Brief research reportBody image and health locus of control among male patients with incisional hernias
Introduction
In the United States over 4 million laparotomies are performed annually (National Center for Health Statistics, 1996). It is reported that up to 15% of patients undergoing this surgical procedure will develop a postoperative abdominal defect resulting in an incisional hernia (Santora & Roslyn, 1993). Moreover, wound infection after abdominal procedures can increase the risk of incisional hernia to 30%, translating into the development of at least 600,000 incisional hernias each year, of which approximately 200,000 repairs are performed (Anthony et al., 2000). Incisional hernias can vary in size and appearance, from small amounts of intraabdominal contents bulging through scar tissue to larger hernias that may contain significant amounts of bowel, some of which may actually rest outside the abdominal cavity beneath the skin.
Departure from sociocultural standards of appearance is generally assumed to correspond with increased problems of psychosocial functioning given the emphasis on physical attractiveness within Western society (Stice & Shaw, 2002). Investigations have examined body image (BI), a multidimensional construct representing attitudes toward the body (Pruzinsky & Cash, 2002), among people with disfiguring conditions including burn injuries (Fauerbach et al., 2000, Thombs et al., 2008), vitiligo (Kent, 1999) and scleroderma (Benrud-Larson et al., 2003), and mixed findings have emerged. For example, disfigurement is not always uniformly associated with BI, as importance of appearance (Thombs et al., 2008) and visibility and severity of disfigurement have played equivocal roles in explaining BI satisfaction among people with disfiguring conditions (Heinberg, Fauerbach, Spence, & Hackerman, 1997). Body image dissatisfaction, however, routinely corresponds with depression (Benrud-Larson et al., 2003) and reduced quality of life (Fauerbach et al., 2000). It is unknown whether significant changes in abdominal appearance correspond with altered perceptions of physical appearance and health among individuals with incisional hernias, but the large number of people suffering from incisional hernias and the psychological difficulties associated with BI dissatisfaction together warrant increased attention to members of this population for intervention purposes.
To help achieve this objective, the scope of the present study was broadened to include an examination of beliefs about health and their relation to disfigurement, as onset of incisional hernias is not fully predictable. Three dimensions of health locus of control (HLC), a belief system reflecting the extent to which people perceive personal control over their health (Wallston, Wallston, & DeVellis, 1978), are commonly identified and differentially associated with health outcomes. Internal HLC (IHLC), or beliefs that health outcomes are controlled by personal traits and behaviors, is often inversely related to depression (Arraras, Wright, Jusue, Tejedor, & Calvo, 2002), anxiety (Bonetti et al., 2001) and physical functioning (Burker, Evon, Galanko, & Egan, 2005). Powerful others HLC (PHLC), or beliefs that health outcomes are controlled by other individuals such as health professionals, relatives or friends, is more frequently associated with adjustment among people with acute health conditions (Cicirelli, 1987, Wiegmann and Berven, 1998). Whereas, chance HLC (CHLC), or beliefs that health outcomes are controlled by random luck or chance, is frequently related to poor emotional functioning (Crisson & Keefe, 1988). Given these links between HLC and adjustment, it is important to identify whether incisional hernias are associated with maladaptive patterns of HLC so that interventions may be appropriately developed.
In sum, the prevalence of incisional hernias and the potential impact of associated disfigurement on BI and psychological health warrant further clarification of the relations between these variables. The current study sought to provide an initial characterization of BI and HLC in people with incisional hernias. On the basis of findings linking disfigurement with poor BI (Benrud-Larson et al., 2003, Fauerbach et al., 2000), it was hypothesized that patients with incisional hernias would report significantly lower BI than non-hernia controls across selected domains of body image and the abdominal region, specifically. It was also predicted that perceptions of HLC among patients with incisional hernias would reflect the limited personal control they had over their health condition and report lower IHLC, higher CHLC, and higher PHLC than non-hernia controls.
Section snippets
Participants
The sample consisted of 66 male veterans who sought treatment at a Veterans Affairs Medical Center (VAMC) (January 2007–January 2008). Approximately half of the samples (n = 32) were patients seeking treatment for an incisional hernia, whereas the other half (n = 34) were patients undergoing evaluation for a medical condition at either general or colorectal surgery clinics. Of these medical conditions, some were associated with low visibility (e.g., polyps, hemorrhoids, metastatic lesions,
Body image differences by group
To test the hypothesis that patients with incisional hernias would report lower BI than non-hernia controls, independent-samples t-tests were used to compare group differences in BI across MBSRQ scales (see Table 1). Assumptions of Levene's test for equality of variances were met. A Bonferroni adjustment to the alpha level was used for these planned comparisons of BI and the alpha level was set at p < .008. Analyses indicated that patients with incisional hernias reported significantly lower
Discussion
The purpose of the current study was to examine whether BI and HLC of patients with incisional hernias differed from patients without incisional hernias. Between-group comparisons indicated that patients with incisional hernias reported lower satisfaction with their mid-torso region than non-hernia controls. Aspects of the upper body such as the abdomen are salient to male body image (Garner, 1997), and, as such, patients with abdominal appearance departing significantly from the average or
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