Arthritis and perceptions of quality of life: an examination of positive and negative affect in rheumatoid arthritis patients

Coping and Life Satisfaction: Mediating Role of Ego-Resiliency in Patients with Rheumatoid Arthritis

OBJECTIVE

Ego-resiliency is attributed the status of a "meta resource" that is responsible for a flexible selection of coping strategies depending on the requirements of a specific difficult situation. A considerably burdensome critical life event is the development of a chronic illness such as rheumatoid arthritis (RA). Apart from coping with the symptoms, a fundamental task confronting patients is maintaining their quality of life. This raises the question of whether ego-resiliency serves as a mediator between coping strategies and quality of life.

MATERIALS AND METHODS

210 RA patients were invited to participate in this study. They were requested to complete a questionnaire that included the Satisfaction with Life scale, the stress coping inventory Mini-COPE, and the Ego-Resiliency scale. The collected data were analyzed by a simple mediation procedure and estimation of simple correlation coefficients.

RESULTS

The analysis demonstrated that ego-resiliency (r = 0.46; p < 0.001) and emotion-focused coping (r = 0.39; p < 0.001) determined life satisfaction. Additionally, ego-resiliency mediated the relation between emotion-oriented coping strategies and life satisfaction. Partial mediation was observed (a = 0.45**; b = 0.36**; c = 0.39**; c' =0.22**; R2 = 0.24; F = 35.65; p < 0.001).

CONCLUSION

Our observations partly support the assumption about a controlling role of ego-resiliency in the process of selecting coping strategies according to demands of situations.

Affect and Incident Participation Restriction in Adults With Knee Osteoarthritis

OBJECTIVE

Participation restriction, common among people with knee osteoarthritis (OA), may be influenced by affect. We examined the risk of incident participation restriction over 84 months conferred by positive and negative affect among people with knee OA.

METHODS

Participants were from the Multicenter Osteoarthritis Study and had or were at high risk of knee OA. Participation restriction was measured using the Instrumental Role Limitation subscale of the Late-Life Disability Index, and affect was measured using the positive affect and depressed mood subscales of the Center for Epidemiologic Studies Depression Scale. Robust Poisson regression was used to calculate the risk of incident participation restriction over 84 months conferred by combinations of low and high positive and negative affect, adjusting for covariates.

RESULTS

Of 1,810 baseline participants (mean age 62.1 years, 56% female), 470 (26%) had incident participation restriction over 84 months. Participants with low positive affect had 20% greater risk of incident participation restriction than those with high positive affect; participants with high negative affect had 50% greater risk of incident participation restriction compared to those with low negative affect. Participants with both low positive and high negative affect had 80% greater risk of incident participation restriction compared to other combinations of positive and negative affect.

CONCLUSION

Low positive and high negative affect, both alone and in combination, increase the risk of participation restriction among adults with knee OA. Efforts aimed at preventing participation restriction in this population should consider these mood states.

The buffering role of positive affect on the association between pain intensity and pain related outcomes

Objectives

Chronic pain is a significant problem worldwide and is associated with significant elevations in negative affect, depressive symptoms, sleep problems, and physical dysfunction. Positive affect could potentially buffer the impact of pain on patient functioning. If it does, then positive affect could be directly targeted in treatment to benefit individuals with chronic pain. The purpose of this study was to test for such moderating effects.

Methods

This was a cross-sectional study, we administered measures of pain intensity, depressive symptoms, sleep problems, pain interference, and positive and negative affect to 100 individuals with chronic back or knee pain in a single face-to-face assessment session.

Results

The associations between pain intensity and negative affect, and between pain intensity and depressive symptoms were moderated by positive affect. This moderation effect was explained by the fact that participants with low positive affect evidenced strong associations between pain intensity and both depression and negative affect; participants with high positive affect, on the other hand, evidenced weak and non-significant associations between pain intensity and both depression and negative affect. Positive affect did not moderate the associations between pain intensity and either sleep problems or pain interference.

