Patterns of coping in rheumatoid arthritis

Abstract

One hundred and fifty eight outpatients were assessed on a 36 item coping questionnaire in order to examine the impact of coping on the disability and psychological well being of individuals with rheumatoid arthritis. To consider the total pattern of coping strategies accepted and rejected by these individuals, the data was subjected to a cluster analysis. Hierarchical clustering techniques suggested the four group solution as optimum. Following a k means iterative solution external validity for the four groups was considered. The main findings indicate that the pattern of coping exerts a significant influence on symptom perception, disability and psychological well being. The findings are discussed in relation to two approaches to the impact of coping on chronic illness.     

Optimism and coping as determinants of psychosocial adjustment to rheumatoid arthritis

Psychosocial adjustment in 66 patients with chronic rheumatoid arthritis, with a mean duration of 12 years with the disease, were evaluated in a prospective design, with 62% of the sample followed up 16 months later. It was predicted that dispositional optimism would predict adjustment over time and that perceived support and perceived control would be related to psychosocial adjustment at the time of concurrent measurement. At Time 1, psychosocial adjustment was associated with greater optimism and perceived support and less disability. Optimism at Time 1 was the only significant predictor of changes in adjustment at Time 2 controlling for Time 1 adjustment and Time 2 disability. It was found that optimism temporally precedes increases in psychosocial adjustment. In terms of coping strategies, wishful thinking was related to poorer social adjustment, whereas problem-focused coping was marginally related to positive adjustment. Neither coping strategy predicted adjustment across time. Optimism at Time 1 did predict problem-focused coping at Time 2. Perceived social support regarding a specific circumstance at a given point in time enables one to persist in solving a task. Interventions to enhance the quality of life of individuals coping with progressive deteriorative disease must look at the influence of their behavior and attitude on those who provide care for them.     

The psychosocial effects of rheumatoid arthritis on the patient and the well partner

Rheumatoid arthritis (RA) is a chronic disorder that can have a severe impact on patient's lives. This present study investigated four questions regarding the psychosocial effects on patients and their well partners. First we found that depression for both patients and partners were slightly elevated and 35.7% of patients and 23.3% of well partners had scores above the cut-off for possible clinical depression on the Center for Epidemiological Studies Depression Scale. Second, there was no significant difference between the patients' level of distress and that of the partners. Third, there were moderate positive correlations between patients' and partners' scores on measure of psychological functioning. Fourth, there were no differences in either the patients' or partners' well-being based on the gender of the patient. Finally, an exploratory analysis was conducted to examine the factors which influence the patients' and partners' depression and their view of the relationship.     

Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis

Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.     

Helplessness and depression in rheumatoid arthritis

Depression is common in rheumatoid arthritis (RA) populations and has been hypothesized to result from patients' belief that they cannot control their disease or its impact. In a sample of 106 patients with RA, we found that scores on a measure of helplessness mediated the relationship between severe, disabling RA and depression. Further, this association was independent of the previously demonstrated correlation between cognitive distortion and depression in RA patients. Thus, both helplessness and cognitive distortion may be important factors in the development and treatment of depression among RA patients.     

Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer.

In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection.     

Hardiness and health among women with rheumatoid arthritis

The relations among hardiness (and its components) and demographic variables, objective health, disability, and perceived health were investigated for 33 women with rheumatoid arthritis. Hardiness and demographic variables were measured once while objective health, disability, and perceived health were measured at three monthly intervals. Hardiness and/or component scores were significantly (P < 0.05) related to age and to employment status but were unrelated to education and to marital status. The control dimension of hardiness was positively correlated with the average percentage of circulating T-cells (r = 0.38, P < 0.05), and with average perceived health compared to one's same age peers (r = 0.53, P < 0.01). Hardiness appears to be a useful construct for understanding adaptation to rheumatoid arthritis, and studies of patients with chronic diseases can shed light on the precursors and consequences of hardiness.     

