Symptom reporting in asthma patients and insulin-dependent diabetics

doi:10.1016/0301-0511(95)05157-0

Biological Psychology

Volume 42, Issues 1–2, 5 January 1996, Pages 231-244

https://doi.org/10.1016/0301-0511(95)05157-0 Get rights and content

Abstract

In this paper, results from two studies are presented.

1.
(1) Sixty-eight diabetics registered their blood glucose levels both as estimated and as measured and they indicated the intensity of 20 symptoms on a symptom checklist. Data were assessed twice a day over a 30-day period. During this period, blood glucose levels decreased slightly, the accuracy of blood glucose estimation improved, and for about half of the subjects specific symptoms could be identified, which covaried closely with blood glucose levels over time.
2.
(2) Fifty-three asthmatic patients monitored their peak flow each morning and evening over a period of 30 days. Before measuring peak flow, the patients estimated their peak flow and indicated the intensity of 28 symptoms specific for asthma. For about half of the sample, symptoms were identifiable, which correlated highly with measured peak flow. A substantial increase in the accuracy of estimated peak flow could be observed over time.

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Cited by (18)

Symptoms and the body: Taking the inferential leap
2017, Neuroscience and Biobehavioral Reviews
Citation Excerpt :
Similarly, Ryan et al. (2002) found that estimation of blood glucose was only 28% accurate for hypoglycemia and 38% for euglycemia in a sample of adolescents and young adults. Although there have been studies showing greater correlations (0.70) between estimated and actual blood glucose (Schandry et al., 1996), symptom perception in this context is generally considered inaccurate. Evidence also shows that physicians’ assessment of symptoms is more highly correlated with objective organic parameters (0.52–0.92) than those of patients (0.34–0.70; Turner et al., 2010).
The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of “medically unexplained” or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.
Affective health bias in older adults: Considering positive and negative affect in a general health context
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Because subjective health reports are a primary source of health information in a number of medical and research-based contexts, much research has been devoted to establishing the extent to which these self-reports of health correspond to health information from more objective sources. One of the key factors considered in this area is trait affect, with most studies emphasizing the impact of negative affect (negative emotions) over positive affect (positive emotions), and focusing on high-arousal affect (e.g., anger, excitement) over moderate- or low-arousal affect (e.g., relaxed, depressed).
The present study examines the impact of both Positive and Negative Affect (PA/NA)—measured by items of both high and low arousal—on the correspondence between objective health information and subjective health reports. Another limitation of existing literature in the area is the focus on samples suffering from a particular diagnosis or on specific symptom reports; here, these effects are investigated in a sample of community-dwelling older adults representing a broader spectrum of health.
153 older adults (M_age = 71.2) took surveys assessing Perceived Health and Affect and underwent an objective physical health assessment. Structural equation modeling was used to investigate the extent to which the relationship between Objective Health and Perceived Health was moderated by PA or NA, which would indicate the presence of affective health bias.
Results reveal a significant moderation effect for NA, but not for PA; PA appeared to serve a more mediational function, indicating that NA and PA operate on health perceptions in distinct ways.
These findings provide evidence that in our high-functioning, community-dwelling sample of older adults, a) affective health bias is present within a general health context, and not only within specific symptom or diagnostic categories; and b) that both PA and NA play important roles in the process.
Daily mood, shortness of breath, and lung function in asthma: Concurrent and prospective associations
2010, Journal of Psychosomatic Research
Citation Excerpt :
Third, an adequate assessment of mood states should reflect the possibility that emotional states of both positive and negative valence are capable of compromising lung function, as suggested by patients' self-report and experimental studies (for reviews see Refs. [21,22]). An exclusive focus on negative emotionality or distress as shown by earlier diary studies [6,16] would not reflect the variety of potential emotional influences on the airways. In addition, designing mood ratings both along a categorical and dimensional model of emotions is more informative, because prior studies have focused mostly on either mood categories (such as global positive and negative mood, happiness, sadness, anxiety, or anger [8,11,12]) or bipolar dimensional models (such as positive vs. negative affect, pleasantness, or arousal [7,9,13]).
