Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China

Abstract

In western countries, negative illness perceptions are associated with poor health status and affect health outcomes in primary care populations. The aim of this study is to examine the relationship between illness perception and mental and physical health status in general hospital outpatients in China. This multicentre, cross-sectional study analysed a total of 281 consecutive patients from four general hospital outpatient departments of internal medicine and traditional Chinese medicine in Beijing and Kunming. The patients answered questionnaires concerning illness perception (Brief-IPQ), somatic symptom severity (Patient Health Questionnaire-15), illness behaviour (Scale for the Assessment of Illness Behaviour), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (Twelve-Item Short Form Health Survey). Negative illness perception, especially negative emotional reactions, perceived illness consequences, encumbering illness concerns, and strong illness identity were significantly associated with high emotional distress, impairing illness consequences, and a low mental and physical quality of life. Using a multiple linear regression model, five strongest correlates of negative illness perception were high anxiety, seeking diagnosis verification, low mental and physical quality of life and high somatic symptom severity. The variance explained by this model was 35%. Chinese general hospital outpatients showed associations between negative illness perceptions and poor mental and physical health status that were similar to those of primary care patients in western countries. The main difference was that no association with perceived illness control was found in Chinese patients. Chinese physicians should be sensitised to their patients’ negative illness perceptions and should focus on helping patients cope with uncertainty and anxiety by providing an understandable illness model and increasing control beliefs.

Keywords:

• illness perception
• health status
• quality of life
• China
• general hospital

Acknowledgements

The authors thank Dr Jie Song and Dr Zhao Ruo Yao for establishing contact between the German and the Chinese study partners. Many thanks go to Claudia Hoener for her contributions to data collection and assembly. We are grateful to Suning Xu for the introduction to Chinese ways of feeling, thinking and living. Many thanks to Dr Zhao Xiaohui from the Department of Psychological Medicine of the Union Hospital in Beijing for her mentoring during data collection. The cooperation of the participating patients is also gratefully acknowledged. We thank American Journal Experts for proofreading the manuscript.