Abstract
We aimed at analyzing important predictive factors for experienced negative emotional and social effects of rheumatoid arthritis (RA) two years after diagnosis in patients aged 18–65 years. The first group included 41 participants, who had psychosocial problems (PSP) already at diagnosis, and who received an intervention by a medical social worker to improve coping capacity and social situation. The second group included 54 patients (NPSP) without such problems at diagnosis. All completed a questionnaire mapping their social situation, the Hospital Anxiety and Depression Scale (HADS), the Sense of Coherence Scale (SOC) and the General Coping Questionnaire (GCQ) at diagnosis and after 24 months. The most pronounced predictive factor for a strong impact of the disease was high scores on HADS depression scale. After 24 months, PSP participants had a more strained life situation, with higher scores on anxiety and depression and lower on SOC, in comparison with NPSP. NPSP participants improved their coping strategies regarding self-trust, cognitive revaluation, protest and intrusion, but deteriorated regarding problem focusing and social trust. PSP patients kept their initial coping strategies, except for intrusion decreasing over time, and seemed to have a more rigid coping pattern. However, the experienced negative impact of the disease increased over time in both groups despite improvement in sickness related data. Mostly influenced areas were economy, leisure time activities and social life. We conclude that psychosocial consequences of RA are more connected to emotional and social vulnerability than are RA-related clinical factors.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-118) contains supplementary material, which is available to authorized users.
Highlights
Rheumatoid arthritis (RA) is a common chronic disorder, affecting nearly 0.5% of the Swedish population (Simonsson et al 1999), with an estimated annual incidence among women at 0.29‰ vs. 0.18‰ among men (Soderlin et al 2002)
The differences in social situation between psychosocial problems (PSP) and no pronounced psychosocial problems (NPSP) patients were unchanged from baseline to follow-up, i.e. the PSP patients were younger, more often unmarried, divorced, or widowed, more often reported a strained financial situation, and more often were on longterm sick-leave or early retirement pension
We found that having higher scores on Hospital Anxiety and Depression Scale (HADS) depression was the only statistically significant predictor of perceived negative effects 24 months after diagnosis, being a consistent finding after adjustment and seemingly robust
Summary
Rheumatoid arthritis (RA) is a common chronic disorder, affecting nearly 0.5% of the Swedish population (Simonsson et al 1999), with an estimated annual incidence among women at 0.29‰ vs. 0.18‰ among men (Soderlin et al 2002). Studies have shown that patients with RA using passive coping strategies are at risk of developing psychological co-morbidity (Treharne et al 2007), and to have more pain (Covic et al 2000). In general it is unclear which coping strategies leads to psychological distress in later in the course of RA (Vriezekolk et al 2011). Another concept related to coping is “Sense of coherence” (SOC) (Antonovsky 1993), focusing on health-preserving factors in counteracting negative consequences of psychosocial stress (Schnyder et al 1999). Protective factors measured by the scale are comprehensiveness, meaningfulness, manageability, and resistance resources
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