Background Rheumatoid Arthritis (RA) is associated with negative psychological outcomes, including depression. Denial is a coping strategy in stressful situations, with well-documented impact on psychological and physical outcome, but has been little studied in RA.
Objectives To investigate several psychological, social, demographic, and physical factors as predictors of the use denial as a coping strategy in RA.
Methods Patients:118 hospital outpatients with early RA (4 years; N = 84). Denial: Reaction to Impairment and Disability Inventory (RIDI). Other assessments: Age, Sex, VAS for Pain and Fatigue, Arthritis Self-Efficacy Scale (ASES), Patient Knowledge Questionnaire (PKQ), Social Support Survey (SSS), Health Assessment Questionnaire (HAQ). Statistics: Principal component analysis (to examine factor structure of Denial questions); hierarchical multiple regression (to determine predictors of Denial).
Results Three denial factors with eigenvalues >1 were extracted: “Future Denial” (3 items; 33% of variance), “Conditional Improvement” (3 items; 22% of variance), and “Present Denial” (1 item; 16% of variance). The Future Denial subscale had good internal consistency (alpha = 0.83 compared to alpha = 0.47 for Conditional Improvement). Early RA and being single were the only significant predictors of Future Denial. Better functional ability was the only predictor of Present Denial. No factors predicted the use of Conditional Improvement.
Conclusion Aspects of denial, particularly Future Denial, may be utilised in the early stages of RA, mainly by those without a partner to rely upon, as a coping strategy to “buy time” in order to come to terms with actual and potential disease impact. Patients who report better functional ability may also be denying current loss of ability; this raises questions about the beneficial nature of self-deceptive attitudes in RA patients and may be clarified by a longitudinal study. Denial should be taken into account when assessing both physical and psychosocial outcomes in RA.
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