Background Previous research has suggested that disability benefit claimants with rheumatic diseases may feel helpless with regard to their disease (1). Also, health care and vocational professionals often encounter claimants who feel victimized and experience a sense of resentment and injustice (2). Helplessness may contribute to this latter condition termed embitterment (3). It is important to know what other factors possibly contribute to the development of this disabling condition. Embitterment is triggered by situations that violate the basic belief that one is worthy of consideration and respect (4), and illness invalidation by colleagues and superiors at work is one such experience that patients with rheumatic diseases regularly face (5).
Objectives Our objective was to examine in patients with rheumatic diseases after a disability benefit examination (a) the prevalence of helplessness and embitterment and (b) the association of helplessness and invalidation at work with embitterment.
Methods A survey containing questionnaires for helplessness, embitterment, and illness invalidation at work was completed by 501 claimants who had recently (9 to 12 weeks) received the result of a disability benefit examination. Diagnoses were: fibromyalgia (n=98), rheumatoid arthritis (n=43), osteoarthritis (n=136), another rheumatic disease (n=50), and multiple rheumatic diseases (n=168).
Results Patient groups had similar levels of helplessness (p =.94) and embitterment (p =.78), with 17 to 26 percent of patients having high levels of embitterment. Helplessness (p <.001) and embitterment (p <.01) were high in comparison to working reference patients not having a disability benefit examination. Male gender (p =.04), helplessness (p <.001), the two invalidation aspects discounting and lack of understanding (p <.001), and the combinations of helplessness with these invalidation aspects (p <.01) were predictive of more embitterment.
Conclusions Our results suggest that helplessness and embitterment are high in disability benefit claimants with a rheumatic disease, which is problematic insofar as it limits well-being, functioning and potential to overcome the challenges of work disability. To the extent that helplessness and invalidation at work are determinants of embitterment, interventions targeting helplessness and invalidation might reduce embitterment.
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Disclosure of Interest None Declared
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