title: Illness perceptions of people with long-term conditions are associated with frequent use of the emergency department independent of mental illness and somatic symptom burden.
abstract: OBJECTIVE
  To determine whether illness perceptions of patients with long-term conditions (LTCs) are associated with urgent healthcare use and whether this association is independent from mental illness and somatic symptom burden.
  
  
  METHODS
  Illness perceptions (B-IPQ) and somatic symptom severity (PHQ-15) were assessed in 304 patients with diabetes, rheumatological disorders and COPD attending an Accident and Emergency Department (AED) in Greece over a one year period. The presence of mental illness was determined by the Mini International Neuropsychiatric Interview. A Generalized Linear Model (Negative Binomial) regression was used to determine the associations of illness perceptions with AED use after adjusting for mental illness, somatic symptom severity, disease parameters and demographics.
  
  
  RESULTS
  Eighty-six patients (28.3%) reported at least one visit to the AED during the previous year and 75 (24.7%) twice or more. 124 patients (40.8%) had some form of mental disorder with 85 (28.0%) meeting criteria for major depressive disorder. The degree to which the patients had an understanding of their illness (illness comprehensibility) (p<0.01) along with younger age (p<0.05), additional comorbidities (p<0.05) and greater somatic symptom burden (p<0.001) was strongly associated with AED use; AED visits were expected to be reduced by 9.1% for each unit increase in illness comprehensibility.
  
  
  CONCLUSIONS
  The way people perceive their illness influences urgent healthcare seeking behavior independent of somatic symptom burden. This finding indicates that information provision may prove effective in reducing urgent healthcare use and encourage the design of psycho-educational interventions targeting disease-related cognitions in an attempt to prevent unnecessary healthcare utilization.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Ninou
authors.affiliation: Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Guthrie
authors.affiliation: Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Paika
authors.affiliation: Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Ntountoulaki
authors.affiliation: Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.affiliation: Department of Philosophy, Education and Psychology, Section Psychology, University of Ioannina, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Karagiannopoulou
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece. Electronic address: tyfantis@cc.uoi.gr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012216:Rheumatic Diseases; D012938:Social Perception
keywords: Anxiety; Chronic illness; Depression; Emergency department; Illness perceptions