Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis

Abstract

Aims: This paper aims to systematically review the illness perceptions of stroke patients and to examine the association between illness representation and psychological distress in empirical research studies.

Background: Patients' perceptions of health threats determine their coping behavior. Several recent studies have focused on illness belief and distress in stroke patients. This information is suitable for a meta-analysis to further understand stroke patients' illness perceptions.

Design: Systematic review and meta-analysis.

Method: An electronic literature search was conducted using the CINAHL, MEDLINE, PubMed, Cochrane library, and Google Scholar databases. Search strategies were title (stroke or cerebrovascular accident or CVA or cerebral vascular event or transient ischemic attack or TIA) and keyword (disease or illness) and keyword (perceptions or attitudes or opinion or experience or view or reflection or beliefs). The literature search covers the period of January 1990 to October 2018. Seven articles were included in the meta-analysis and Fisher's z was calculated with correlation coefficient or regression coefficient values for eight illness representation dimensions and psychological distress. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 3.0 software.

Results: A total of 49 studies were reviewed, and seven studies with a total of 507 participants were eligible for the meta-analysis. For patients' perceived anxiety and depression, six of seven studies, with 285 to 461 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that stroke patients' perception of a strong illness identity, timeline-acute/chronic, timeline-cyclical, consequences, and emotional responses were significantly and positively related to anxiety and depression. The pooled z-value ranged from 0.189 to 0.460. Conversely, for protective-related factors, such as stroke patients' perceived personal control, treatment control, and illness coherence, only perceived illness coherence was significantly negatively associated with depression (z-value, -0.122; 95% CI: -0.241, -0.002). For patients' perceived overall distress, three of seven studies with 173 participants showed that there were significant and positive associations between identity, consequence, emotions, and distress (z-value ranges = 0.493-0.711) as well as a significant and negative association between illness coherence and overall distress (z-value, -0.226; 95% CI: -0.379, -0.073).

Conclusion: An association between illness representation and distress exists in stroke patients. Risk factors are the most significant in terms of this relationship, and protective factors do not have a protective health impact. Protection factors need to be promoted to reduce patient distress.

Keywords: Anxiety; Belief; Cerebrovascular accident; Depression; Distress; Illness perceptions; Illness representation; Meta-analysis; Stroke.