLLOWING: 1) which diseases are perceived as the most embarrassing, and 2) what level of shame is attributed to the embarrassing diseases by affected patients. Additionally, the authors assumed that the differentiation variable for the second aim would be the level of infectiousness (or non-infectiousness) of a given disease. MATERIAL AND METHODS: A two-stage study was carried out in 2011-2013. Three groups of patients affected by various diseases were included into the actual study: 1) people suffering from non-infectious (42 psoriasis and 42 acne subjects) and 2) infectious (25 syphilis cases) diseases. The patients filled in an original questionnaire, designed especially for the purpose of the study. RESULTS: As the most shameful acne patients consider syphilis, but patients with syphilis - AIDS. Patients with syphilis assigned to their disease the greatest shame (average 75%), and the lowest - acne patients (average 30%). Patients with psoriasis assessed on 52% shame experienced because of the disease. CONCLUSIONS: The conducted study confirmed the accuracy of the empirical assumptions which may be applicable in prevention as well as therapy of negative consequences of shame.

Selected aspects of the living situation of persons suffering from syphilis - Poznan study.

In the last years, a considerable increase in syphilis incidence was observed in Poland. This is a condition with serious health and psychosocial consequences. The research demonstrates that one of the events which significantly modify the course of human life is the somatic disease experience; hence, it was decided to examine selected aspects of the living situation of persons suffering from syphilis, which refer to the social position held by these persons. Materials for the research were collected based on the anonymous authors' survey composed of 16 questions. The research lasted for two years and covered a group of 42 syphilitic patients (35 males and 7 females). The mean age of male patients was 35.7 and of female patients 37.0 years. Among the participants, 8 persons had been subjected to treatment for a few years, 11 for about a year, and 22 persons had recently become ill. Patients assessed the attitude toward themselves mostly as invariable, followed by unstable; 45.2% of subjects considered their position in the family as average and 42.9% as high; 28.6% of patients assessed their occupational position as average and the same number admitted to be currently out of work. Most frequently, unemployed were patients who had been affected by the disease for several years (62.5%), whereas their social position was assessed either as high (47.6%) or average (45.2%). Irrespective of the duration of the disease, patients (during hospitalization) usually met a lot of people. It has been proven that most of the syphilitic patients do not have negative attitude toward themselves and do not assess their social position as inferior, regardless of the duration of the disease. Such a picture of the living situation may be a manifestation of the compensation for the negative mental state, activation of other defense mechanisms or proper strategy of coping with the stressor. The generally optimistic image of the studied group of syphilitic patients may constitute a warning against an increased risk from the infected persons.

Management of the stressful stigma attached to sexually transmitted disease (preliminary report).

BACKGROUND: Syphilis and other sexually transmitted diseases may cause some psychological problems and anxiety among the infected patients. OBJECTIVES: The aim of the study was to examine the differences in stress level and stress coping strategies of patients infected with syphilis and healthy controls. Also, the authors aimed at establishing types of strategies to cope with the stigma of sexually transmitted diseases. MATERIAL AND METHODS: The study was a survey of 21 syphilis infected subjects and 21 healthy subjects, paired according to age and gender The respondents used the SRRS questionnaire with some additional questions and the Mental Adjustment to Disease Mini-MAC Scale in Polish adapted version. The latter was given to the syphilis-infected subjects only RESULTS: The syphilis infected subjects experienced more acute stress than the healthy subjects. Most healthy subjects used the active task strategy to cope with stress while the infected subjects (particularly females) chose the escape strategy and the 'waiting out' strategy The infected males preferred an active style of coping with the stigma; among the females, the anxiety style was dominant. CONCLUSIONS: Syphilis is a source of permanent stress and awareness of the possible social consequences is a strong stimulus, prompting the stigma bearer to keep its existence a secret.