Abstract
Purpose
The present study aimed to examine the effects of injury perceptions and perceived daily stress on health-related quality of life (HRQL) of individuals affected by a physical injury.
Methods
Two hundred and forty injured individuals completed questionnaires assessing HRQL (Medical Outcome Health Survey short-form 36), perceived daily-life stress (Perceived Stress Scale), and injury perceptions (Brief-InjPQ).
Results
The direct effects of stress on HRQL scores were not moderated by gender. Emotional representation of the injury significantly mediated the links between PSS and all HRQL subscales only among women, but not among men. However, the mediation of the HRQL total score by emotional representations was significant for both genders. In addition, treatment control perceptions of the injury mediated the link between PSS and self-assessed health among men but not women, and injury-self perceptions mediated the link between PSS and physical functioning among men but not women.
Conclusion
These findings underscore the importance of perceived daily stress, gender, and injury perceptions as key factors for explaining variance in HRQL following injury. In addition to their conceptual contributions, the findings have clinical implications for treating injured populations.
Similar content being viewed by others
Notes
Comparisons between this sample and a comparable healthy sample were reported elsewhere (10).
We did not ask participants for the specific treatments they have received, but the health system in Israel is universal and participation in a medical insurance plan is compulsory. Every resident has a right to receive all of the services included in the medical services basket at a reasonable quality level. The Health Basket covers all costs of medical diagnosis and treatment in a variety areas of medicine, including first aid, hospitalization, surgery, and paramedical services such as physiotherapy and occupational therapy, and mental healthcare. (see also: https://www.israel.org/mfa/aboutisrael/israelat50/pages/the%20health%20care%20system%20in%20israel-%20an%20historical%20pe.aspx).
References
Cao, X. Y., Chen, L., Tian, L., & Jiang, X. L. (2015). Psychological distress and health-related quality of life in relocated and nonrelocated older survivors after the 2008 Sichuan earthquake. Asian Nursing Research, 9(4), 271–277. https://doi.org/10.1016/j.anr.2015.04.008.
Gauffin, E., Oster, C., Sjoberg, F., Gerdin, B., & Ekselius, L. (2016). Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn. Burns, 42(8), 1781–1788. https://doi.org/10.1016/j.burns.2016.05.016.
Gopinath, B., Jagnoor, J., Harris, I. A., Nicholas, M., Casey, P., Blyth, F., . . . Cameron, I. D. (2017). Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study. Traffic Injury Prevention, 18(3), 251–256. https://doi.org/10.1080/15389588.2016.1244335
Hagger, M. S., Chatzisarantis, N. L. D., Griffin, M., & Thatcher, J. (2005). Injury representations, coping, emotions, and functional outcomes in athletes with sports-related injuries: A test of self-regulation theory. Journal of Applied Social Psychology, 35(11), 2345–2374. https://doi.org/10.1111/j.1559-1816.2005.tb02106.x.
Bryant, R. A., O'Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167(3), 312–320. https://doi.org/10.1176/appi.ajp.2009.09050617.
Skogstad, L., Tøien, K., Hem, E., Ranhoff, A. H., Sandvik, L., & Ekeberg, Ø. (2014). Psychological distress after physical injury: A one-year follow-up study of conscious hospitalised patients. Injury, 45(1), 289–298. https://doi.org/10.1016/j.injury.2012.10.001.
Wiese-Bjornstal, D. M., Smith, A. M., Shaffer, S. M., & Morrey, M. A. (1998). An integrated model of response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10(1), 46–69. https://doi.org/10.1080/10413209808406377.
Shiloh, S., Heruti, I., & Leichtentritt, R. (2016). A common-sense model of injury perceptions. Journal of Health Psychology, 21(8), 1516–1526. https://doi.org/10.1080/08870446.2018.1518528.
Leventhal, H., Phillips, L. A., & Burns, E. (2016). The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39(6), 935–946. https://doi.org/10.1007/s10865-016-9782-2.
Heruti, I., Levy, S., & Avitsur, R. (2018). Physical injury, health, and well-being: Role of stress perception. Injury-International Journal of the Care of the Injured, 49(8), 1546–1551.
