Occupation as a mediator of depression in people with rheumatoid arthritis

Abstract

In this study we investigate the association between rheumatoid arthritis and depression, and examine if the increase in depression among individuals with rheumatoid arthritis (RA) compared to individuals without RA, is attributable to poor ability to perform important daily occupations. The occupations of work, self care, leisure, rest and sleep were analysed, using regression analyses, to see which predicted depression. The participants were 143 adults with rheumatoid arthritis (RA) and 142 without RA. A daily and hourly record of occupations in which they were engaged was completed for seven days. The amount of time individuals spent in these five occupations, their perceived occupational competence, the value they attached to the occupation and basic demographic information (age, gender, marital status and employment status) were included in the analysis along with their depression score. Occupational competence (time spent in occupation x perceived performance) in work, self care, leisure and sleep was a strong mediator of depression. Having competence in rest was not important nor were any of the demographic variables except employment status. Occupational value (time spent in occupation x perceived value) of the five occupations was not a mediator.

Rheumatoid Arthritis and Self Esteem: The Impact of Quality Occupation

“…Evidence suggesting that individuals with RA experienced occupational limitation is overwhelming (Blalock, Orlando, Mutran, DeVellis & DeVeillis, 1998;Giorgino et al;Katz & Yelin 1994a;MacKinnon, Noh, & Miller, 1998;MacKinnon, 1992;Yelin, Lubeck, Holman, & Epstein, 1998). Furthermore, there is evidence to suggest a strong link between occupational performance and certain aspects of psychological well-being.…”

“…Considerable research attention has focused on the nature and consequences of this chronic illness, with a growing body of literature investigating the psychological well-being of individuals who have RA. To date studies have shown that individuals with RA have higher levels of depression and anxiety (Krol et al, 1993;MacKinnon, Noh, & Miller, 1998;Smedstad, Moum, Vaglum, & Kvien, 1996), both of which were linked with chronic illness in general (Fitzpatrick, Newman, Lamb, & Shipley, 1988;Katz & Yelin, 1994b;Sheasby, Barlow, Cullen, & Wright, 2000) and loss of engagement in valued occupations (Katz & Yelin, 1994a). Evidence examining the presence, level, and consequence of self-esteem has received less attention, especially when considering important aspects of occupational limitations experienced and the impact on the individual living with a chronic illness.…”

Conducting a needs assessment to justify the provision of occupational therapy services in a rheumatology outpatient clinic

“…‘Arthritis is one of the most prevalent chronic health conditions and also the leading cause of physical disability in non‐institutionalised adult populations’ (MacKinnon, Noh & Miller, 1998; p. 82). A health needs study by the North Eastern Health Care Network (1997), of which the ARMC was a part, stated that this clinical group was the most prevalent disabling condition for all age groups over 25 years of age, in the geographical locality.…”

“…(1999) demonstrated that pain levels, physical disability, psychological distress and disease severity can predict the concerns and learning needs of this client group. Furthermore, MacKinnon et al (1998) stated that depression in people with rheumatoid arthritis is associated with the ‘severity or degree of disability, functional loss, pain and occupational deprivation’ (p. 83).…”

The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

“…The stress resulting from the inability to perform simple day to day tasks independently, the associated discomfort and the insult to patient’s aesthetic sensibilities result in high levels of depression in this group; at approximately 20% it is twice that of the general population [ 4 ]. It is well recognised that occupation, including paid employment has a large influence on personal well being and society as a whole [ 5 - 8 ].…”