رضایت از زندگی پس از سکته مغزی: نقش شناخت بیماری

Objective To describe illness cognitions two months and two years post stroke and to investigate changes in illness cognitions over time. We also examined the associations between illness cognitions and life satisfaction at two months and two years post stroke and investigated if changes in illness cognitions predicted life satisfaction two years post stroke, taking demographic and stroke-related factors and emotional symptoms into account. Methods Prospective cohort study in which 287 patients were assessed at two months and two years post stroke. The illness cognitions helplessness (maladaptive), acceptance (adaptive) and perceiving benefits (adaptive) were measured with the Illness Cognition Questionnaire. Life satisfaction was assessed with two life satisfaction questions. Correlational and regression analyses were performed. Results Patients experienced both maladaptive and adaptive illness cognitions two months and two years post stroke. Only acceptance increased significantly from two months to two years post stroke (p ≤ 0.01). Helplessness, acceptance and perceiving benefits were significantly associated with life satisfaction at two months (R2 = 0.42) and two years (R2 = 0.57) post stroke. Furthermore, illness cognitions two months post stroke and changes in illness cognitions predicted life satisfaction two years post stroke (R2 = 0.57). Conclusion Illness cognitions and changes in illness cognitions were independently associated with life satisfaction two years post stroke. It is therefore important during rehabilitation to focus on reducing maladaptive behavior and feelings to promote life satisfaction, and on promoting adaptive illness cognitions.

Stroke is one of the leading causes of disability in the Western world [1]. A stroke can lead to permanent physical, psychological, and psychosocial consequences, such as mobility problems [2], emotional problems like anxiety and depression [3], cognitive impairments [4], and decreased life satisfaction [5] and [6]. Demographic factors, stroke characteristics and physical impairments are the most commonly investigated determinants of quality of life (QoL) post stroke [7]. These factors, however, do not completely explain why some patients with severe impairments adapt well, whereas other patients with minor impairments experience low levels of QoL [8]. It is assumed that the way patients think about and perceive their illness accounts for much of the individual differences in their QoL [9]. According to Leventhal's Common Sense Model, patients create mental representations of their illness when faced with a chronic disease [10] and [11]. Through cognitive re-evaluation of uncontrollable illness experiences patients ascribe meaning to their illness and generate coping responses, which in turn affect outcome. These representations relate to thoughts about, for example, the causes of the illness, worries and fears, the ability to control the illness, and accepting the illness [12] and can be maladaptive as well as adaptive in terms of outcome [9] and some are typically more adaptive than others. These representations have been investigated using terms such as illness cognitions, illness perceptions, illness representations and appraisals. The role of illness cognitions has been recognized in the development, maintenance, and modification of psychological well-being in several chronic diseases, like rheumatoid arthritis and multiple sclerosis [9], cancer [13] and [14], chronic fatigue syndrome [15], and spinal cord injury [16, submitted]. Limited research has been performed into illness cognitions of stroke patients [17], [18], [19] and [20]. Acceptance of the illness and appraisals of threat and benefit were associated with depression post stroke [17] and [18]. Furthermore, female stroke patients associated their emotional state with the cause of pain [19], and maladaptive illness cognitions were associated with more severe symptoms of posttraumatic stress disorder [20]. However, associations between illness cognitions and life satisfaction, and changes in illness cognitions over time have to our knowledge never been investigated in the stroke population. Knowledge of associations between illness cognitions and life satisfaction in stroke patients and the susceptibility of illness cognitions to change over time is important. This knowledge may lead to the application of interventions to improve the life satisfaction of stroke patients by focusing on reducing illness cognitions which are negatively associated with life satisfaction, but also on promoting illness cognitions which are positively association with life satisfaction. Hence, the first two aims of this study were to describe illness cognitions in stroke patients two months and two years post stroke and to investigate changes in illness cognitions over time. We expected feelings of helplessness to decrease over time and feelings of acceptance and benefits of the stroke to increase over time. The third aim was to examine the association between illness cognitions and life satisfaction at two months and two years post stroke. The fourth aim was to examine whether illness cognitions at two months are predictive of life satisfaction at two years and to examine associations between changes in illness cognitions with life satisfaction at two years post stroke.