Heruti, I., Levy, S., Avitsur, R., Deutscher, D., Gutvirtz, M., Berkovitz, T., et al. (2018). Development of the injury perceptions questionnaire (InjPQ). Psychology & Health, 33(5), 614–633. https://doi.org/10.1016/j.injury.2018.06.022.
Shiloh, S., Heruti, I., Diamis, A., Levy, S., Avitsur, R., Deutscher, D., . . . Berkovitz, T. (2018). The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes. Psychology & Health, 33(12), 1519–1536
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404.
Hewitt, P. L., Flett, G. L., & Mosher, S. W. (1992). The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample. Journal of Psychopathology and Behavioral Assessment, 14(3), 247–257. https://doi.org/10.1007/bf00962631.
Shields, G. S., & Slavich, G. M. (2017). Lifetime stress exposure and health: A review of contemporary assessment methods and biological mechanisms. Social and Personality Psychology Compass. https://doi.org/10.1111/spc3.12335.
Malamardi, S. N., Kamath, R., Tiwari, R., Nair, B. V., Chandrasekaran, V., & Phadnis, S. (2015). Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India. Indian Journal of Occupational and Environmental Medicine, 19(3), 134–137. https://doi.org/10.4103/0019-5278.173998.
De Civita, M., Regier, D., Alamgir, A. H., Anis, A. H., FitzGerald, M. J., & Marra, C. A. (2005). Evaluating health-related quality-of-life studies in paediatric populations: Some conceptual, methodological and developmental considerations and recent applications. Pharmacoeconomics, 23(7), 659–685. https://doi.org/10.2165/00019053-200523070-00003.
Seid, M., Varni, J. W., & Jacobs, J. R. (2000). Pediatric health-related quality-of-life measurement technology: Intersections between science, managed care, and clinical care. Journal of Clinical Psychology in Medical Settings, 7, 17–27.
Simon, A. E., Chan, K. S., & Forrest, C. B. (2008). Assessment of children's health-related quality of life in the United States with a multidimensional index. Pediatrics, 121(1), e118–126. https://doi.org/10.1542/peds.2007-0480.
Lewin-Epstein, N., Sagiv-Schifter, T., Shabtai, E. L., & Shmueli, A. (1998). Validation of the 36-item short-form Health Survey (Hebrew version) in the adult population of Israel. Medical Care, 36(9), 1361–1370. https://doi.org/10.1097/00005650-199809000-00008.
Ware, J. E., & Sherbourne, C. D. (1992). The mos 36-item short-form health survey (Sf-36) 1. conceptual-framework and item selection. Medical Care, 30(6), 473–483. https://doi.org/10.1097/00005650-199206000-00002.
Giladi, A. M., McGlinn, E. P., Shauver, M. J., Voice, T. P., & Chung, K. C. (2014). Measuring outcomes and determining long-term disability after revision amputation for treatment of traumatic finger and thumb amputation injuries. Plastic and Reconstructive Surgery, 134(5), 746e–755e. https://doi.org/10.1097/PRS.0000000000000591.
McHorney, C. A., Ware, J. E., Jr., Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–66. https://doi.org/10.1097/00005650-199401000-00004.
Cohen, S., & Janicki-Deverts, D. (2012). Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334. https://doi.org/10.1111/j.1559-1816.2012.00900.x.
Bend, G.(2007). The association between perceived stress, burnout and sperm quality in young men. M.A. Thesis. Sackler Faculty of Medicine. Tel-Aviv University.
Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology., 49(12), 1373–1379.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.
Kim, K., & Kim, J. S. (2017). Factors influencing health-related quality of life among Korean cancer survivors. Psycho-oncology, 26(1), 81–87. https://doi.org/10.1002/pon.4105.
McKinley, S., Fien, M., Elliott, R., & Elliott, D. (2016). Health-related quality of life and associated factors in intensive care unit survivors 6 months after discharge. American Journal of Critical Care, 25(1), 52–58. https://doi.org/10.4037/ajcc2016995.
