Sot. Sei. Med. Vol. 16. pp. 899 to 905. 1982 0277-9536/82/080899-07$03.00/0 Printed in Great Britain Pcrgamon Press Ltd zyxwvutsr PSYCHOLOGICAL REACTIONS TO THE ONSET OF CHRONIC ILLNESS MARY T. WESTBROOK’ and LINDA L. VINEY’ ‘Department of Behavioural and General Studies, Cumberland College of Health Sciences. Lidcom N.S.W., and ‘Department of Psychology, The University of Wollongong. Australia Abstract-Patients (N = 126) interviewed during hospitalization at the onset of chronic illness were found to be experiencing considerable emotional arousal. Their psychological reactions were assessed by applying content analysis scales to accounts of their current experiences and comparing these accounts of non-patients. Multivariate analysis of variance indicated that patients experienced signifi- cantly more anxiety, depression, and directly and indirectly expressed anger, as well as positiv and that they perceived themselves to be more helpless. Canonical analyses were applied to investigate the relationships between patients’ reactions and their biographic and illness-related characteristics. Patients’ reactions were related to demographic factors and their perceptions of their handicaps. No relationshins were found between nattems of reaction and patients’ life styles, medical records of their illnesses or the types of their disa&lities. INTRODUCTION The first aim of this research was to identify patterns of psychological reactions of patients to the onset of chronic illness. Much past research concerned with chronically ill patients has provided only descriptive accounts of their reactions [1] or has used measures which are idiosyncratic to that particular study [2]. In this study measures were applied which would en- able comparison of the experiences of chronically ill patients with those of people who were not being sub- jected to the stress of hospitalization for chronic ill- ness. The second aim of the research was to examine whether patients’ reactions to chronic illness could be predicted on the basis of biographical and illness- related information. The onsetof chronic illness seems to be a time of high emotionalarousal, or of crisis [3] for patients. While the pattern of this psychological reaction differs from patient to patient the literature suggests that it involves considerable uncertainty [4-6], anxiety [7-lo] and depression [9,10,11-131. Much anger may also be generated by the frustrations of chronic illness[7,1416]. This anger may be expressed di- rectly or indirectly. Patients also vary in the extent to which they feel helpless or competent [16-183; and these psychological states can influence theirrehabili- tation[19,20].Chronic illness may also lead to a loss of sociability [21,22] which, if retained in the form of effective use of social supports, is another aid to reha- bilitation [23,24].Moraleis another important facili- tatorof rehabilitation [25]. It can be surprisingly high in patients with severe illness [26]. It was this range of aspects of patients’ psychological reactions which was assessed. The relationship of patients’biographies to the reactions was first examined in terms of broaddemo- graphic variables. Sex and socioeconomic status have been found to be associated with the impact of com- parable stress [27] and with reactions to illness [28,29]. Age has been shown to be associated with reactions to myocardial infarction [30] and to cancer [31]. All these variables have been found to be related to successful rehabilitation [32]. The demographic variables included in the present study were sex, age, educational attainment and occupational status. The value of life style as a predictor of patients’ reactions was also assessed. People with a senseof coherence in their lives are said to be better able to cope with demands like the stress of chronic illness [33]. People who are involved in life, as measured by having an ongoing marital relationship (or its equival- ent), rearingchildren,having leisure pursuits,and enjoying work, would have a stronger sense of coher- ence and so might react with less distress to the crisis of becoming chronically ill. Whether the onset of disability is sudden or gradual seems likely to influence patients’ reactions to it. For example, patients with gradual onset describe the feel- ings of uncertainty they experience followed by a feel- ing of relief when a diagnosis was made. Information regarding onset of illness and staff judgements of patients’ discomfort, coping, cooperation and appear- ance at admission were obtainedfrom the hospital medicalrecords. This informationregarding illness behaviouris of the kind used to identify typical patient roles such as the ‘good’ and ‘bad’ patient [ 173. People who assume different rolesmay differ in their psychological reactions to their illness. The relationship between aspects of the patients’ illness and their reactions was explored in termsof the World Health Organization’s [34] distinction between disease, impairment, disability and handicap. WHO argues that classifying people who are ill in terms of their diseases is an efficient approach to dis- orders that can be prevented or cured. Because it stops short of dealing with the consequences of dis- ease, it is of limited use in classifying the chronically ill. WHO has therefore proposed additionalclassifi- cations based on zyxwvutsrqponmlkjihgfedcbaZYXW impairments “abnormalities of body structure and appearance and with organ or system function”, disabilities, “the consequences of impair- ments in terms of functionalperformance and ac- tivity”and handicaps, “the disadvantages experienced 899