Work disability and the experience of pain and depression in rheumatoid arthritis

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Abstract

People with rheumatoid arthritis (RA) who are work disabled report more pain and depression than do those who are able to continue in paid employment. This paper explores the connections between work ability, clinical disease factors and symptom reports among people with this chronic disease. Using the expanded Biopsychosocial model of disease and illness it is shown that both work ability and clinical factors have independent, additive effects on pain and depression. The paid work effect is found even after controlling for the large and significant effect of pain on depression and depression on pain. This suggests that the pain and depression experience associated with RA is a function of both the underlying disease and the structural barriers that prevent continued participation in the workplace. It also suggests that contrary to popular notions of how disease severity affects symptoms, one does not have to be in the highest categories of disease severity to be in the highest levels of depression and/or pain.

References (65)

  • L. Eisenberg

    Psychiatry and society: a sociobiological synthesis

    N. Engl. J. Med.

    (1977)
  • H. Fabrega

    The need for an ethnomedical science

    Science

    (1975)
  • H. Fabrega

    The position of psychiatry in the understanding of human disease

    Archs gen. Psychiat.

    (1975)
  • A. Young

    The anthropologies of illness and sickness

    Ann. Rev. Anthropol.

    (1982)
  • A. Young

    Rational men and the explanatory model approach

    Cult. Med. Psychiat.

    (1982)
  • A. Kleinman

    Editor's note

    Cult. Med. Psychiat.

    (1983)
  • A. Kleinman

    The Illness Narratives

    (1988)
  • A. Kleinman et al.

    Culture and Depression

    (1985)
  • L.E. Kazis et al.

    Pain in the rheumatic diseases

    Arthritis Rheum.

    (1983)
  • H. Flor et al.

    Chronic back pain and rheumatoid arthritis: predicting pain and disability from cognitive variables

    J. Behav. Med.

    (1988)
  • J. Parker et al.

    Pain in rheumatoid arthritis: relationship to demographic, medical, and psychological factors

    J. Rheumatol.

    (1988)
  • R.F. Meenan et al.

    Outcome assessment in clinical trials

    Arthritis Rheum.

    (1984)
  • Mechanic D. and Angel R.J. Some Factors Associated with the Report and Evaluation of Back Pain. J. Hlth Soc. Behav.28,...
  • K.O. Anderson et al.

    Rheumatoid Arthritis: Review of psychological factors related to etiology, effects and treatment

    Psychol. Bull.

    (1985)
  • D.J. Hawley et al.

    Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients

    J. Rheumatol.

    (1988)
  • R.G. Frank et al.

    Depression in rheumatoid arthritis

    J. Rheumatol.

    (1988)
  • H. Moldofsky et al.

    Pain and mood patterns in patients with rheumatoid arthritis

    Psychosom. Med.

    (1970)
  • K.G. Kramlinger et al.

    Are patients with chronic pain depressed?

    Am. J. Psychiat.

    (1983)
  • R.F. DeVellis et al.

    Predictors and pain and functioning in arthritis

    Hlth Educ. Res.

    (1986)
  • S.J. Blalock et al.

    Self-evaluation processes and adjustment to rheumatoid arthritis

    Arthritis Rheum.

    (1988)
  • D. Coburn

    Job alienation and well-being

    Int. J. Hlth Serv.

    (1979)
  • H.M. Brenner

    Mental Illness and the Economy

    (1973)

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