Gemmell, L. A., Terhorst, L., Jhamb, M., Unruh, M., Myaskovsky, L., Kester, L., et al. (2016). Gender and racial differences in stress, coping, and health-related quality of life in chronic kidney disease. Journal of Pain and Symptom Management, 52(6), 806–812. https://doi.org/10.1016/j.jpainsymman.2016.05.029.
Breuer, K., Goldner, F. M., Jager, B., Werfel, T., & Schmid-Ott, G. (2015). Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis. Journal of the European Academy of Dermatology and Venereology, 29(10), 1898–1904. https://doi.org/10.1111/jdv.12999.
Bugge, I., Dyb, G., Stensland, S. O., Ekeberg, O., Wentzel-Larsen, T., & Diseth, T. H. (2017). Physical injury and somatic complaints: The mediating role of posttraumatic stress symptoms in young survivors of a terror attack. Journal of Traumatic Stress, 30(3), 229–236. https://doi.org/10.1002/jts.22191.
Cardoso, J., Almeida, T., Ramos, C., & Sousa, S. (2018). Relationship between childhood trauma and sleep disturbances: The role of perceived stress as a mediator. Journal of Aggression Maltreatment & Trauma, 27(10), 1075–1089. https://doi.org/10.1080/10926771.2018.1501628.
Grynderup, M. B., Nabe-Nielsen, K., Lange, T., Conway, P. M., Bonde, J. P., Francioli, L., . . . Hansen, A. M. (2016). Does perceived stress mediate the association between workplace bullying and long-term sickness absence? Journal of Occupational and Environmental Medicine, 58(6), E226–E230. https://doi.org/10.1097/jom.0000000000000750.
Lamis, D. A., Hirsch, J. K., Pugh, K. C., Topciu, R., Nsamenang, S. A., Goodman, A., et al. (2018). Perceived cognitive deficits and depressive symptoms in patients with multiple sclerosis: Perceived stress and sleep quality as mediators. Multiple Sclerosis and Related Disorders, 25, 150–155. https://doi.org/10.1016/j.msard.2018.07.019.
Smith, M. A., Riccalton, V. C., Kelly-Hughes, D. H., Craw, O. A., Allen, S. F., O'Connor, D. B., et al. (2018). The relationship between Type D personality and physical health complaints is mediated by perceived stress and anxiety but not diurnal cortisol secretion. Stress-The International Journal on the Biology of Stress, 21(3), 229–236. https://doi.org/10.1080/10253890.2018.1435637.
Schnurr, P. P., & Green, B. L. (2004). Trauma and health: Physical health consequences of exposure to extreme stress (1st ed.). Washington, DC: American Psychological Association.
Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry, 4(4), 295–304.
Hammen, C., Henry, R., & Daley, S. E. (2000). Depression and sensitization to stressors among young women as a function of childhood adversity. Journal of Consulting and Clinical Psychology, 68(5), 782–787. https://doi.org/10.1037/0022-006x.68.5.782.
Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132(6), 959–992. https://doi.org/10.1037/1942-9681.s.1.37.
Hajian-Tilaki, K., Heidari, B., & Hajian-Tilaki, A. (2017). Are gender differences in health-related quality of life attributable to sociodemographic characteristics and chronic disease conditions in elderly people? International Journal of Preventive Medicine. https://doi.org/10.4103/ijpvm.IJPVM_197_16.
Wijnhoven, H. A. H., Kriegsman, D. M. W., Snoek, F. J., Hesselink, A. E., & de Haan, M. (2003). Gender differences in health-related quality of life among asthma patients. Journal of Asthma, 40(2), 189–199. https://doi.org/10.1081/Jas-120017990.
Aitken, L. M., Chaboyer, W., Kendall, E., & Burmeister, E. (2012). Health status after traumatic injury. The Journal of Trauma and Acute Care Surgery., 72(6), 1702–1708. https://doi.org/10.1097/TA.0b013e318246bfe9.
