An investigation of the relationship between levels of uncertainty, illness representations, coping strategies, psychological and physical functioning in chronic illness
Objectives: Theoretical models have helped conceptualise how individuals
appraise and make sense of chronic illness and its psychological impact. Little
attention has been given to the impact of uncertainty on this process. The objective
was to investigate the relationship between levels of uncertainty, illness
representations, coping, psychological and physical functioning in two chronic
illnesses. The Self-Regulatory Model (SRM, Leventhal, Meyer & Nerenz, 1980) was
used as a theoretical framework.
Design: A cross-sectional design was used. It was hypothesised that a clear
medical diagnosis would reduce levels of uncertainty and increase illness
representations regarding control of symptoms. It was also hypothesised that high
levels of uncertainty would independently predict increased psychological distress.
Method: Patients suffering from chronic spinal pain and rheumatoid arthritis
were recruited from local clinical departments. The levels of uncertainty, illness
representations, coping strategies, mood and physical functioning of 85 participants
were assessed using standardised questionnaires.
Results: Chronic pain patients were found to have greater levels of uncertainty
and psychological distress than rheumatoid arthritis patients. Rheumatoid arthritis
patients had stronger beliefs about control of their condition. Uncertainty was not
found to be a significant independent predictor of anxiety or depression. However,
there appeared to be a degree of overlap between the variables of uncertainty and
Conclusions: The findings highlight a complex relationship between the aspects of
the SRM and uncertainty, with many components impacting on each other. Although
levels of uncertainty were not found to be predictive of psychological distress, it is an
area that warrants further investigation in order to understand how patients manage
uncertainty. Within a clinical setting, issues of uncertainty should be addressed at all
levels of care, maximising the patient's control beliefs, reducing the impact of
uncertainty on their cognitive, emotional and physical functioning.