Conclusion

The findings are consistent with the possibility that positive affect may buffer the impact of pain intensity on negative affect and depressive symptoms. Longitudinal and experimental research is needed to determine the potential benefits of treatments that increase positive affect on negative affect and depressive symptoms in chronic pain populations.

Implications

The study findings suggest the possibility that “positive psychology” interventions which increase positive affect could benefit individuals with chronic pain by reducing the impact of pain on negative outcomes. Research to test this possibility is warranted.

Updating Theory on Organizational Stress: the Asynchronous Multiple Overlapping Change (AMOC) Model of Workplace Stress

This article examines the plausible interactions and ramifications of chronic and acute stressors in the workplace. Our position is that current organizational change and work stress models inadequately address the subjective experience of employees. We use existing physiological adaptation paradigms as starting points to illuminate the psychological responses to multiple and simultaneous environmental demands. A new framework is developed, the Asynchronous Multiple Overlapping Change (AMOC) model, to account for the complexity of contemporary work settings. We suggest that the net effect of employee response to continuous major and minor organizational changes is a primary contributor to employee resistance to change: The cumulative impact of multiple and sometimes conflicting change initiatives eventually overwhelms cognitive appraisal and coping mechanisms. Other theoretical, empirical, and practical implications of the proposed framework are also discussed.

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.

Predicting Pain and Adjustment in Rheumatoid Arthritis

The role of disclosure and emotional processing of stressful life events has not been studied in chronically ill populations. We attempted to predict the pain, physical dysfunction, and affective disturbance of 82 patients with rheumatoid arthritis (RA) from their life stress and from various measures of emotional processing: disclosure to others and thought frequency about stressful events, positive and negative emotional expression, ambivalence about emotional expression and secrecy. After controlling for demographics (gender, race, education, disability status), disease measures (duration of diagnosis, objective disease activity), and life stress, we found that pain was related to an increased expression of negative emotion; physical dysfunction was related to an increased frequency of thinking about stressful events; and affective disturbance was related to both increased ambivalence about emotional expression and increased thought frequency. We conclude that RA pain and adjustment are better predicted by emotional processing of stressful life events—including disclosure to others and emotional expression—than by the experience of stressful events, per se.

Older American Indians' Perspectives on Health, Arthritis, and Physical Activity: Implications for Adapting Evidence-Based Interventions, Oregon, 2013

Introduction

Despite the high prevalence of arthritis and physical disability among older American Indians, few evidence-based interventions that improve arthritis self-management via physical activity have been adapted for use in this population. The purpose of this study was to identify beliefs about health, arthritis, and physical activity among older American Indians living in a rural area in Oregon to help select and adapt an arthritis self-management program.

Methods

In partnership with a tribal health program, we conducted surveys, a focus group, and individual interviews with older American Indians with arthritis. Our sample comprised 6 focus group participants and 18 interviewees. The 24 participants were aged 48 to 82 years, of whom 67% were women. Forms B and C of the Multidimensional Health Locus of Control (MHLC) instrument, modified for arthritis, measured MHLC.

Results

The concepts of health, arthritis, and physical activity overlapped in that health was a holistic concept informed by cultural teachings that included living a healthy lifestyle, socializing, and being functionally independent. Arthritis inhibited health and healthy behaviors. Participants identified barriers such as unreliable transportation and recruiting challenges that would make existing interventions challenging to implement in this setting. The Doctor subscale had the highest MHLC (mean = 4.4 [standard deviation (SD), 1.0]), followed by the Internal subscale (3.9 [SD, 1.4]) and the Other People subscale (2.8 [SD, 1.1]).

Conclusions

Existing evidence-based programs for arthritis should be adapted to address implementation factors, such as access to transportation, and incorporate cultural values that emphasize holistic wellness and social interconnectedness. Culturally sensitive programs that build on indigenous values and practices to promote active coping strategies for older American Indians with arthritis are needed.

The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review

AIM

This systematic review examines how specific coping strategies are associated with psychological and physical outcomes in rheumatoid arthritis.

