Background Researchers began to unravel the complex interactions between mental and physical health. Some particular feelings (intense emotions) triggered by a chronic disease as rheumatoid arthritis (RA) can induce different types of mood, such as generalized anxiety or stress with possible implications on disease activity and the quality of life HRQoL.
Objectives The aims of the study were to investigate the associations of the intense positive and negative feelings, level of negative affect with aspects of HRQoL and disease activity in RA patients.
Methods 50 patients with RA who met the 2010 ACR/EULAR classification criteria for RA but without an emotional disorder or mental health diagnosis were enrolled in this study. Disease activity was assessed with DAS 28-CRP, and visual analog scale (VAS) for pain. The study used: the Short Form-36 (SF-36), general questionnaire for assessment HRQoL, Depression, Anxiety and Stress Scale (DASS-21R) to measure the three related negative emotional states of depression, anxiety and stress. Both of them were Romanian validated versions of the original questionnaires1,2. Information about positive and negative feelings was collected by open- questions. Pearson correlations were used to verify associations between normally distributed variables, One Way Anova to compare means for different intense feelings and linear regression to identify the predictors for DAS 28-CRP, and components of HRQoL.
Results The response rate was 74%. The study included 89% females, mean age 53.4 ± 13.3 years, mean duration of the disease 10.5 ± 7.1 years, DAS 28-CRP score 4.2 ± 1.1, mean pain score 4.9±2 cm. We found a moderate negative correlation between total DASS-21 scale and mental component score (MCS) of HRQoL (R=-0.428;p=0.007*). Intense feelings in the last month: positive, negative, positive and negative, without feelings are correlate with DAS28 CRP – F (3,35)=5.931, p=0.00. We identified that predictors for DAS 28 CRP are MCS with F(1,37)=13.176, p=0.00 with R2=0.263, and PCS with F(1,37)=16.371, p=0.00 with R2=0.306. The significant predictors for MCS were total DASS-21R score F(1,36)=8.062, p=0.00 with R2=0,183, depression score F(1,37)=4.139, p=0.04 with R2=0,317, anxiety score F(1,36)=6.961, p=0.01 with R2=0,162 and stress score F(1,37)=4.928, p=0.03 with R2=0,118. For PCS the only significant predictor we found was DAS-CRP F(1,37)=16,279, p=0.00 with R2=0,306.
Conclusions The negative affect doesn't impact the disease activity or pain in RA but it influences the mental health component of HRQoL. The experienced intense emotions (feelings) are very important for mental health and also for disease activity in RA and could represent a starting point for further research in orther to avoid bias in clinical trials.
Mihaila V., et al.: General population norms for Romania using the Short Form 36 health survey (SF-36). Quality of Life Newsletter.2001;26:17–18
Lovibond JH, Lovibond PF, Perte A, Albu M. Manual pentru Scala de depresie, anxietate si stress-DASS. Adaptarea si standardizarea pe populatia din Romania, (2011),Ed ASCR,Cluj-Napoca.
Acknowledgement Group of Romanian Person Centered Psychotherapists working with patients with rheumatoid arthritis: Georgeta Niculescu, Anca Gauca, Paul Diaconescu, Nicoleta Stancu
Disclosure of Interest None declared