The effects of coping, social support, attribution and cognitive illness representation on outcome measures of pain, disability and psychological well-being in rheumatoid arthritis patients.

Abstract

This study investigates the psychosocial aspects of rheumatoid arthritis (RA),a chronic debilitating disease. It explores the quality of life in a low socio-economic group of clinic-based adult RA patients. The aims of the study were as follows: (1) to assess the impact of both socio-demographic and psychosocial factors on RA health outcome, (2) to develop a multivariate, predictive model for RA, and (3) to assess the moderating role (or stress-reducing function) of psychosocial factors between the objective experience of RA and the subjective experience of RA. A sample of 186 RA patients with a mean age of 49.51 years and a mean duration of RA of 10.80 years were subjected to a series of selfadministering questionnaires to assess their subjective experience of the disease. Coping, social support, causal attribution, cognitive illness representation, pain and functional status were assessed. The objective experience of RA was based on those health status measures that included the following: firstly, ESR levels (a laboratory measure), and secondly, class (classified level of disability) and joint status (severity of joint inflammation) which were assessed and recorded by the rheumatologist. The data obtained were subjected to a systematic statistical analysis to assess the following: (1) the relationships between the socio-demographic factors, psychosocial factors and factors representing RA health outcome using correlational analysis (Pearson r), (2) the value of socio-demograhic and psychosocial factors in predicting subjective and objective RA health outcomes using step-wise hierarchical multivariate regression analysis, and (3) the moderating or stress-reducing effect of psychosocial factors between the objective and subjective health status measures using moderated regression analysis. Findings revealed that psychological factors, especially coping, were more significant predictors than socio demographic factors of RA health outcome (quality of life of RA individuals). Furthermore, the psychosocial factors coping, network social support, helplessness and causal attribution were found to play a moderating role in RA health outcome. The results of the study confirm both the health-sustaining and the stress-reducing function of psychological factors. Theoretically this study is located within the stress and coping paradigm of Lazarus and Folkman (1984).