BACKGROUND AND METHODS

Rheumatoid arthritis is a long-term condition that people cope with but it is unclear whether specific coping strategies have an effect on mood and function. Therefore a systematic review was undertaken of the coping with arthritis literature and 174 studies were initially included. Further examination determined that 31 studies (11 longitudinal and 20 cross sectional) were finally included in the review. The 31 studies were clinically and methodologically diverse; therefore the analysis of results was a qualitative synthesis. Coping strategies that contributed to the prediction of outcomes were allocated to a new structure for the classification of coping.

RESULTS

The results demonstrated there was not sufficient, consistent evidence to support the overall view that individual coping strategies contributed to longitudinal outcomes in rheumatoid arthritis. However, major differences in the design of included studies may have hindered the comparison of results. There was some evidence from longitudinal studies that patients who used resting, inactivity, etc. (helplessness category) experienced negative outcomes. Avoidance (escape) was the most common overall category associated with predominantly negative outcomes in both cross-sectional and longitudinal studies.

CONCLUSIONS

There was generally limited evidence to suggest an association between coping strategies and outcomes but the design of studies and the lack of clarity about coping strategies were identified as problems. This study used a new framework for the conceptualisation of coping strategies, thus contributing to further examining the utility of coping strategies and contributing to their redefinition.

RELEVANCE TO CLINICAL PRACTICE

The use of helplessness (inactivity and passive coping) and escape/avoidant coping strategies, including denial and wishful thinking, could be identified and addressed by nurses and other health professionals to reduce the associated negative outcomes.

The role of positive affect in pain and its treatment

OBJECTIVE

This narrative review summarizes and integrates the available literature on positive affect (PA) and pain to: (1) provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and pain; (2) provide a theoretical foundation from which to understand how PA operates in the context of chronic pain (CP); and (3) highlight how the prevailing psychosocial treatments for CP address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with CP.

RESULTS

In experimental studies, the evidence suggests PA is analgesic. In clinical studies, the association of PA and pain is dynamic, time variant, and may be best considered in context of its interacting role with negative affect.

DISCUSSION

We offer an "upward spiral" model of PA, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance CP self-management.

The making of expert patients: the role of online health communities in arthritis self-management

Chronic disease is an epidemic, one that requires patients to play an active role in managing symptoms and disease affect. This study used ethnomethodology (N = 8231) to understand how patients with arthritis use online health communities to exchange disease-related information to better manage their chronic disease. The findings show that online health communities facilitate self-management behaviors through the exchange of health information and disease experience. These online health communities act as self-management programs led by peers with the same chronic disease through the exchange of health information based on experience, working to improve members' health literacy related to arthritis.

Affect mediates the association between mental adjustment styles and quality of life among Chinese cancer survivors

This study examined the association between mental adjustment styles and quality of life, and affect as a mediator among 238 Chinese cancer survivors. Regression analysis showed that quality of life was positively associated with fighting spirit and negatively associated with fatalism. Path analysis showed that greater fighting spirit was associated with more positive affect, which in turn was associated with higher quality of life. Greater fatalism was associated with less positive affect and more negative affect, which in turn was associated with lower quality of life. Findings suggest that positive affect and negative affect are important in understanding mental adjustment styles and its health implications.

Massage on experimental pain in healthy females: A randomized controlled trial

This randomized controlled study evaluated the effect of massage on affect, relaxation, and experimental pain induced by electrical stimulation. Participants were 96 healthy women ( M age = 20.13 ± 5.93 years; 84.4% White) randomly assigned to a 15-minute no-treatment control, guided imagery, massage or massage plus guided imagery condition. Multilevel piecewise modeling revealed no group differences in pain intensity, threshold, or tolerance. The two massage conditions generally reported decreased pain unpleasantness, lower unpleasant affect, maintenance of pleasant affect, and increased relaxation compared to the no-treatment condition. The results suggest that massage may alter immediate affective qualities in the context of pain.

Affect balance style, experimental pain sensitivity, and pain-related responses

OBJECTIVES

Affect is neurobiologically based, influences emotions, contributes to temperamental characteristics, and can be evaluated from both state and trait perspectives. Associations between state-related positive affect (PA), negative affect (NA), and chronic pain have been investigated. However, little is known about the relationship between trait affect patterns and pain-related experiences. Affect balance style (ABS) provides a framework to assess the combined contribution of trait PA and NA. Psychological factors and experimental pain sensitivity are indicated as predictors of chronic pain onset. The current study investigated the relationship between ABS, pain sensitivity, and pain-related measures in healthy adults.