Neurodevelopmental and psychosocial risk factors in serial killers and mass murderers

Multiple and serial murders are rare events that have a very profound societal impact. We have conducted a systematic review, following PRISMA guidelines, of both the peer reviewed literature and of journalistic and legal sources regarding mass and serial killings. Our findings tentatively indicate that these extreme forms of violence may be a result of a highly complex interaction of biological, psychological and sociological factors and that, potentially, a significant proportion of mass or serial killers may have had neurodevelopmental disorders such as autism spectrum disorder or head injury. Research into multiple and serial murders is in its infancy: there is a lack of rigorous studies and most of the literature is anecdotal and speculative. Specific future study of the potential role of neurodevelopmental disorders in multiple and serial murders is warranted and, due to the rarity of these events, innovative research techniques may be required.     

Gender differences in psychosocial risk factors among Slovenian adolescents

This study investigated psychosocial risk factors in adolescents and assessed gender differences in the frequency of their occurrence. A specially designed questionnaire, which included validated scales for the evaluation of depression (Zung Self-rating Depression Scale) and self-esteem (Rosenberg Self-Esteem Scale), was administered to a representative sample of Slovenian adolescents. The final sample consisted of 4,590 high school students of both sexes, aged 14 to 19 years. Data analysis revealed several significant gender differences. Girls more often than boys reported family conflict, personal problems, physical inactivity, attempts to control body weight, use of psychoactive drugs, suicidal ideation, and suicide attempts. Their level of depression was higher and self-esteem lower when compared with their male counterparts. Boys more often than girls indicated that they watched a great deal of television, were the victims of peer violence, and drank alcohol.     

Personality characteristics of individuals with chronic rheumatoid arthritis

MMPI profiles of 22 chronic arthritic patients were compared to 22 control pain (nonorganic) patients. While elevations were noted in the HS, D, and Hy scales for the rheumatoid patients, the over-all profiles differed from controls on the PA scale.     

Sequelae of cesarean and vaginal deliveries: psychosocial outcomes for mothers and infants

Mother-infant dyads grouped according to whether the infants had been delivered vaginally (n = 74) or by planned (n = 37) or unplanned cesarean (n = 56) were compared on psychosocial outcomes at 4 and 12 months postpartum. Hypotheses were that unplanned cesarean delivery would be related to less optimal outcomes and that this relationship would be mediated by mother's appraisal of the delivery and would attenuate over time. No delivery-related differences in mother-infant interactions were found at 4 or 12 months postpartum with one exception: Women low in neuroticism who delivered by unplanned cesarean showed less positive affect toward their infants at 4 months than did women high in neuroticism who delivered by unplanned cesarean or women in any other group. There was some evidence of the mediating role of maternal appraisal of the delivery on these effects. In general, the results indicate little cause for concern about the quality of mother-infant interactions following cesarean deliveries.     

An analysis of coping profiles and adjustment in persons with rheumatoid arthritis

This study examined dispositional and situative antecedents of vigilant and avoidant coping behavior. Seventy-two subjects were classified in coping style on the basis of their responses to the vigilance and cognitive avoidance scales of the Mainz Coping Inventory (MCI, Krohne, 1989), and alternatively, on their trait anxiety and defensiveness scores (cf. Weinberger, Schwartz, & Davidson, 1979). In a subsequent laboratory task, subjects were exposed to various conditions of predictability of an aversive event. In anticipation of an aversive loud tone, coping behavior was operationally defined as choosing to listen either to a warning channel (i.e., vigilance) or instead to music (i.e., avoidance). Probability of occurrence of a warning signal while listening to the warning channel varied across trials, being either 0%, 33%, 66%, or 100%. Subjects were exposed to each level and were informed about the respective probability in advance. In general, listening to the warning channel increased with an increase in the probability of the warning signal. However, four groups of subjects who differed in their pattern of coping behavior across trials were observed: rigid-avoidant copers (always listening to music), rigid-vigilant copers (always monitoring the warning channel), flexible copers (switching from music to warning channel with increasing probability of warning), and inconsistent copers (vacillating between music and warning channel regardless of probability of warning). Coping style classifications did not show substantial associations with coping behavior. However, subjects demonstrating the inconsistent coping pattern scored high on trait anxiety.     

