Clinical Prediction of Medical Rehospitalization: Psychological Assessment with the Battery of Asthma Illness Behavior

Abstract

Psychomaintenance in chronic illness refers to the perpetuation of chronicity or the defeat of medical management because of psychological, as opposed to strictly physical, reasons. The Battery of Asthma Illness Behavior (BAIB) has been developed to assess psychomaintenace potentials among chronic asthmatics. In this study of 57 adult asthmatic patients, the clinical utility of the BAIB was assessed by having two psychologists predict the likelihood of rehospitalization within six months following intensive medical treatment. Independent, blind predictions using the BAIB, but in the absence of any demographic or medical information, enabled hit rates of 70% and 84% by te psychologists. Moreover, the predictions were independent of the objective severity of the patients' asthma, indicating that the clinical judgments were not merely readings of the patients' asthma severity on the basis of the BAIB scores. The need for rapid, clinical assessment of psychological factors maintaining chronic illness was discussed.

Psychological Factors in Asthma and Psychoeducational Interventions

“…The use of healthcare services by asthmatic patients as well medication (especially relief and preventive ones) was also directly linked with anxiety. Particularly, anxiety is predicted due to hospitalizations (Dirks et al, 1978(Dirks et al, , 1981Kinsman et al, 1982) and their duration (Put et al, 1999). These results agree with others, who argue that high anxiety leads to poor discrimination between anxiety symptoms and breathing symptoms, thus leading to an overuse of medical care (Spinhoven et al, 1997;Cluley & Cochrane, 2001).…”

“…Is well known that patients classified as non-adherent (those taking less 70% of the prescription) presented high anxiety and depression levels (Zigmond et al, 1983;Thomas et al, 2011). Corroborating former studies (Dirks et al, 1978;Staudenmayer et al, 1979;Dirks & Kinsman, 1981;Baron et al, 1986;Put et al, 1999), the data from this study suggest that the most anxious patients are more vigilant over their symptoms, use more medication and more often turn to healthcare services for help. With this behaviour they would suffer from great psychological stress with their disease in the short term (higher values of anxiety, with less quality of life associated with asthma), but in the long run it may result in better control over the illness.…”

Subjective symptomatology of asthma in an outpatient population.

“…These considerations led researchers at the National Jewish Hospital-National Asthma Center in Denver to develop the Battery of Asthma Illness Behavior, which is designed to assess the characteristics of adults associated with effective self-management of asthma (7)(8)(9)(10)(11)(12). A key element in this battery is the Asthma Symptoms Checklist (ASC) (13,14), a Likert-type instrument on which patients report the frequency with which 36 specific symptoms occur in connection with their asthma attacks.…”

The Prediction of Psychomaintenance in Chronic Asthma

“…In the first study [40], two psychologists blind to all patient characteristics except BAIB scores, were able to predict rehospitalization, independently of the patient's objec tive medical status. Psychologist A was correct in 84% of his predictions, while psychologist B was correct in 70% of his predictions.…”