METHODS

Participants (n=372) completed quantitative sensory testing, pain-related questionnaires, and the Positive and Negative Affect Scale. ABS groups were categorized as Healthy (high PA, low NA), Low (low PA, low NA), Depressive (low PA, high NA), and Reactive (high PA, high NA). Z-scores were computed for 3 experimental pain measures: ischemic, pressure, and heat.

RESULTS

ABS groups significantly differed on ischemic pain sensitivity and pain-related measures. Specifically, the Healthy group demonstrated lower ischemic pain sensitivity compared with the Reactive group (P=0.02); the Depressive and Reactive groups endorsed higher somatic symptoms compared with the Healthy group (P<0.02); the Low and Depressive groups reported more physical stimuli sensitivity than the Healthy group (P<0.02); and the Reactive group indicated more passive coping strategies then the Low and Healthy groups (P=0.001).

DISCUSSION

Findings from the study suggest that among healthy adults, trait affect patterns are associated with ischemic experimental pain sensitivity and other pain-related measures.

Adjusting to recent onset of rheumatoid arthritis: a qualitative study

The purpose of this study was to examine men’s and women’s experiences living with rheumatoid arthritis (RA). Using semi-structured, in-depth telephone interviews, nine women and seven men who were recently diagnosed with RA (disease duration < four years) were interviewed about their experiences adjusting to RA. Line-by-line coding using thematic analysis was used to identify themes. Findings from the qualitative analysis revealed six categories emerging from the data: 1. degree of severity of the impact of the disease, 2. appraisal about what the illness means to me, 3. availability of social support, 4. perception of self-efficacious behaviours, 5. use of coping strategies, and 6. RA’s effect on valued life activities. A number of participants described positive thinking about managing their RA; whereas others described negative thinking. Individuals’ appraisals and perceptions about their illness coupled with how their illness affected their ability to fulfill their role responsibilities were important in their adjustment to RA. Social support was also identified as key in learning to live with RA. For individuals with RA, the impact of the disease on their ability to maintain normal life is important, and as such it is vital that healthcare professionals have a better understanding of the perceptions and experiences that individuals have living with RA.

Behavior change, acceptance, and coping flexibility in highly distressed patients with rheumatic diseases: feasibility of a cognitive-behavioral therapy in multimodal rehabilitation

OBJECTIVE

To describe the development and feasibility of the integration of a cognitive-behavioral therapy (CBT) within a multimodal rehabilitation program for highly distressed patients with rheumatic diseases.

METHODS

Development included the detailed specification of the theoretical and empirical-based underpinnings of the CBT and the comprehensive description of its design and content. Feasibility was assessed by percentage of eligible patients, attrition and attendance rates, and patient satisfaction.

RESULTS

The developed CBT component seeks to decrease psychological distress and improve activities and participation across multiple life domains by accomplishing behavior change, acceptance, and coping flexibility. Motivational interviewing was applied to endorse patients' own reasons to change. Forty percent (35/87) of the eligible patients were admitted to the program. Attendance rate (>95%) was high. Patient satisfaction ranged from 6.8 to 8.0 (10-point scale).

CONCLUSION

Integrating CBT within a multimodal rehabilitation program is feasible. An acceptable proportion of the intended patient sample is eligible and patient's attendance and satisfaction is high.

PRACTICE IMPLICATIONS

Patients with impaired physical and psychosocial functioning despite adequate medical treatment pose a great challenge. Their treatment outcome may be improved by screening and selecting highly distressed patients and offering them a CBT embedded in multimodal rehabilitation program.

Examining the role of positive and negative affect in recovery from spine surgery

Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed-model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6-week positive affect predicted functional status, and 6-week negative affect predicted pain interference and pain-related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain-related disability at 3-month follow-up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.

