Health and/or absence of disease are complex concepts that are dynamic across time and cultures. The well known definition of health by the WHO is currently debated and new definitions are being proposed. Notwithstanding, the WHO’s ICF framework of health, which endorses the biopsychosocial model of health, is universally accepted. It recognizes that the impact of ‘disease’ on body functions and structures, activities and participation in social roles is in continuous interaction with the context in which the person lives, being the environment and the person himself. In the ICF model, a distinction is made between mental functions (that comprise also psycho-social and personality functions) which belong the body functions and which can be disturbed/limited as a direct consequence of the disease and the personal factors, which belong to the contextual part and which are traits or scene setters that make humans to differ from each other but are not a consequence of disease. Examples of limitations in mental functions as a consequence of disease are depression, anxiety, experience of self. Examples of personal factors are level of level of literacy, optimism, illness perceptions, coping strategies, adaptability. For both the mental functions as well as the personal factors the ICF offers a classification. In line with the concept of the ICF, mental functions and personal factors continuously interact with each other and on their turn they interact with other activities and with participation. More specific frameworks to understand the impact of personal traits are available and can help to prove or falsify hypotheses on the way an individual’s personality can be mediate the relation between disease and experienced health.
While the discussion on the definitions and relations between mental/psychological functions and personal factors remain, there is increasing evidence of the role of personal factors and health outcome. Especially the role of gender, education, illness perceptions, coping strategies has been repeatedly confirmed in relation to mental and physical health, social roles (especially work participation) and health care utilization. While some of these factors cannot be modified, some of them are potentially modifiable and receive increasing attention in education and self-management programs. Another interesting and important field of research is the role psychological factors play in reference shift that is typical for patients with chronic diseases. Finally, more and more attention is given to personal factors as a cause of inequalities and even inequities in health, such as for example the reduced access to hip fracture of persons of Afro-American origin in the USA.
While in rheumatology high level of effort has been done into to selection of domains to assess ‘biomedical outcomes’ and in validation of the measure that assess these domains, such efforts are mainly lacking with regard to selection and assessment of psychological and personal factors. It would be nice when attendees of the session could join efforts on this interesting but also important issue.
Disclosure of Interest None Declared
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