HEALTH / WELL-BEING

Understanding Veterans’ Causal Attributions of Physical Symptoms

Article

Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms is considered particularly important among those with medically unexplained symptoms and illnesses (MUS). The aim of this study was to examine Veterans’ causal attributions of their physical symptoms. Veterans with MUS were surveyed about the cause of their physical symptoms. Veterans with more severe post traumatic stress disorder (PTSD) and physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared to those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared to those with high PTSD and physical symptom severity. This has important implications for patient-provider communication and development of agreement around MUS treatment.

Abstract

Background: Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms is considered particularly important among those with medically unexplained symptoms and illnesses (MUS); yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans). The goal of the current study was to examine Veterans’ causal attributions of their physical symptoms. Methods: 91 combat Veterans with MUS were surveyed using a mixed-methods design about the cause of their physical symptoms, physical symptom severity, and PTSD symptoms. Causal attributions of physical symptoms were analyzed through thematic response analysis and grouped into categories. Chi-square analysis was used to assess the distribution of causal attribution types across Veterans with varying physical symptom severity and PTSD symptom severity. Results: Veterans with MUS reported an average of 7.9 physical symptoms, and attributed the cause of their symptoms to seven different categories (“Don’t Know,” “Stress/Mental Health,” “Deployment/Environment,” “Functional/Symptom,” “Medically Explained,” “Medically Unexplained Syndrome,” and ‘Lifestyle”). Exploratory chi square analysis revealed significant differences in causal attributions across physical symptom severity and severity of PTSD symptoms. Veterans with more severe PTSD and physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared to those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared to those with high PTSD and physical symptom severity.

Full Reference

Understanding Veterans’ Causal Attributions of Physical Symptoms Justin Kimber, Nicole Sullivan, Nicole Anastasides, Sarah Slotkin, Lisa M. McAndrew Int J Behav Med. Author manuscript; available in PMC 2021 Jun 1. Published in final edited form as: Int J Behav Med. 2021 Jun; 28(3): 299–307. doi: 10.1007/s12529-020-09918-0 PMCID: PMC7855405