Symptoms Catastrophizing and Symptoms-Related Social Hypervigilance Among Chinese Patients with Irritable Bowel Syndrome

This dissertation, "Symptoms Catastrophizing and Symptoms-related Social Hypervigilance Among Chinese Patients With Irritable Bowel Syndrome" by Zhaowen, Wu, 吳兆文, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder among adults. Using the standardized Rome II criteria, the point prevalence in Western countries is estimated at between 10% and 20%. Although the prevalence appears to be lower among Chinese adults, IBS is a major public health concern because it tends to run a chronic course, impairs patients' quality of life, and accounts for 20% to 50% of referrals to gastroenterology clinics. The aetiology of IBS is multi-dimensional. Among various illness coping strategies, symptoms catastrophizing (SC) has been found to be predictive of poorer illness outcome in Western studies. SC is characterized by fear, panic and loss of control. With reference to local clinical experience and the interpersonal orientation of Chinese, another illness coping strategy, symptoms-related social hypervigilance (SSH) was conceptualized in this study. SSH is characterized by heightened social consciousness, relentless pursuit of total symptoms control and a strong sense of disappointment for failure to do so. SSH is believed to be common among Chinese IBS patients and has important implications for clinical practice. Both SC and SSH are yet to be studied rigorously in Chinese populations. Objectives: The study aimed to evaluate the clinical relevance of SC and SSH to Chinese IBS patients. Specific objectives were: 1) Operationalize SSH through scale development; 2) Evaluate SC as a psychological construct in Chinese IBS patients; 3) Explore models predicting IBS illness outcome; 4) Examine the impacts of SC and SSH on illness behaviour; and 5) Explore the psycho-behavioral mechanisms of SC and SSH. 9 Method: Research method was primarily quantitative, complemented by qualitative interviews. Study 1 was a quantitative study - a cross-sectional questionnaire survey at a primary care, a gastroenterology and a Chinese medicine clinic. Study 2 was a qualitative study - follow-up clinical interviews with selected participants to gain in- depth understanding of SC and SSH among Chinese IBS patients. Results: 309 patients from the three study sites participated in the questionnaire survey, and 23 of them were interviewed in the follow-up clinical interviews. Regarding the self-constructed SSH scale, exploratory factor analysis provided a 9- item 3-factor solution. The three factors were 1) anticipating negative perceptions from others; 2) hiding symptoms in social situations; and 3) assuming responsibility for symptom control. The SSH scale showed satisfactory psychometric properties in internal consistency (Cronbach's alphas between 0.72 and 0.86) and concurrent construct validity. The Chinese version 6-item SC scale also showed satisfactory psychometric properties in internal consistency (Cronbach's alpha at 0.91) and concurrent construct validity. SC showed the statistical characteristics of a partial mediator between IBS symptoms severity and illness outcome. SSH had significant positive correlation (r = 0.25 to 0.48) with 'proactive' illness behaviours (e.g. seeking treatments and learning various symptoms self-management methods), even after controlling for symptoms severity. In contrast to findings in the West, anxiety and depression did not have significant correlation with IBS symptoms severity, illness outcome and other health and mental health measures include