Hasselberg, M., Kirsebom, M., Bäckström, J., Berg, H. Y., & Rissanen, R. (2019). I did NOT feel like this at all before the accident: Do men and women report different health and life consequences of a road traffic injury? Injury Prevention, 25(4), 307–312. https://doi.org/10.1136/injuryprev-2017-042673.
Silver, K. E., Kumari, M., Conklin, D., & Karakurt, G. (2018). Trauma and health symptoms in a community sample: Examining the influences of gender and daily stress. The American Journal of Family Therapy., 46(2), 153–167. https://doi.org/10.1080/01926187.2018.1461031.
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359.
Street, A. E., & Dardis, C. M. (2018). Using a social construction of gender lens to understand gender differences in posttraumatic stress disorder. Clinical Psychology Review, 66, 97–105. https://doi.org/10.1016/j.cpr.2018.03.001.
Grace, S. L., Krepostman, S., Brooks, D., Arthur, H., Scholey, P., Suskin, N., . . . Stewart, D. E. (2005). Illness perceptions among cardiac patients: Relation to depressive symptomatology and sex. Journal of Psychosomatic Research, 59(3), 153–160. https://doi.org/10.1016/j.jpsychores.2005.05.005.
Edelstein, O. E., Werner, P., Dresner-Pollak, R., Tordjman, K., Jaffe, A., Toledano, Y., et al. (2012). Illness perceptions among osteoporotic men and women: Correlates and gender differences. Journal of Men's Health, 9(3), 168–175. https://doi.org/10.1016/j.jomh.2012.03.012.
Fink, G. (2016). Stress: Concepts, cognition, emotion, and behavior. Boston: Academic Press.
Diefenbach, M. A., & Leventhal, H. (1996). The common-sense model of illness representation: Theoretical and practical considerations. Journal of Social Distress and the Homeless, 5(1), 11–38. https://doi.org/10.1007/bf02090456.
Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17(1), 1–16. https://doi.org/10.1080/08870440290001494.
Hagger, M. S., Koch, S., Chatzisarantis, N. L. D., & Orbell, S. (2017). The common sense model of self-regulation: Meta-analysis and test of a process model. Psychological Bulletin, 143(11), 1117–1154. https://doi.org/10.1037/bul0000118.
Arran, N., Craufurd, D., & Simpson, J. (2014). Illness perceptions, coping styles and psychological distress in adults with Huntington's disease. Psychology, Health & Medicine., 19(2), 169–179. https://doi.org/10.1080/13548506.2013.802355.
Costa, E. C. V., Vale, S., Sobral, M., & Graça Pereira, M. (2016). Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain. Psychology, Health & Medicine., 21(4), 483–495. https://doi.org/10.1080/13548506.2015.1109673.
de Heer, E. W., Vriezekolk, J. E., & van der Feltz-Cornelis, C. M. (2017). Poor illness perceptions are a risk factor for depressive and anxious symptomatology in fibromyalgia syndrome: A longitudinal cohort study. Frontiers in Psychiatry, 8, 217. https://doi.org/10.3389/fpsyt.2017.00217.
Karademas, E. C., Barouxi, E., & Mavroeides, G. (2019). Positive and negative affect and well-being in cardiac patients and their spouses: The mediating role of illness representations. Psychology and Health, 34(3), 289–305. https://doi.org/10.1080/08870446.2018.1525490.
Langston, S., Edwards, M. S., Lyvers, M., & Stapleton, P. (2016). Illness perceptions and treatment outcomes in Hepatitis C. New Zealand Journal of Psychology, 45(2), 22–28.
Mo, P. K., Lau, J. T., & Wu, X. (2018). Relationship between illness representations and mental health among HIV-positive men who have sex with men. AIDS Care, 30(10), 1246–1251. https://doi.org/10.1080/09540121.2018.1445825.
Sadeghi, M., Ghasemi, G., & Karimi, M. (2019). Effect of 12-week rebound therapy exercise on static stability of patients with spinal cord injury. Journal of Sport Rehabilitation, 28(5), 464–467. https://doi.org/10.1123/jsr.2017-0303.