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

Differences in psychosocial responses to pain between sufficiently and insufficiently active adults with arthritis

Objective: Adults with arthritis struggle to meet the physical activity recommendation for disease self-management. Identifying psychosocial factors that differentiate adults who meet (sufficiently active) or do not meet (insufficiently active) the recommendation is needed. This study sought to examine differences in psychosocial responses to arthritis pain among adults who were sufficiently or insufficiently active.

Design: This prospective study included adults with medically diagnosed arthritis (N = 136, M_age = 49.75 ± 13.88 years) who completed two online surveys: (1) baseline: pain and psychosocial responses to pain and (2) two weeks later: physical activity.

Main outcome measures: Psychosocial responses examined in this study were psychological flexibility in response to pain, pain anxiety and maladaptive responses to pain anxiety.

Results: A between-groups MANCOVA comparing sufficiently active (n = 87) to insufficiently active (n = 49) participants on psychosocial responses, after controlling for pain intensity, was significant (p = .005). Follow-up ANOVA’s revealed that sufficiently active participants reported significantly higher psychological flexibility and used maladaptive responses less often compared to insufficiently active participants (p’s < .05).

Conclusions: These findings provide preliminary insight into the psychosocial profile of adults at risk for nonadherence due to their responses to arthritis pain.     

Prevalence,correlates, and psychosocial outcomes of sport participation in young adult cancer survivors

Young adult cancer survivors (YACS) face unique challenges from their disease and treatments that may influence their sport participation choices as well as their psychosocial response.ObjectivesTo examine the prevalence, correlates, and psychosocial outcomes of sport participation in YACS.DesignA provincial, population-based mailed survey of 588 YACS in Alberta, Canada, was completed in May 2008 and included measures of sport participation, psychosocial health (depression, self-esteem, and stress), quality of life (QoL), and medical and demographic variables.ResultsOne third (32.5%) of YACS reported participating in a sport in the past month with the most common being golf (40.8%) and ice hockey (8.3%). YACS participating in sport reported an average frequency of 1.7 (SD = 1.0) days/week and an average duration of 119 min/session (SD = 68) for a total of 189 (SD = 164) min/week. Independent t-tests showed that YACS who participated in sport reported better psychosocial health and QoL including physical QoL (p < 0.001), mental QoL (p < 0.001), self-esteem (p < 0.001), depression (p < 0.001), and stress (p < 0.001). In multivariate regression analysis, 8.5% (p < 0.001) of the variance in sport participation was explained by being male (β = 0.17, p < 0.001), Caucasian (β = 0.15, p = 0.001), in better general health (β = 0.15, p < 0.001), and having a normal body mass index (β = ?0.10, p = 0.024).Discussion/conclusionsSport participation is associated with better psychosocial health and QoL in YACS but only a third participated in the past month. Randomized controlled trials examining sport as an intervention strategy to increase physical activity and improve health outcomes in YACS are warranted.     

Life stress and lymphocyte alterations among patients with rheumatoid arthritis

The relation between life stress and immune parameters was investigated for 33 female rheumatoid arthritis (RA) patients interviewed during three routine monthly clinic checkups. Life stress from major and minor events, coping efficacy, and self-reported psychological distress were assessed, and immunofluorescence of T-cells and B-cells was performed on the blood drawn during each visit. Small stressful events were positively related to the proportion of circulating B-cells, psychological distress was inversely related to proportion of circulating T-cells, and major life events were associated with lower T-helper/T-suppressor cell ratios.     

Assessment of long-term psychosocial sequelae among POW survivors of the Korean Conflict

Psychological and psychiatric assessments were performed among 20 prisoner-of-war (POW) Korean-Conflict survivors. Results revealed extraordinary biological and psychological abuse with weight losses exceeding 35% of preservice weights and long-term cognitive, emotional, and behavioral sequelae. The full range of posttraumatic stress disorder symptoms was seen in 90% to 100% of the cases with high prevalence of co-morbidity, specifically mood (75%), other anxiety (45%), and alcohol abuse (20%) disorders. Documented by clinical investigators at POW release and now more than 30 years later, symptoms of apprehensiveness, confusion, detachment, and depression reflect the persistence of psychiatric morbidity over time.