Search

The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic disease. The authors propose 3 generic illness cognitions that reflect different ways of reevaluating the inherently aversive character of a chronic condition: helplessness as a way of emphasizing the aversive meaning of the disease, acceptance as a way to diminish the aversive meaning, and perceived benefits as a way of adding a positive meaning to the disease. A self-report instrument, the Illness Cognition Questionnaire, was developed to assess these cognitions across different chronic diseases. The results support the reliable and valid assessment of these illness cognitions in patients with rheumatoid arthritis and multiple sclerosis and indicate the maladaptive function of helplessness and the adaptive function of acceptance and perceived benefits for the long-term physical and psychological health of patients with a chronic disease

Two multidimensional health status instruments of rheumatic diseases, the Dutch-AIMS2 and the IRGL (Impact of Rheumatic diseases on General health and Lifestyle), were compared in a sample of 284 rheumatoid arthritis patients with regard to their measurement properties and usefulness for research purposes. Both questionnaires showed an excellent reliability (Cronbach's alpha), and were highly comparable with regard to their construct and convergent validity. Second-order factor analysis confirmed the physical, psychological and social health dimensions for both questionnaires. The comparability between the instruments was established by high intercorrelations between the physical and psychological health dimensions. Sufficient convergent validity was indicated by the strong correlations between the physical functioning scales and clinical and laboratory measures. The main differences between both questionnaires relate to their length and emphasis on health aspects. The Dutch-AIMS2 is characterized by a more extensive assessment of the physical dimension and the additional measurement of general health aspects. The shorter IRGL exclusively assesses the main health dimensions with a more comprehensive measurement of the psychological and social dimensions. The instrument that reflects the subject in question most adequately should be chosen

To determine if social support and the reaction of the spouse to the patient's pain are contributing factors to psychological distress in male and female patients with rheumatoid arthritis (RA). Physical, social, and psychological aspects of health were assessed in 97 male and 132 female patients who were living with a spouse. Differences between male and female patients were analyzed by means of analysis of covariance while controlling for age and duration of RA. In multiple regression analyses the influence of social support and reaction of the spouse concerning psychological distress was determined after age, duration of RA, and physical functioning had been controlled. Criticism of the spouse significantly contributed to anxiety in male patients and to depression and anxiety in female patients. In addition, male and female patients differed in the social support resources that contributed to psychological distress. A relatively low number of friends was associated with depression in males. A relatively low level of potential support was associated with more anxiety in females. High levels of criticism of the spouse and low levels of social support are associated with more psychological distress in male and female patients. The number of friends is a social support resource in male patients and potential emotional support a resource in female patients

The association between self-report physical disability scores and psychological well being in patients with rheumatoid arthritis (RA) has been described in several recent publications on patients with widely varying disease durations. We describe the results of a study into these relationships in patients with RA with a disease duration of less than 1 year. In this cross sectional study on 113 patients with recent onset RA disability was assessed with 3 self-report indices and with measurement of grip strength. Correlation coefficients between disability measures and disease activity measures (joint tenderness/swelling score, erythrocyte sedimentation rate [ESR)]), psychological well being (cheerful mood, depressive mood, and anxiety), and demographical variables were calculated; hierarchical regression analysis was done with disability measures as the dependent variables. All disability scales were correlated moderately strongly with the joint score and ESR, and with psychological well being. No relation was found with age, sex, marital status, or rheumatoid factor status. Regression analysis showed the variance of 9-15% in disability could be explained by psychological well being after disease activity had been controlled for. Patients with recent onset RA appear not to be obviously different with respect to the moderately strong association between physical disability and psychological well being from patients with RA of longer duration in other published reports

Health status encompasses not only physical aspects, but also psychological and social aspects. A multidimensional health status questionnaire was used in 69 Dutch patients with rheumatoid arthritis to assess their physical, psychological and social well being. The same day clinical and laboratory data were recorded. The health status questionnaire provided additional information to clinical and laboratory findings. The various clinical and laboratory measures of disease activity reflect aspects other than the self-reported measure of physical well being. As such they are not interchangeable. Furthermore clinical and laboratory measures of physical well being appeared to be unrelated with psychological and social measures. In contrast, the patients' self-report of physical well being was related only with depressive mood and to some extent with anxiety