Hopman, P., & Rijken, M. (2015). Illness perceptions of cancer patients: relationships with illness characteristics and coping. Psychooncology, 24(1), 11–18. https://doi.org/10.1002/pon.3591.
Kidd, T., Poole, L., Leigh, E., Ronaldson, A., Jahangiri, M., & Steptoe, A. (2016). Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery. Journal of Behavioral Medicine, 39(1), 120–127. https://doi.org/10.1007/s10865-015-9677-7.
Pai, H. C., Li, C. C., Tsai, S. M., & Pai, Y. C. (2019). Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis. International Journal of Nursing Studies, 94, 42–50. https://doi.org/10.1016/j.ijnurstu.2019.01.015.
Rassart, J., Apers, S., Kovacs, A. H., Moons, P., Thomet, C., Budts, W. . . Luyckx, K., APPROACH-IS consortium and the International Society for Adult Congenital Heart Disease (ISACHD). (2017). Illness perceptions in adult congenital heart disease: A multi-center international study. International Journal of Cardiology, 244, 130–138. https://doi.org/10.1016/j.ijcard.2017.06.072.
Lee, S. Y., & Park, C. L. (2018). Trauma exposure, posttraumatic stress, and preventive health behaviours: A systematic review. Health Psychology Review, 12(1), 75–109.
Cloitre, M., Khan, C., Mackintosh, M. A., Garvert, D. W., Henn-Haase, C. M., Falvey, E. C., et al. (2019). Emotion regulation mediates the relationship between ACES and physical and mental health. Psychological Trauma, 11(1), 82–89. https://doi.org/10.1037/tra0000374.
Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy, 11(1), 3–16. https://doi.org/10.1002/cpp.388.
Cameron, L. D., & Jago, L. (2008). Emotion regulation interventions: A common-sense model approach. British Journal of Health Psychology, 13, 215–221. https://doi.org/10.1348/135910708x288800.
Claar, R. L., & Blumenthal, J. A. (2003). The value of stress-management interventions in life-threatening medical conditions. Current Directions in Psychological Science, 12(4), 133–137. https://doi.org/10.1111/1467-8721.01248.
Martelli, M. F., Auerbach, S. M., Alexander, J., & Mercuri, L. G. (1987). Stress management in the health-care setting: Matching interventions with patient coping styles. Journal of Consulting and Clinical Psychology, 55(2), 201–207. https://doi.org/10.1037//0022-006x.55.2.201.
Jones, A. S. K., Fernandez, J., Grey, A., & Petrie, K. J. (2017). The impact of 3-d models versus animations on perceptions of osteoporosis and treatment motivation: A randomised trial. Annals of Behavioral Medicine, 51(6), 899–911. https://doi.org/10.1007/s12160-017-9913-1.
Krasnoryadtseva, A., Dalbeth, N., & Petrie, K. (2019). Does seeing personal medical images change beliefs about illness and treatment in people with gout? A randomised controlled trial. Psychology and Health., 11, 1–17. https://doi.org/10.1080/08870446.2019.1626396.
Acknowledgements
The authors would like to thank the following students for contributing to the data collection as a part of this study: MA students: Gabriela Alimi, Amiad Abrahams, Elena Gurevich, Naama Reiter, Or Aharon-Dvir; BA students: Adar Elharar, Sheer Almagor, Shay Bejerano, Moran Zohar Harshoshanim, Liat Genkin, Anton Kotlyar, Dorli Kuntz, and Nitzan Shlessinger.
Funding
This study was partially supported by a seed grant provided by the Academic College of Tel Aviv-Yaffo (SL, IH, RA). The funding source had no involvement in the study design, analysis of the data, or writing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Research involving human participants
All procedures performed the study were approved by the ethics committee of The Academic College of Tel Aviv-Yaffo (#2014003/01) and in accordance with the ethical standards the 1964 Helsinki declaration and its later amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Shiloh, S., Levy, S., Heruti, I. et al. Health-related quality of life after injury: examining the roles of perceived daily-life stress and injury perceptions. Qual Life Res 29, 3053–3063 (2020). https://doi.org/10.1007/s11136-020-02548-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-020-02548-9