Prediction of handicap and emotional distress in patients with recurrent vertigo: Symptoms, coping strategies, control beliefs and reciprocal causation

doi:10.1016/0277-9536(94)90100-7

Social Science & Medicine

Volume 39, Issue 4, August 1994, Pages 573-581

https://doi.org/10.1016/0277-9536(94)90100-7 Get rights and content

Abstract

Factors predicting handicap and distress were examined in a longitudinal study of 101 patients suffering from recurrent vertigo (dizziness). Analysis of a questionnaire assessing coping strategies yielded four distinct individualised coping styles: problem-focused information-seeking; distraction; denial; and relinquishing responsibility. After controlling for the severity of physical and psychological symptoms and distress, handicap was negatively related to internal locus of control and positively correlated with relinquishing responsibility. Symptoms of somatic anxiety predicted an increase in handicap over a 7 month period, while handicap and somatic anxiety symptoms predicted an increase in distress. These results are interpreted in terms of a reciprocal causal relationship between handicap and distress, mediated partly by somatic symptoms. Parallels with pain, panic and phobia suggest that patients with vertigo might benefit from psychological therapies.

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Vestibular deficits and psychological factors correlating to dizziness handicap and symptom severity
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Greater psychological distress was significantly associated with both dizziness handicap and severity and, together with the other psychological variables, contributed the most to the variance explained within the adjusted models. This link may exist for a variety of reasons such as the close anatomic connections in the central nervous system [47], less likelihood to engage in behaviours that promote adaptation or greater likelihood to engage in avoidance behaviours [48], as well as enhanced perception and increased attention to somatic symptoms [49]. Although the role of psychological factors has been researched in functional vestibular and medically unexplained syndromes, the results of the current study suggest these factors are relevant to disorders regardless of whether they are classified as medically explained or unexplained (functional).
To determine the relative contribution of demographic variables, objective testing and psychological factors in explaining the variance in dizziness severity and handicap.
One-hundred and eighty-five consecutive patients on the waiting list to attend a diagnostic appointment in a tertiary neuro-otology clinic with a primary complaint of vertigo or dizziness completed a cross-sectional survey. Primary outcomes were the Dizziness Handicap Inventory and the vertigo subscale of the Vertigo Symptom Scale-Short Form. Psychological questionnaires assessed anxiety and depressive symptoms, illness perceptions, cognitive and behavioural responses to symptoms, beliefs about emotions and psychological vulnerability. Patients also underwent standardised audio-vestibular investigations and tests to reach a diagnosis at appointment.
Objective disease characteristics were not associated with handicap and only the presence of vestibular dysfunction on one test (caloric) was associated with symptom severity. Almost all the psychological factors were correlated with dizziness outcomes. The total hierarchical regression model explained 63% of the variance in dizziness handicap, and 53% was explained by the psychological variables. The regression model for symptom severity explained 36% of the variance, and 30% was explained by the psychological factors. In adjusted models, factors associated with dizziness handicap included age, female gender, distress, symptom focusing, embarrassment, avoidance, and beliefs about negative consequences. Fear avoidance was the only independent correlate in the fully adjusted model of symptom severity.
Self-reported dizziness severity and handicap are not correlated with clinical tests of vestibular deficits but are associated with psychological factors including anxiety, depression, illness perceptions, cognitive and behavioural responses.
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The impact of the disease on ability to carry out daily activities has been estimated to be moderate [6]. Nevertheless, the outcome of MD is often life-changing causing inability to perform daily activities and emotional distress [8,9]. Attitude toward illness is one of the key elements in determining the individual's ability to deal with the illness [10].
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The SOC reflected the disabilities caused by symptoms of MD and psychosocial factors including verbal score scale (VSS) anxiety (p < 0.01) and loss of vitality (p < 0.001). Higher SOC scores were related to better scores in EQ-5D and lower scores in MD-impact. Positive attitudes consequential to MD were associated with higher SOC scores reflecting better control over the consequences of disease.
SOC is an element of patient's attitude toward illness and correlates with perceived good health. Patients with higher SOC scores are more content with their quality of life. Future research should focus on whether influencing modifiable psychological factors, such as positive attitudes, could improve adaptive ability in MD.
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Prediction of handicap and emotional distress in patients with recurrent vertigo: Symptoms, coping strategies, control beliefs and reciprocal causation

Abstract

Lancet

J. Psychosom. Res.

J. Psychosom. Res.

J. Psychosom. Res.

Soc. Sci. Med.

Behav. Res. Therapy

Behav. Res. Ther.

The prevalence of psychological disturbance in neurootology outpatients

Clin. Otolaryngol.

(1988) Adjustment in Meniere's disease

Morbidity Statistics from General Practice

Auditory and vestibular rehabilitation in the adult

Horizons in Med.

Psychosocial consequences of vertigo

Psychol. Hlth

Rehabilitation of vertigo

Vestibular rehabilitation: an exercise approach to managing symptoms of vestibular dysfunction

Seminars Hearing

Somatic and psychological factors contributing to handicap in people with vertigo

Br. J. Audiol.

Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study

Clin. Otolaryngol.

Psychiatric morbisity in patients with peripheral vestibular disorder: a clinical and neuro-otological study

J. Neurol. Neurosurg. Psychiat.

Contribution of symptoms and beliefs to handicap in people with vertigo: a longitudinal study

Br. J clin. Psychol.

Meniere's disease: a psychosomatic disorder?

Psychol. Rep.

Psychological profile of patients with Meniere's disease

Archs Otolaryngol. Head Neck Surgery

Psychosomatic study of 60 patients with vertigo

Psychother. and Psychosom

Coping with chronic illness

Approach, avoidance and coping with stress

Am. Psychol.

Coping with chronic illness: a study of illness controllability and the influence of coping strategies on psychological adjustment

J. Consult. clin. Psychol.