Physical illness is stressful. However, given time and appropriate help and support, most people can adjust to even the most serious, disabling and life-threatening conditions. Coping with illness is a dynamic process and people have to make a series of adjustments as they assimilate new information, manage their emotions and make appropriate adjustments to their family life and social situation. Chronic illness usually involves having to go through this process many times as different complications of the illness arise over time.
Approximately a quarter of people with physical illness develop mental health problems as a consequence of the ‘stress’ of their physical condition. The process of adjustment fails and people develop depression, anxiety, panic or some other form of mental disorder. If anxiety and depression develop in the context of physical illness, recovery from the physical condition is impeded, pain can become more difficult to control, confidence to participate in rehabilitation programmes is reduced, and in extreme cases the patient can come to believe that they are a burden on their family or the hospital and would be better off dead. Physical illness in the elderly is a major risk factor for suicide.
Factors which influence response to illness
One of the most important determinants of coping with illness is how individuals perceive their illness. Leventhal's self-regulation model of health and illness is a useful framework for understanding people's response to illness (Leventhal et al, 1980). In this model the formation of a cognitive representation of an illness is viewed as the critical first step prior to the adoption of coping behaviours to manage that health threat. Leventhal et al define illness representations as patients’ own implicit common sense beliefs about their illnesses. The representation is viewed as a schema that is formed, activated and modified in response to stimulus information about the illness. Information sources may include symptoms, lay information from personal or vicarious experience, and expert information from medical practitioners. Illness representations are considered to be multidimensional, comprising five main components: identity, perceived consequences, timeline, perceived cause, and control/cure (Box 5.1).