Chronic diseases are "illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely" (Centers for Disease Control and Prevention (CDC) 2003). Chronic diseases carry life-changing consequences that demand important psychological adjustment. A number of factors come into play when considering a person's adjustment and successful coping: distal e.g. socioeconomic variables, culture/ethnicity, and gender-related processes and proximal e.g. interpersonal relationships, personality attributes, cognitive appraisals, and coping processes. Longitudinal surveys investigating chronic diseases and the way in which sufferers face them have aided in the development of a variety of effective coping strategies. Such strategies are vital in dealing with the onset of such a life altering disease and the common co-morbidity of depression (which can prove to be a chronic disease in itself) with other chronic diseases, further highlights the need for effective coping strategies.
Adjustment is commonly defined as 'the presence or absence of diagnosed psychological disorder, psychological symptoms, or negative mood' and researchers are increasingly examining positive affect and perceived personal growth as indicators of adjustment for the following reasons: many sufferers of chronic disease report positive adjustment (Mols et al 2005) and, also, positive adjustment is not just the absence of distress. It is also important to view adjustment as a dynamic process - stage theories of adjustment tend to be ill supported for this reason; illness can both improve and flare up and a person is better equipped at different stages in his/her life to deal with this than at others. It is unarguable, however, that experiencing chronic illness carries psychological consequences. Strong evidence that such illness creates life disruption can be seen in large-scale, prospective studies where adjustment is assessed prior to and following disease diagnosis. One such example is that of the Nurses' Health Study cohort of 48,892 women where 759 were diagnosed with breast cancer during a four-year period (Michael et al. 2000). These women indicated an increase in pain and declines in physical and social function, vitality, and ability to perform emotional and physical roles, compared to women who did not receive a cancer diagnosis. There are a number of contributors to adjustment to chronic disease such as personality, socio- economic variables, culture/ethnicity, and gender related processes. The role of personality in adjustment is a particularly interesting one to discuss and tends to fall under two perspectives: personality as a risk factor (Smith & Gallo 2001) or as a protective factor or stress-resistance resource e.g. resilience (Ouellette & DiPlacido 2001). Recently, the role of dispositional optimism (Scheier & Carver 1985) has been the most frequently examined personality attribute in relation to disease-related adjustment. Individuals with ischemic heart disease displayed fewer depressive symptoms a year after discharge if initial optimism on discharge was observed (Shnek et al. 2001). It also appears that optimism predicts faster in-hospital recovery and return to normal life activities for people undergoing CABG surgery (Scheier et al. 1989; Contrada et al. 2004). The emotionally protective effects of optimism seem to work by encouraging the use of approach-oriented coping strategies and affective social support, alongside reducing disease-related threat appraisals and avoidant coping (Carver et al. 1993, Scheier et al. 1989, Schou et al. 2005, Trunzo & Pinto 2003). Interpersonal support is also key in adjustment, although only if implemented correctly and effectively to the individual's needs. Such support works in a variety of ways and affects adaptive outcomes through physiological, emotional, and cognitive pathways (Wills & Fegan 2001).It can aid sufferers in using effective coping strategies by offering a better understanding of the problem and through increasing motivation to take action. Positive health behaviors may be encouraged through support as well as minimizing risky behaviors whilst also easing physiological reactivity to stress. A problem shared is a problem halved right? Furthermore, discussing disease-related concerns in a supportive, uncritical social environment enables people to better understand and tackle the adaptive tasks of illness. The absence of support is demonstrated through social isolation prior to a breast cancer diagnosis in the Nurses' Health Study cohort. Such social isolation predicted poorer quality of life four years post-diagnosis. However, research on couples in which one partner has a chronic illness illustrates how social support may negatively (or not at all) affect patients' adjustment. Depressive symptoms, as a result of chronic illness, may encourage feelings of irritation and resentment in the spouse that can lead to increased anger and reduced support provision (Druley et al. 2003, Revenson & Majerovitz 1990). Also, patients may misinterpret partners' negative comments as suggesting them to be incompetent or powerless. In a study of older women with osteoarthritis, (Martire et al. 2002), such a pattern of spousal interaction predicted increased depressive symptoms six months later.
It is not, however, just the coping with chronic illness that researchers are interested in. The way in which psychological theory can help to predict and change behaviours in order to promote health and well-being is also examined. Lifestyle is often linked with personal health and is commonly used in the fields of health promotion, preventive medicine and health research (Backett and Davison, 1995). How we live and what we do clearly affects our health, as seen through public health initiatives such as sanitation and clean drinking water, which improved the health of populations in the West in the early twentieth century (significantly reducing deaths from infectious diseases and promoting longer life expectancies). In Western societies today, the main causes of illness and death are a result of individual lifestyles (McKeown, 1979), such as smoking, excessive drinking and poor diet that have been linked to heart disease, stroke and cancer (Matarazzo, 1984). A distinction is made between positive health behaviour (health enhancing) and negative health behaviour (detrimental to health) and health psychologists can encourage people to behave in ways that are healthier, then particular types of illness may be prevented, life expectancy increased, quality of life enhanced and the onset of chronic illness delayed (Taylor, 1999). Perceptual and cognitive factors appear to have received the most attention in research into what determines health behaviour. Many Psychologists view cognitive factors as the most important determinants of behaviour and as a result social cognition approaches have evolved. These approaches cover everything from tooth brushing and condom wearing to visiting physicians and adhering to medical advice. The health locus of control is an interesting concept (people who believe they have more control over their health are more likely to behave in health promoting ways). Research has applied this concept to a range of health-related behaviour. One large study conducted in eighteen European countries found that young adults with a high internal locus of control were more likely to engage in healthy behaviours (exercise, seat belt use etc) than those with a low internal locus of control. Similarly, Friis et al. (2003), found that elderly people with a higher internal health locus of control were more likely to walk one mile per week than others. Such findings suggest that interventions to increase peoples' internal health locus of control may prove effective in increasing positive health behaviours. Models, such as The Health Belief Model, have also been developed to promoted healthy behaviour and are used for health education programmes. The Health Belief Model suggests that if an individual believes he/she may end up with heart disease later in life (susceptibility) and believed that heart disease was a serious condition (severity) and also believed that exercise would reduce the risk of getting heart disease later on (benefits) and this would outweigh the cons of taking time/costing money (costs), then he/she would be more likely to take up some form of regular exercise. Research has illustrated how these dimensions are directly related to health behaviour (especially beliefs about susceptibility), although the model has not proved so successful in in predicting more complex behaviours e.g. smoking.
It is evident from investigation that people do learn to cope with chronic illness, depending on a variety of factors such as social support and personality traits. Equally as interesting is the way in which health may be promoted and predicted through psychological theory. Such development in theory is vital in the promotion of an altogether healthier, longer living population and demonstrates the complexity of the relationship between physical and mental well-being.
