School of Nursing and Midwifery Research Unit, 1 Norfolk Arthritis Register, Norfolk and Norwich University Hospital NHS Trust, UK School of Medicine Health Policy and Practice and 2 School of Medicine Health Policy and Practice, University of East Anglia, Norwich and 3 Department of Surgical Oncology and Technology, Imperial College London, London, UK.
Correspondence to: J. Ramjeet, School of Nursing and Midwifery Research Unit, Yorkon Building, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK. E-mail: J.Ramjeet{at}uea.ac.uk
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Abstract |
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Methods. One hundred and twelve patients with IP of up to 18 months' duration from the Norfolk Arthritis Register completed questionnaires measuring coping, anxiety, disability and pain.
Results. Thirty-six per cent of the patients were at risk of depressive symptoms. Women had significantly higher levels of depression and anxiety than men. Regression analyses showed that pain and (low) illness acceptance predicted levels of depression. Younger age, wishful thinking and covering up predicted anxiety levels.
Conclusions. The study found higher levels of depression and anxiety for women than men with early IP. Psychological distress was predicted by younger age, specific coping strategies and high levels of pain.
KEY WORDS: Rheumatoid arthritis, Gender, Coping, Psychological adjustment
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Introduction |
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The aim of this study was to examine the role of gender, age and coping in psychological adjustment in a community sample of patients. Specifically, there would be (i) gender differences in levels of depression and anxiety, and (ii) positive correlations between physical and psychological measures. Finally, we explored the extent to which age, gender, and coping strategies would be significant predictors of psychological distress.
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Method |
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Table 1 shows baseline characteristics of the male and female groups.
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Measures
Depression
The Centre for Epidemiological Studies Depression Scale (CES-D) [12] was designed to measure depressive symptomatology in the general population. This measure offers a cut-off point score (16) for risk of depression.
Anxiety
Anxiety was measured by the State-Trait Anxiety Inventory (STAI) [13]. Trait anxiety measures how a person generally feels, and was used as a general indicator of anxiety.
Disability and pain
The Stanford Health Assessment Questionnaire (HAQ) [14] was used to measure disability. A baseline HAQ of >1 is the most important predictor of future disability [10].
Pain was measured with a 101-point visual analogue scale (VAS) [15].
Disease measures
Rheumatoid factor and tender swollen joint count were collected.
Coping with illness
Coping was measured with the London Coping with Arthritis Questionnaire (LCA) [16], designed specifically for RA patients.
Design and statistical analyses
A cross-sectional design was used with an alpha level of 0.05 for all statistical tests. As the CES-D scores were not normally distributed, a square root transformation was applied and the transformed scores were used. The t-test was used to examine gender differences, and correlations with hierarchical linear regression analyses were used to explore relationships between psychological and physical variables.
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Results |
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The overall mean trait anxiety score (STAI) for women was 37.82 (S.D. = 10.38), while men had a mean score of 33.58 (S.D. = 8.32). The t-test demonstrated women also had significantly higher anxiety scores than men (t = 2.14, P<0.05).
There were no significant gender differences in levels of disability or pain.
There were significant positive correlations between variables of pain, disability, anxiety and depression, and between disability, pain and tender/swollen joint count.
Predictors of psychological distress in early IP
Hierarchical regression analyses were performed in order to determine the predictors of depressive symptoms. Sex and age were entered into the regression in step 1, pain and disability were entered in step 2 and then the coping strategies in step 3.
The results indicated that age and gender together accounted for 7.8% of the variance [adjusted R2 = 0.08, F(2, 106) = 5.50, P<0.01]. When pain and disability were added to the model, this accounted for 27.6% of the variance [adjusted R2 = 0.28, F(4, 104) = 11.30, P<0.01] and when coping was entered the whole model accounted for 39% of the total variance [adjusted R2 = 0.39, F(8, 100) = 9.64, P<0.01]. In the final model, pain and the coping strategy of accepting the illness (low) were significant predictors of depression.
A second hierarchical regression analysis was performed to predict levels of trait anxiety. Age and gender together accounted for 16% of the variance in levels of anxiety symptoms [adjusted R2 = 0.16, F(2, 106) = 11.19, P<0.01]. When pain and disability were added, this accounted for 27% of the variance [adjusted R2 = 0.27, F(4, 104) = 10.71, P<0.01]. When coping strategies were entered, the whole model accounted for 38% of the total variance [adjusted R2 = 0.38, F(8.100) = 9.39 P<0.01]. In the final model, (younger) age, wishful thinking and covering up were significant predictors of trait anxiety.
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Discussion |
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The results of the regression analysis indicated that, together with high levels of pain and younger age, specific coping strategies predicted distress. The direction of the relationship is still unclear, however, as the data are cross-sectional.
Possible markers of the presence of anxiety and depression are high levels of disability and pain [18]. When patients present with increased levels of these symptoms, health-care professionals should be alerted to the possibility of concurrent distress.
This study's findings suggest that younger age, passive coping strategies and high levels of pain are risk factors for the presence of distress. For some early IP patients, however, psychological interventions targeting pain and mood may be necessary.
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Acknowledgments |
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D.G.I.S. completed a sponsored talk/meeting and received a grant from Wyeth, Schering Plough and Abbott (manufacturer of biological treatment for RA). No other conflict of interest has been declared by the other authors.
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References |
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