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Table of Contents
Vol. 67, No. 4-5, 1998
Issue release date: July–October 1998
Psychother Psychosom 1998;67:222–225

Graphic Representation of Illness: A Novel Method of Measuring Patients’ Perceptions of the Impact of Illness

Büchi S. · Sensky T. · Sharpe L. · Timberlake N.
a Imperial College School of Medicine, West Middlesex University Hospital, Isleworth, UK; b Division of Psychosocial Medicine, University of Zürich, Switzerland

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Background: Health outcome is multi-faceted, and for both research and clinical practice, greater knowledge of its facets is required. The Pictorial Representation of Illness and Self Measure (PRISM) was developed as a simple, rapid measure of the current impact of illness and symptoms on the individual. Methods: The PRISM task was completed by 26 outpatients with rheumatoid arthritis participating in a larger study of psychosocial correlates of arthritis, which included assessment of disease variables, functional impairment, pain, depression and patients’ appraisals of their illness. In the PRISM task, the patient was asked to imagine that a small board represents his/her life and a fixed disk on the board represents his/her ‘self’. The task was to place another (Illness) disk on the board to represent the current importance of illness in the patients’ life. The main outcome measure was the distance between the Self and Illness disks. Findings: Only 2 patients had difficulty understanding the task. PRISM distance did not correlate with any disease variables. It correlated inversely with pain, functional impairment and depression, and positively with coping resources. PRISM distance correlated with perceived control over illness and negatively with awareness of illness. Interpretation: PRISM is an innovative measure, simple and well accepted by patients. It appears to measure what in German is termed leidensdruck, the burden of suffering due to illness. It offers a promising measure of an intangible but important health outcome, hitherto neglected, applicable to research interventions and clinical practice.

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  1. Sensky T: Patient’s reactions to illness: Cognitive factors determine responses and are amenable to treatment. Br Med J 1990;300:622–623.
  2. Sensky T, Catalan J: Asking patients about their treatment: Why their answers should not always be taken at face value. Br Med J 1992;305:1109–1110.
  3. Bowling A: Measuring Disease: A Review of Disease-Specific Quality of Life Measurement Scales. Buckingham, Open University Press, 1995.
  4. Bech P: Rating Scales for Psychopathology, Health Status and Quality of Life: A Comendium of Documentation in Accordance with the DSM-IIIR and WHO Systems. Berlin, Springer, 1993.
  5. Cairns J: Measuring health outcomes: Condition specific and patient specific measures are of limited use when allocating resources. Br Med J 1996;133:6.
  6. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–324.
  7. Fries JF, Spitz P, Kraines RJ, Holman HR: Measurement of patient outcome in rheumatoid arthritis. Arthritis Rheum 1980;23:137–145.
  8. Stucki G, Liang MH, Stucki S, Bruhlmann P, Michel BA: A self-administeed rheumatoid arthritis disease activity index (RADAI) for epidemiologic research. Arthritis Rheum 1995;38:795–798.

    External Resources

  9. Ware JE: SF-36 Physical and Mental Health Summary Scales: A User’s Guide. Boston, Medical Outcomes Trust, 1994.
  10. Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361–370.
  11. Antonovsky A: Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco, Jossey-Bass, 1987.
  12. Weinman J, Petrie KJ, Ross-Morris R, Horne R: The Illness Perception Questionnaire: A new method for assessing cognitive representations of illness. Psychol Health 1996;11:431–445.
  13. Büchi S, Sensky T, Allard S, Stoll T, Schnyder U, Klaghofer R, Buddeberg C: Sense of coherence – a protective factor for depression in rheumatoid arthritis. J Rheumatol, in press.
  14. Michels KB, Rosner BA: Data trawling: To fish or not to fish. Lancet 1996;348:1152–1153.
  15. Flor H, Turk DC: Chronic pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables. J Behav Med 1988;11:251–265.
  16. Affleck G, Tennen H, Pfeiffer C, Field J: Appraisals of control and predictability in adapting to a chronic disease. J Pers Soc Psychol 1987;53:273–279.
  17. Fitzpatrick R, Newman S, Lamb R, Shipley M: Helplessness and control in rheumatoid arthritis. Int J Health Sci 1990;1:17–23.
  18. Hawley DJ, Wolfe F, Cathey MA: The sense of coherence questionnaire in patients with rheumatic disorders. J Rheumatol 1992;19:1912–1918.
  19. Smith TW, Peck JR, Milano RA, Ward JR: Cognitive distorsion in rheumatoid arthritis: Relationship to pain and disability. J Consult Clin Psychol 1988;56:412–416.

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