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Title: Beliefs about 'stroke' and 'its effects' : a study of their association with emotional distress
Author: Townend, E.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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This thesis was developed using cognitive theory, past research on emotional adaptation to disability and observations from piloting. It aimed to describe emotional distress and a set of beliefs in ‘stroke’ and ‘its effects’, and to longitudinally investigate associations between specific beliefs and distress, taking into account relevant background variables. In addition to incorporate an open-ended approach for further exploration of beliefs relevant to emotional distress and disorder. A consecutive series of 89 patients, without severe cognitive or communication impairment, were interviewed one month (baseline) after admission to a stroke unit and 81 were interviewed again at nine months (follow-up). Distress was measured using global Hospital Anxiety and Depression scale scores. Specific beliefs in stroke and ‘its effects’ investigated were: Attributions (Causal controllability, ‘Why me?’, ‘Found meaning?’); Negative self-evaluations (Acceptance of disability, Negative identity change, Shame); Beliefs in recovery and recurrence (Recovery locus of control, Confidence in recovery, Recurrence fear). Background variables measured were: Demographics, Stroke severity, disability, Pre-stroke depression, Social support and Life events. The DSMIV structured clinical interview (SCID) was used to assess depressive disorder (major or minor) and common anxiety disorders (generalised anxiety disorder, agoraphobia, social phobia, post traumatic stress disorder) and as a means for exploring relevant beliefs. A qualitative interview was used to explore patients’ own experiences and main concerns. Significant associates were found between distress and most belief variables at baseline, follow-up and across time. Backward linear regression analyses for distress were used to study belief variables taking background variables into account. At baseline and follow-up these analyses supported the statistical significance of negative self-evaluative beliefs and recurrence fear in association with distress. Across time, a role for causal controllability and acceptance of disability was supported. However, these results also highlighted the pervasive influence of a pre-stroke history of depression and of initial distress levels across time. The SCID interview identified that many patients met criteria for depressive disorder (33% at one and 30% at nine months) or anxiety disorder (35% at one and 33% at nine months) but also yielded information regarding specific stroke-related beliefs relevant to distress versus adaptation. The qualitative interview provided insight into patients’ idiosyncratic concerns. This extended the main findings, for example, by illustrating the varied nature of recurrence fear beliefs and highlighting individuals’ needs to give as well as receive social support.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available