Cognitive-affective assets and vulnerabilities: two factors influencing adaptation to fibromyalgia

This study set to explore whether variables related to cognitive-affective assets would complement measures of psychological vulnerability for the prediction of physical functioning and pain tolerance in 138 women with Fibromyalgia Syndrome (FMS). Depression, anxiety, stress response and negative affect were defined a priori as measures of vulnerability, while pain self-efficacy, internality and positive affect were identified as assets. Confirmatory factor analyses supported the validity of the hypothesised two-factor structure in FMS. A structural equation model (SEM) revealed that the two factors were associated with different outcomes in FMS as predictors. Pain and associated symptoms appeared related to psychological vulnerabilities in FMS patients, whereas physical functioning and tolerance for pain were better predicted by assets. These results are discussed with reference to current theoretical models concerning the role of psychological factors in FMS, and intervention methods designed to improve quality of life and reduce pain in FMS patients.

Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample

The purpose of this study was to assess the relative effects of coping self-efficacy and catastrophizing on physical functioning. Over a 9-month period, studying changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target. Data came from a randomized, longitudinal controlled trial comparing exercise, self-management and the two combined to treat 254 individuals with early knee osteoarthritis. A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects. Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing. Treatments targeting both self-efficacy and catastrophizing may have greater impact on physical functioning compared to treatments that focus on only one.

Symptoms of Depression Predict the Trajectory of Pain Among Patients with Early Inflammatory Arthritis: A Path Analysis Approach to Assessing Change

Objective.

To assess the longitudinal relationships, including directionality, among chronic pain, symptoms of depression, and disease activity in patients with early inflammatory arthritis (EIA).

Methods.

One hundred eighty patients with EIA completed an examination, including swollen joint count, and were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the McGill Pain Questionnaire (MPQ) at 2 timepoints 6 months apart. Cross-lagged panel path analysis was used to simultaneously assess concurrent and longitudinal relationships among pain, symptoms of depression, and number of swollen joints.

Results.

Pain, symptoms of depression, and number of swollen joints decreased over time (p < 0.001) and were prospectively linked to pain, symptoms of depression, and number of swollen joints, respectively, at 6 months. Symptoms of depression and pain were correlated with each other at baseline (0.47) and at 6-month followup assessments (0.28). Baseline symptoms of depression significantly predicted pain symptoms at 6 months (standardized regression coefficient = 0.28, p = 0.001), whereas pain and disease activity did not predict the course of any other variable after controlling for baseline values.

Conclusion.

Symptoms of depression predicted the trajectory of pain from baseline to 6 months. In addition, there were reciprocal/bidirectional associations between pain and symptoms of depression over time. More research is needed to better understand the relationship between pain and depressive symptoms and how to best manage patients with EIA who have high levels of both.

The role of psychological variables in explaining depression in older people with chronic pain

OBJECTIVES

Depression is commonly associated with chronic pain, and is also a common condition in the elderly. However research in the area of depression and pain is scarce. The aim of the present work was to analyse how cognitive-behavioural and perceptual variables help to explain the presence or absence of depression in older people with chronic pain caused by osteoarthritis.

METHOD

A total of 104 older adults were evaluated using a protocol that measured depression, perceptual characteristics of pain (intensity, frequency and duration), beliefs about pain, self-efficacy beliefs, coping style, coping strategies and pain behaviours.

RESULTS

Using Student's t-tests and discriminant analysis, we found that psychological variables such as catastrophizing, passive coping, complaint behaviour, avoidance, coping self-statements, ignoring pain sensations and stability and mystery beliefs help to explain depressive symptomatology.

CONCLUSION

The present study confirms the important role of cognitive-behavioural variables in the discrimination between older adults who suffer pain with and without symptoms of depression. Moreover, certain variables that in young adults had been seen to play a non-adaptive role, such as ignoring pain sensations, were seen to have an adaptive function in the elderly. Also, our results are in support of depression models - such as Abramson's Hopelessness Model - proposing that depression in chronic pain patients, unlike in other groups of depressed people, is characterized by absence of self-blame feelings.

Positive and negative affect and health functioning indicators among older adults with chronic illnesses

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.

Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients

BACKGROUND

Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life for chronic pain patients.

PURPOSE

This theoretically based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports of positive affect (PA) and negative affect (NA), and the relations of pain severity to both PA and NA.

METHODS

Participants were women, 36 with osteoarthritis and 86 with fibromyalgia, who completed an initial assessment for demographics, pain catastrophizing, and pain acceptance, and 2 to 12 weekly assessments of pain severity, PA, and NA.

RESULTS

Multilevel modeling analyses indicated that pain acceptance was related to higher levels of PA but was unrelated to NA. Furthermore, pain acceptance moderated the relation of NA and pain severity, such that expected increases in NA during pain exacerbations were buffered by higher levels of pain acceptance.

CONCLUSIONS

These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.

Pain, Positive and Negative Social Exchanges, and Depressive Symptomatology in Later Life

Objectives: Pain in older adulthood is correlated with both depressive symptomatology and positive and negative social exchanges, but the direction of these relationships remains unclear. This study investigated whether (a) pain is associated with increases in negative exchanges and decreases in positive exchanges and (b) negative exchanges play a greater role than positive exchanges in accounting for the association between pain and depressive symptomatology. Methods: Data were derived from the Later Life Study of Social Exchanges, a longitudinal survey of noninstitutionalized older adults. Interviews assessed participants' sociodemographic and biopsychosocial characteristics, as well as their interactions with network members. Results: Pain was significantly associated with negative exchanges, and both pain and negative exchanges predicted greater depressive symptomatology over time. Positive social exchanges, however, were not related to either pain or depression. Discussion: The findings underscore the value of examining older adults' social exchanges in efforts to understand pain-induced depressive symptomatology.

Illness-related factors, stress and coping strategies in relation to psychological distress in HIV-infected persons in Hong Kong

This study examined the relationships among illness-related factors, stress, coping strategies and psychological distress in HIV-infected persons in Hong Kong (N=118). Multiple regression analyses were used to examine the models of psychological distress as a function of demographic factors, illness-related factors, psychosocial stressors and coping. Results showed that positive thinking was inversely related to psychological distress and avoidance was associated with higher level of anxiety. However, the use of problem solving was found to be inversely related to anxiety. Results are discussed in the context of Chinese culture and the service in Hong Kong.

Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis

The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.

Evaluation of Reliability, Validity, and Preference for a Pain Intensity Scale for Use With the Elderly

The main objective of this research was to determine the initial psychometric properties of the Spanish Version of the Faces Pain Scale-Revised (FPS-R) as a measure of pain intensity for use with the elderly. To assess the scaling properties, validity, and reliability of the FPS-R, a total sample of 177 subjects aged 65 years or older participated in this study. Ranking procedures, placement tasks, and test-retest methods were used. The participants were asked to rate their pain intensity by using the FPS-R and a pain thermometer (PT) and to inform about their affective state. They were also asked to imagine themselves in 5 hypothetical painful situations (Geriatric Painful Events Inventory) and rate the degree of pain by using the FPS-R and the PT at 2 different times. Rank ordering tasks for the individual faces showed excellent agreement between the expected ranking and the one provided by the participants (Kendall's W = 0.75, P < .0001). The pain intensity ratings reported with FPS-R and the PT were very similar, and the relationship between the intensity of pain experienced and participant's negative affective state was statistically significant (r = 0.32, P < .01). Test-retest correlations on the Geriatric Painful Events Inventory ranged from 0.44 to 0.7. All the participating subjects were asked to choose the pain scale they preferred. Our data suggest that, regardless of their age and/or gender, the subjects preferred the FPS-R to the PT. Overall, these results provide preliminary evidence of its reliability and convergent and criterion-related validity as well as its strong ordinal properties with a sample of elderly subjects.

PERSPECTIVE

This article presents the evaluation of reliability, validity, and preference for a pain intensity scale for use with the elderly, the Faces Pain Scale-Revised. This scale could help clinicians to assess the intensity of pain in cognitively intact elderly patients and might also be helpful in making decisions about treatment. Likewise, it could be used by researchers who wish to evaluate the effects of available treatments.

