Original articles
Depression, illness perception and coping in rheumatoid arthritis

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Abstract

This study aimed to establish the relationship between depression, illness perception, coping strategies, and adverse childhood events in rheumatoid arthritis patients. Sixty-two out-patients with rheumatoid arthritis (RA) completed the Hospital Anxiety and Depression Scale, Illness Perception Questionnaire, London Coping with Rheumatoid Arthritis Questionnaire, and Childhood Development Questionnaire, and underwent a clinical assessment of their physical state. Depressed patients were more disabled than the nondepressed, had a more negative view of their illness, and used more negative coping strategies. There was no association between depression and childhood adversity. Once disability was controlled for, there continued to be a significant correlation between depression and: (i) viewing the consequences of the illness negatively (Spearman’s correlation coefficient r=0.37, p=0.003); and (ii) the perceived ability to control the illness (r=−0.26, p=0.04). The relationship between depression and negative coping strategies became insignificant. This study indicates the close relationship between depression and a negative view of the illness.

Introduction

In recent years there has been a growing trend to explore the psychological features of patients who suffer from rheumatoid arthritis (RA). Anxiety and depression are the most frequently measured variables. Using semistandardized psychiatric interviews, the prevalence of depression in subjects with RA has been found to be between 12.5% and 25% [1]. Such prevalence rates of depression are consistent with rates of depression among other chronic illness populations 2, 3, and are higher than that found among the general population.

The etiology of depression in RA is complex. When depression is measured by semistandardized interview, there is little evidence of a direct relationship between markers of the severity of arthritis and the extent of depression 4, 5. Social factors such as isolation and conflict have been shown to predict depression in this group of patients 2, 6, 7. Cognitive variables are also likely to be important in determining the mood of RA patients. Subjective illness representations, based on implicit, common-sense beliefs, may influence psychological well-being and an individual’s ability to cope [8]. Negative or maladaptive coping strategies (e.g., self-blame and avoidance) have been associated with depression in RA patients [9], whereas positive or adaptive coping styles are associated with improved well-being 10, 11.

Many of the etiological factors for depression in RA are likely to be interrelated in a complex fashion. In addition, it is likely that there are possible uninvestigated confounding variables that independently predict these etiological variables. An example of this might be childhood experiences that independently predict vulnerability to depression in adult life [12], but that also predict adult illness behaviors, thus influencing how individuals adapt to being ill 13, 14. With respect to arthritis this is a subject that has been little explored.

This study examines the relationship between depression, illness perception, and the effects of coping in a population of out-patients with RA. In addition, the role of adverse experiences in childhood in predicting depression in this group is investigated. Specifically, we hypothesize that, in patients with rheumatoid arthritis, depression is correlated with: (i) a negative perception of their illness, that is, it is more serious/has a greater influence on their life; (ii) a reduced ability to cope; and (iii) more adverse experiences in childhood.

Section snippets

Study population

Consecutive patients with rheumatoid arthritis (RA), according to the American Rheumatism Association criteria [15], attending two rheumatology out-patient clinics in teaching hospitals were studied. All subjects were between 18 and 80 years of age.

Subjects were excluded if they were considered to have significant other major illness, to increase the homogeneity of the group.

Assessments

Potentially suitable subjects were identified by examination of their clinic notes prior to their attendance in

Results

Seventy-two eligible subjects with RA (ARA criteria) were initially approached. Two subjects refused consent and eight did not complete/return their questionnaires fully despite remailing. Analysis was thus performed on 62 subjects (86% of those approached). Forty-six consecutive cases were recruited from one clinic and 16 from the other.

Fifty-two patients were female and 10 were male. The median age was 59.5 years (interquartile range [IQR]=50.75–68). The great majority of subjects had

Discussion

The main finding of the study is the clear association between depression and illness perception. Components of illness perception that correlate most strongly with depression are consequence, indicating patients view their illness as serious, and control/cure, indicating they feel they have little control over their illness. The relationship between these components of illness perception and depression is evident even when disability is controlled for. The association between the control/cure

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