- Emerged in last few decades
- Psych, social and cultural factors also in etiology
- More successful at predicting who becomes ill
- Emphasises health as a positive state above and beyond illness
Health is a state of complete physical, mental and social well-being, not just the mere absence of disease
Social systems (society)
- Marriage/dyadic relationships
- Social networks
What is illness?
- Illness sometimes sued to distinguish what people feel or experience in contrast to disease which is more the biomedical definition of what is wrong.
- The experience of illness and disease can be separate for a number of reasons:
- Diseases may not make someone feel ill immediately (eg. hypoertention, diabetes)
- People can feel ill/experience symptoms without having any specific disease.
How do we know we are 'ill'?
- Perceive or have some awareness of our symptoms
- Attribute symptoms to illness (instead of other, perhaps transient causes such as a poor nights sleep, missing lunch etc)
- Plan/take action (eg. visit a doctor)
Simplified symptom perception model
- Info input-> attention -> detection -> attribution -> experience (symptoms)
Symptom perception and response: path analytic model
When do we identify something as a symptom?
- Chronic disease (if we have a disease, more likely to perceive things as symptoms)
- Attention/processing: if attention is sufficiently diverted, may not become aware of bodily signs nor make the attribution that they may be a symptom.
- When it is socially/culturally appropriate: eg men thought to get heart problems more, may attribute arm pain to heart.
Many factors moderate symptom perceptions
- Gender: expectations around if its ok to have/report symptoms vs be 'tough'
- Pain thresholds: there are substantial individual differences in amount of pain required before it is perceived.
- Age: children know less about disease.
- Personality: higher neuroticism associated with more attention to internal states and more rapid attribution of bodily signs to symptoms or illness.
- Affect/mood: depression and anxiety can increase interpretation of symptoms as illness
Interpretation and attribution
- Perceiving a symptom is not enough for someone to decide they are 'ill'.
- Culture plays a role in what is accepted
- Gender: women report more symptoms, visit doctor more, greater willingness to attribute symptoms to illness
- Personality: higher neuroticism
Illness/disease prototypes tend to include themes of:
- Disease prototypes: disease expectations
- Identity: how to know whether you or do not have the illness (eg. symptoms)
- Consequences: what will happen because of the illness
- Causes: why did it happen?
- Timeline/duration: how long will it last; even if long term, is it perpetual or cyclical?
- Cureable/controllable: can it be cured, managed or otherwise effectively treated or is it impossible or difficult to do anything about it?
Self regulation model
- Top is more physical route, bottom is psychological.
- Representation of health threat: prototype
- Coping procedures: change behaviour, see doctor, take meds (subjective)
- Appraisal: did my actions helped symptoms?
- Feeds back to self regulation model
Representation of emotion: if you feel anxious, take actions to reduce
Planning and actions
- Once aware of symptoms and attributed to illness.
- Final stage of illness.
- Whether any plan or action is taken and if so what, depends on the awareness and perception of symptoms as well as whether and which illness attributions people make based on those symptoms.
- Even if someone believes they are ill, prototypes around the consequences and controllability can still influence behaviour
Quality of life (QOL)
- QOL: a broad construct trying to capture overall life experience/satisfaction and well being.
- Health-related QOL refers to QOL and how it is affected by illness/disease, symptoms.
- QOL is subjective and influenced both at the individual and societal/cultural levels.
- QOL can change across life stages both bc of actual changes and because of changing goals and experiences. eg infertility not as important for children
Domains of QOL
- OFten separated into domains, and while there is no universal domains, common ones include
- Physical health: eg. pain, energy, cognitive function
- Psychology or mental: positive and negative mood, self esteem
- Independence/activities of daily living: eg. able to dress oneself, mobility, work capacity
- Social relations: eg. satisfying relationships, presence of supportive others
- Environmental: safety, financial resources
- Spiritual/religious: eg. access to and satisfied with spiritual communities, peace
- Increasingly, QOL is being measured and utilised in health care.
- One factor driving this is a growing involvement of patients in making health care decisions.
- While a medical model often may focus on doing anything possible to support and extend life, patients often care more about QOL.
- Medicine to keep people alive longer but poor QOL.
QOL used to measure economic value of treatment.
Quality of life adjusted years (QALY)
- QALY: a measure that integrates both quality and length of life
- 1 QALY= 1 year of life in perfect health
Disability adjusted life year (DALY)
- Used to measure the impact or burden of a disease
- DALYs are estimated by combining the actual years of life lost with the years lived with disability.
- Because DALYs combine both, a fatal disease but that tends to have onset in late life may have lwoer DALYs than a non-fatal disease (eg. depression) if it begins in adolescence and impacts entire life span.
Factors infleuncing QOL
- Ageing: associated with decline in areas such as independence and physical and sometimes increases in others , psychological, social relations
- Disease and illness: pain, affect emotions, cognitive abilities
- Treatment: some treatments reduce quality of life
- Psychosocial factors: having disease can be distressing