Affect and pain in rheumatoid arthritis: Do individual differences in affective regulation and affective intensity predict emotional recovery from pain?

BACKGROUND

Individual differences in adaptation to rheumatoid arthritis are not fully accounted for by illness severity or duration of symptoms.

PURPOSE

In this study, we assessed differences in affect regulation and affect intensity as variables that might be important for identifying women with rheumatoid arthritis who are resilient versus those who have disrupted moods following pain exacerbations.

METHOD

Specifically, affective regulation, affect intensity, active coping, neuroticism and weekly reports of pain, positive affect, and negative affect were assessed in a sample of 81 women diagnosed with rheumatoid arthritis.

RESULTS

Our results indicated that affective regulation, affect intensity, and active coping played important but distinct roles in the ebb and flow of negative and positive affect. In particular, active coping was related to positive affect, whereas affective regulation and affect intensity showed interactive effects, moderating the prospective relationship between pain and negative affect and pain and positive affect.

CONCLUSION

Overall, this study suggests that recovery from rheumatoid arthritis pain can be swift, except for those women who have difficulty regulating strong unpleasant affect.

Positive affect as a source of resilience for women in chronic pain

A sample of 124 women with osteoarthritis or fibromyalgia, or both, completed initial assessments for demographic data, health status, and personality traits and 10-12 weekly interviews regarding pain, stress, negative affect, and positive affect. Multilevel modeling analyses indicated that weekly elevations of pain and stress predicted increases in negative affect. Both higher weekly positive affect as well as greater positive affect on average resulted in lower negative affect both directly and in interaction with pain and stress. Finally, increases in weekly negative affect and higher average negative affect related to greater levels of pain in subsequent weeks. In contrast, higher levels of overall positive affect predicted lower levels of pain in subsequent weeks.

Further validation of the chronic pain coping inventory

Multidisciplinary treatment programs for chronic pain typically emphasize the importance of decreasing maladaptive and encouraging adaptive coping responses. The Chronic Pain Coping Inventory (CPCI), developed to assess coping strategies targeted for change in multidisciplinary pain treatment, is a 64-item instrument that contains 8 subscales: Guarding, Resting, Asking for Assistance, Relaxation, Task Persistence, Exercising/Stretching, Coping Self-Statements, and Seeking Social Support. A previous validation study with 210 patients in a Canadian academic hospital setting supported an 8-factor structure for the CPCI. The current study was undertaken to validate the CPCI among 564 veterans with a more extended history of chronic pain. Patients completed the study questionnaires before multidisciplinary treatment. A confirmatory factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. The confirmatory factor analysis results strongly supported an 8-factor model, and the regression analyses supported the predictive validity of the CPCI scales, as indicated by their association with measures of patient adjustment to chronic pain.

PERSPECTIVE

This article validated the 8-factor structure of the CPCI by using a confirmatory factor analysis and a series of linear regressions. The results support the applicability and utility of the CPCI in a heterogeneous population of veterans with severe chronic pain treated in a tertiary teaching hospital. The CPCI provides an important clinical and research tool for the assessment of behavioral pain coping strategies that might have an impact on patient outcomes.

Social support and psychological adjustment among Latinas with arthritis: a test of a theoretical model

BACKGROUND

Among people coping with chronic illness, tangible social support sometimes has unintended negative consequences on the recipient's psychological health. Identity processes may help explain these effects. Individuals derive self-worth and a sense of competence by enacting social roles that are central to the self-concept.

PURPOSE

This study tested a model drawing from some of these theoretical propositions. The central hypothesis was that tangible support in fulfilling a highly valued role undermines self-esteem and a sense of self-efficacy, which, in turn, affect psychological adjustment.

METHODS

Structured interviews were conducted with 98 Latina women with arthritis who rated the homemaker identity as being of central importance to the self-concept.

RESULTS

A path analysis indicated that, contrary to predictions, tangible housework support was related to less psychological distress. Emotional support predicted greater psychological well-being. These relationships were not mediated by self-esteem or self-efficacy. Qualitative data revealed that half of the sample expressed either ambivalent or negative feelings about receiving housework support.

