The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69205

Sarit A. Golub, MPH, Department of Psychology, Harvard University, 33 Kirkland Street, Room1444, Cambridge, MA 02138, 617-496-1495, sgolub@wjh.harvard.edu

Studies of health-related quality of life among patients living with chronic illness reveal contradictory findings; in many cases, there is no correlation between objective health status (e.g. pain, impairment, disability) and patients’ quality of life ratings. One factor influencing these subjective ratings may be patients’ perceptions of the impact of their illness on aspects of identity. Any illness has the potential to disrupt the three core aspects of the self (reflexive consciousness, interpersonal roles and reputation, executive function; Baumeister, 1997); but in the case of acute illness, these disruptions are limited in duration, and do not pose a threat to the continuity of traits or a unified self-concept. In the case of chronic illness, however, these disruptions become permanent, and may present more direct threats to patients’ identities. In addition, specific limitations imposed on patients by illness (restrictions on physical activity, demanding treatment schedules and side effects, inability to work or maintain an active social life) may be construed as loss of essential trait attributes (athletic, spontaneous, healthy, gregarious). Findings from studies of individuals living with three different chronic illnesses – breast cancer, Parkinson’s disease, and HIV – reveal an important connection between patients’ perceptions of the impact of chronic illness on their sense of self and reported quality of life. A new instrument, called the Self-Illness Assessment (SIA) was designed to measure cognitive models used by subjects to represent the relationship between their sense of self and their illness. The SIA was shown to have good internal consistency and test-retest reliability (all a > .82; all test-retest rs >.69). There were no differences in SIA scores based on gender, age, socio-economic status, or time since diagnosis. Physical and mental health status were measured using the Medical Outcomes Study Short Form (MOS-SF12); quality of life was measured using the Linear Analogue Self-Assessment of Quality of Life (LASA-QL) and the Perceived Adjustment to Chronic Illness Scale (PACIS). After controlling for physical health status and depression, scores on the SIA accounted for a significant proportion of variance in quality of life ratings (R2 change = .16, p = .01). Further analysis demonstrated that individuals for whom the physical, social, or environmental limitations placed on their lives as a result of their illness were construed as loss of core aspects of self reported significantly lower quality of life since diagnosis. These studies suggest that assessing and understanding the impact of illness on identity may be important for the treatment and support of individuals living with chronic illness.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to:
• 3. Discuss threats to identity for patients living with chronic illness and describe how these threats might affect patients' perceptions of their quality of life.
  7. Articulate a method for assessing identity threat, using components of the Self-Illness Assessment (SIA).
  11. Apply findings from studies of quality of life among patients living with chronic illness to issues identified for specific populations with whom they work.

Keywords: Chronic Illness, Quality of Life

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.