Psychological adjustment and systemic lupus erythematosus : a comparative study

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology. Its affects multiple organ systems and is characterised by periods of disease activity and remission. The unpredictable course, treatment and symptomatology of SLE can impact upon the social and personal resources of sufferers. Social resources are those variables influenced by external events, they include stress, uplifts, social support and social networks. Personal resources are mediated more by individuals' perceptions and include self‚ÄövÑvÆefficacy and coping (problem‚ÄövÑvÆ and emotion‚ÄövÑvÆfocused). Deteriorations in social and personal resources accompanying chronic illness suggest a Disease Exacerbation Model. This model proposes that the course of chronic illness is mediated by decrements in social and personal resources which, in turn, influence disease outcomes such as physical disability, psychosocial disruption and psychological distress. The present investigation used a comparative design to test the Disease Exacerbation Model. The participants in the study were 34 individuals with a diagnosis of SLE, 37 multiple sclerosis (MS) sufferers and 38 people without a history of chronic illness. The control group was matched to the chronic illness groups for age, marital status, gender and socioeconomic status. Data were collected by using standardised psychological questionnaires. These included measures of stress, hassles, social network, social support, self-efficacy, coping, psychological distress, physical disability and psychosocial disruption. Individuals with SLE and a chronic illness comparison group (MS) reported significantly fewer uplifts, less social support, more emotion‚ÄövÑvÆfocused coping, as well as greater disability, distress and psychological disruption when compared with healthy people. There were, however, no significant decrements in network size or problem‚ÄövÑvÆfocused coping and no significant increases in hassles. Except for the MS group reporting significantly more disability than SLE sufferers, no other differences were evident between the chronic illness groups. The correlations between social, personal and disease outcome measures suggest that group differences may involve somewhat different underlying processes. For example, social support mediated psychological distress for SLE sufferers, but not for the MS group. To determine which social and personal resource variables are most salient to disease outcome, stepwise multiple regression analyses were performed. For SLE sufferers, increasing hassles and fewer uplifts were associated with elevated psychological distress. Although higher hassle levels and decreasing social support were both correlated with more psychosocial disruption, in the stepwise regression only hassles significantly predicted this disease outcome. Physical disability levels were not significantly related to any social or personal resource measures.