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Relations between illness perceptions, coping, social support, and outcomes in the Chronic Fatigue Syndrome Sleigh, Kenna Marie

Abstract

Chronic fatigue syndrome (CFS) is a disorder of unknown etiology characterized by fatigue, flu-like symptoms, and neurocognitive complaints. Due to the severe impairment associated with the illness patients are often unable to work and must rely on disability income. Few patients recover spontaneously although a sizeable proportion has reported improvement. Since no definitive treatment is available for CFS, it is essential to identify effective ways for patients to adjust to the illness. The purpose of the study was to describe how patients adapt to CFS. A sample of 100 patients diagnosed medically with CFS and meeting the Centers for Disease Control and Prevention (CDC) case definition were recruited primarily from the practices of two hospital-based internists. The respondents were screened for psychiatric conditions and completed a battery of questionnaires at four time points over a 21-month period. Guided by Leventhal's self-regulatory model, multiple regression analyses and ANOVA were utilized to assess the relations between respondents' illness representations, self-management strategies (coping and social support), perceived efficacy of self-management, and outcomes including functioning, psychological distress, and health care utilization. Analyses revealed pessimistic illness representations and coping characterized by catastrophizing, focusing on symptoms, avoidance, and venting predicted unfavorable outcomes. On the other hand, optimistic perceptions and coping by accommodating to the illness, approach strategies, and social support predicted favorable outcomes. Moreover, in addition to the direct associations between illness representations and outcomes, representations were also related to coping. Pessimistic representations predicted maladaptive coping (strategies that predicted unfavorable outcomes) and optimistic perceptions predicted adaptive coping (strategies that predicted favorable outcomes). Coping frequency was a better predictor of outcomes than perceptions of coping efficacy save for physical functioning. To examine change, analyses of differences within and between groups were conducted. When the sample was stratified into short (ill four years) and long illness duration groups (ill four years or more) the long duration group reported fewer health care visits. As a whole the respondents experienced little change in outcomes over a 21-month period but stratification demonstrated that the short illness duration group evidenced a small but statistically significant improvement in physical functioning while the long illness duration group reported less vitality. Coping and social support efficacy decreased over time although for the most part the frequency of self-management behaviors was quite stable. The implications of the study results for the management of CFS and future research were discussed.

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