CONCLUSIONS

Results may reflect social and cultural norms concerning the types of support that are helpful and appropriate from specific support providers. Future research should consider the cultural meaning and normative context of the support transaction. This study contributes to scarce literatures on the mechanisms that mediate the relationship between social support and adjustment, as well as illness and psychosocial adaptation among Latina women with chronic illness.

En las manos de Dios [in God's hands]: Religious and other forms of coping among Latinos with arthritis

This study tested a theoretical model concerning religious, passive, and active coping; pain; and psychological adjustment among a sample of 200 Latinos with arthritis. Respondents reported using high levels of religious coping. A path analysis indicated that religious coping was correlated with active but not with passive coping. Religious coping was directly related to psychological well-being. Passive coping was associated with greater pain and worse adjustment. The effects of active coping on pain, depression, and psychological well-being were entirely indirect, mediated by acceptance of illness and self-efficacy. These findings warrant more research on the mechanisms that mediate the relationship between coping and health. This study contributes to a growing literature on religious coping among people with chronic illness, as well as contributing to a historically under-studied ethnic group.

Spouses' and physicians' perceptions of pain severity in older women with osteoarthritis: dyadic agreement and patients' well-being

This study examined agreement between patients and two role partners (spouses and physicians) on patients' pain severity and the relationships between dyadic agreement and patients' well-being. We hypothesized that compared to disagreement between patients and role partners, dyadic agreement would be related to better psychological well-being (more disease-specific self-efficacy and positive affect, and less depression). Participants were 114 older women with osteoarthritis, their caregiving husbands, and their rheumatologists. Among patient-spouse dyads, agreement was associated with better well-being, especially when compared to spouses' underestimation of patients' pain. Contrary to predictions, patient-physician agreement was not related to better patient well-being. Agreement between patients and physicians was associated with less (rather than more) self-efficacy and positive affect when compared to physicians' underestimation of patients' pain.

The Chronic Pain Coping Inventory-42: reliability and validity

Coping responses have been shown to be associated with physical and psychological functioning in patients with chronic pain. Assessment of coping strategies has received increasing attention, with several measures of cognitive and behavioral coping showing promise. One such instrument is the Chronic Pain Coping Inventory (Pain 60 (1995) 203), a 65-item measure of behavioral and cognitive pain coping strategies often targeted as part of multidisciplinary pain treatment. Initial research has supported the reliability and validity of the CPCI. This article describes the development of an abbreviated (42-item) CPCI. The results demonstrate very high correlations between the original and abbreviated CPCI scales, as well as comparable internal consistency, test-retest stability, and validity coefficients. The findings support the reliability and validity of the abbreviated CPCI, and suggest that it could be substituted for the CPCI without sacrificing reliability and validity in situations where a briefer measure of coping with chronic pain is preferable.

Dimensions of Affect Relationships: Models and Their Integrative Implications

This article presents data from a number of areas of psychology that have dealt with the issue of whether positive and negative affects are independent—the bivariate view—or whether they operate inversely from each other—the unidimensional, bipolar view. Both models have extensive empirical support. A more integrative view, the Dynamic Model of Affect (DMA), specifies conditions under which both bivariate and bipolar models are valid. It is tailored to analyzing both affect systems functioning concurrently. The DMA is reviewed and then extended to show how 3 major areas of research can begin to incorporate the more integrative framework of analyzing co-occurring types of affect.

Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis

This article provides an overview of the emerging literature on biopsychosocial assessment and treatment for two of the most common forms of arthritis: osteoarthritis and rheumatoid arthritis. The article is divided into 3 parts. In the 1st part, the basic elements of the biopsychosocial approach to assessing and treating persons having arthritis is described. In the 2nd part, the authors evaluate studies of biopsychosocial approaches to the assessment of arthritis pain and disability. Six research areas are reviewed: learned helplessness, depression, stress, pain coping, self-efficacy, and the social context of arthritis. The 3rd part of the article reviews studies that testing the efficacy of biopsychosocial treatment approaches for persons having osteoarthritis and rheumatoid arthritis.