The common‐sense model and mental illness outcomes: A meta‐analysis

Abstract

Psychotherapists can improve their patients' outcomes during and after therapy by improving patients' self‐management. Patients who do not effectively manage their mental illness generally have worse outcomes. Leventhal's Common‐Sense Model of Self‐Regulation theorizes that patients' perceptions of their illness (illness representations) guide their self‐management, influencing health outcomes. The present study quantified the relations between illness representations, self‐management and outcomes for mental illnesses. We conducted a meta‐analysis and included articles if they reported (1) on adults with mental illnesses and (2) the correlation between mental illness representations and mental illness outcomes. Twenty‐five articles were included which represented 28 independent samples. The pattern of correlations among illness representations (identity, consequences, timeline, control, coherence and emotional representations), self‐management strategies (attendance, engagement and adherence to treatment) and mental illness outcomes (symptom severity and quality of life) was consistent with analyses from previous studies of mental and physical illnesses. The results found threat‐related illness representations mostly had a large relationship with worse mental illness outcomes and self‐management. Protective illness representations had a small‐to‐large relationship with better mental illness outcomes and self‐management. The results suggest patients' perceptions of their mental illness may be a critical indicator of their mental illness outcomes, including symptom severity and quality of life. This theory‐driven meta‐analysis supports calls for the inclusion of illness representations in psychotherapy for mental illness.

Illness Beliefs, Treatment Beliefs, and Fulfilled Treatment Expectations in Psychosomatic Rehabilitation: Associations with Patient Satisfaction

“…5 Furthermore, there is evidence for the relevance of patients' illness and treatment beliefs in predicting health outcomes in (psychosomatic) rehabilitation. [8][9][10][11] This is consistent with a large body of research in the broader context of mental health 12 and in other health care settings. 13,14 Regarding predictors of patient satisfaction in psychosomatic rehabilitation, there are comparatively few studies.…”

“…39,55 Despite these efforts, the explicit and focused clinical addressing of patients beliefs and expectations may have been undervalued so far 30 -also in the treatment of mental illnesses. 12 Thus, we conclude that it would be worthwhile to further develop interventions that take into account both patients' illness beliefs and treatment-specific treatment beliefs more precisely, ie depending on the treatment focus, beliefs about medication (such as fear of side effects or as becoming dependent on antidepressants), beliefs about psychotherapy (such as presumed effectiveness of psychotherapy), or -as in our study -beliefs about (psychosomatic) rehabilitation. The latter could be done discussing, patients' concrete outcome and process expectations, and their concerns about rehabilitation.…”

“…This confirms our hypothesis and coincides with previous findings on the prediction of health outcomes through protective illness beliefs in the context of psychosomatic rehabilitation, 40 , 41 in meta-analyses of physical illnesses, 14 medically unexplained symptoms, 42 and mental illness. 12 However, those studies also found an association between threat-related illness beliefs (eg, perceived consequences or perceived chronicity of the illness) for worse health outcomes. Contrary to our corresponding hypothesis, this was not the case in our study.…”

“…This is underlined by the results and conclusions of the above mentioned meta-analysis in the context of mental illnesses including 28 independent samples representing 3051 patients with mood, anxiety, schizophrenia spectrum, substance use and eating disorders from twelve different countries in Africa, Asia, North America, and Europe. 12 However, studies in some diagnostic groups are lacking, and most studies are cross-sectional. Therefore, additional research is needed to analyse the dynamic and causal relationships between patient beliefs and outcomes in mental illnesses.…”

Adolescents’ Beliefs About What Symptoms Constitute Depression: Are More Expansive Definitions Helpful or Harmful?

“…Illness representations are broadly categorized as either protective (e.g., seeing depression as something that can be controlled) or threatening (e.g., seeing more symptoms as belonging to depression). This theory has found robust support in both physical and mental illnesses [13,14], including depression speci cally [15,16]. However, it is worth noting that most of this research has been conducted with adults.…”