Sense of coherence and self-sacrificing defense style as predictors of psychological distress and quality of life in rheumatoid arthritis: a 5-year prospective study

Abstract

Individual differences in adjustment during a disease's course determine psychological response and outcome. This study aimed to investigate prospectively whether coping with health stressors and self-sacrificing defense style could predict psychological adjustment and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). Seventy-four consecutive RA patients attending a rheumatology clinic were assessed for psychological distress (SCL-90-R), sense of coherence (SOC scale), self-sacrificing defense style (Defense Style Questionnaire-88), disease activity (DAS-28), pain, disability (Health Assessment Questionnaire) and HRQoL (World Health Organization Quality of Life Instrument, Short Form) at baseline and 5 years later. Multiple regression and moderator analyses were carried out. The results showed that disease activity (p < .001), pain (p = .005), psychological distress (p = .031), social relations HRQoL (p = .042) and environment HRQoL (p = .020) significantly improved over time. SOC was found an independent predictor of improvement in psychological distress (p = .003), overall general health (p = .002) and social relations HRQoL (p = .004); self-sacrificing independently predicted environment HRQoL (p = .042). The self-sacrificing defense style moderated the relationships between improvement in pain and improvement in overall general health (p = .024) and between improvement in pain and improvement in social relations HRQoL (p = .006). These findings indicate that, in RA, SOC predicts improvement in psychological distress and HRQoL over time, while a self-sacrificing defense style moderates the relationship of pain with HRQoL in the long term. These variables may partly explain inter-individual differences in adaptation to RA. Therefore, the design of psychotherapeutic trials targeting the patients' defensive profiles and coping with health stressors capacities is an important research perspective.

Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden

“…None of the age, gender, or SpA subgroups was associated with a transition between the states, whereas self-efficacy was. Findings from patients with rheumatoid arthritis suggest that a sense of coherence is important for improvement in psychological distress (46). This is in accordance with our study, where a better score on self-efficacy at baseline was associated with a better outcome in both anxiety and depression.…”

Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis—an inception cohort study

“…Pain is a debilitating symptom and has been associated with reduced health-related quality of life and increased disability [ 12 , 13 ], and also with future depressive symptoms and work disability [ 14 – 17 ]. In a systematic literature review, the authors report that pain reduction was the most common goal for patients with RA, expressed by 81% of patients [ 18 ].…”

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis

“…Lower income, poorer mental and physical health, and lower life satisfaction and family functioning are also associated with depression in patients with RA (Ho et al, 2011; Treharne et al, 2005). Similarly, factors predicting depressive symptoms include levels of education, symptom severity, lack of emotional support, and emotional coping (Coty and Wallston, 2010; Dobkin et al, 2008; Goulia et al, 2015; Peck et al, 1989; Wolfe and Hawley, 1993). Research suggests that RA patients with greater functional limitations spend more time managing their disease and personal care resulting in increases in depressive symptoms (Katz and Morris, 2007; Serbo and Jajić, 1991).…”