Previous asthma diary studies have yielded equivocal findings on concurrent associations between lung function and mood, and prospective associations have rarely been explored. We therefore examined concurrent and prospective associations between daily mood, shortness of breath, and lung function, and studied between-individual variability and stability of concurrent associations across different times of the day.
Twenty asthma patients and 20 healthy controls recorded their positive and negative mood, shortness of breath, physical activity, peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV₁) using an electronic pocket spirometer with diary functions three times per day for about 21 days.
For both groups, PEF showed positive concurrent associations with ratings of various mood states, whereas FEV₁ was only associated with positive mood. Both indices correlated negatively with shortness of breath. Within-individual concurrent associations varied significantly in both groups and their stability varied across time of the day, with overall higher stability for associations with shortness of breath in asthma and PEF for both groups. Prospectively, higher shortness of breath consistently predicted lower lung function later during the day and on the subsequent day.
The relationship between normal mood variations and lung function is highly variable across individuals and times of the day, limiting the predictive value of average group associations. Shortness of breath is predictive of future lung function decline in asthma. Future longitudinal research should focus on extreme emotional states, effort-independent measures of lung function, and additional indicators of asthma control.
Does optimism affect symptom report in chronic disease? What are its consequences for self-care behaviour and physical functioning?
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The aim of the present study was to examine whether optimistic chronically ill patients [50 multiple sclerosis (MS) patients and 65 Type 1 diabetes mellitus (IDDM) patients] overestimate their health status by decreased symptom report, and to what extent such an optimistic interpretation of health status affects self-care behaviour and physical functioning.
Hierarchical regression analyses were employed to determine the relationship of three concepts of optimistic beliefs (positive outcome expectancies, positive efficacy expectancies and unrealistic optimism) with symptom report, controlling for objective measures of health status; and whether this relationship was mediated by negative affectivity or denial. Hierarchical regression analyses were also employed to assess the impact of optimistic beliefs on self-care behaviour and physical functioning 6 months later.
Optimistic beliefs did not affect symptom report with the exception of positive outcome expectancies relating to decreased fatigue report in IDDM patients, a relationship that was mediated by decreased negative affectivity. In addition, positive efficacy expectancies contributed to more self-care behaviours in both MS and IDDM patients.
Optimistic chronically ill patients do not tend to have a biased perception of their health status, and positive efficacy expectancies appear to encourage self-care behaviour 6 months later.
Symptom perception and respiratory sensation: Clinical applications
2003, Nursing Clinics of North America
Body Sensations: The Conscious Aspects of Interoception
2021, Body Sensations: The Conscious Aspects of Interoception

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Special issue: Interoception and behaviourSymptom reporting in asthma patients and insulin-dependent diabetics

Abstract

British Journal of Diseases of the Chest

Journal of Chronic Disease

Subjective symptomatology of asthma in an outpatient population

Psychosomatic Medicine

Intensive versus standard blood glucose awareness training (BGAT) with insulin-dependent diabetes: mechanisms and ancillary effects

Psychosomatic Medicine

Symptoms and blood glucose levels in diabetics

Journal of the American Medical Association

Psychologische Faktoren beim Asthma bronchiale: Einflüsse und Folgen

Der Bayerische Internist

Symptom awareness and blood glucose estimation in diabetic adults

Health Psychology

Understanding of hypo- and hyperglycemia by youngsters with diabetes and their parents

Journal of Pediatric Psychology

Optimizing glycemic control: can insulin dependent diabetic patients rely on their perception of blood glucose fluctuations in order to make their therapeutic decisions?

Diabetes Research

Symptom perception, symptom bliefs, and blood glucose discrimination in the self-treatment of insulin-dependent diabetes

Special issue: Interoception and behaviour
Symptom reporting in asthma patients and insulin-dependent diabetics