Distress and disease status among patients with rheumatoid arthritis: roles of coping styles and perceived responses from support providers

A meta-analysis of coping strategies and psychological distress in rheumatoid arthritis

PURPOSE

Theory and research indicate that coping plays a central role in the experience of psychological distress in people with rheumatoid arthritis (RA). This study meta-analysed the associations of adaptive and maladaptive coping strategies with psychological distress in people with RA to quantify and better understand the proposed differential relationships, as well as the factors that might influence these links.

METHODS

Searches of four databases identified eligible studies according to a pre-registered protocol. Two random effects meta-analyses examined the direction and magnitude of the links between adaptive coping (problem-focused and emotional approach coping) and maladaptive coping (emotional avoidance and pre-occupation coping) and psychological distress (stress, anxiety, and depression). Study quality was evaluated using a bespoke tool. Moderator analyses for sample characteristics and distress type were conducted.

RESULTS

Searches identified 16 eligible studies with 46 effects. Meta-analysis of maladaptive coping and distress yielded a significant, medium sized association, k = 12, r = .347, 95% CIs [.23, .46]. Moderator analyses were significant only for type of distress, with effects for depression being larger than that for combined distress. Effects did not vary as a function of age, participant sex, or disease duration. Meta-analysis for adaptive coping was not significant, k = 10, r = -.155, 95% CIs [-.31, .01].

CONCLUSIONS

Findings from this first meta-analysis of coping and distress in RA indicate that maladaptive but not adaptive coping is associated with greater distress. Further research is needed to grow the evidence base to verify the current findings especially with respect to adaptive coping.

Beyond solicitousness: a comprehensive review on informal pain-related social support

Adults with chronic pain cite social support (SS) as an important resource. Research has mostly focused on general SS or pain-specific solicitousness, resulting in a limited understanding of the role of SS in pain experiences. Drawing on SS theoretical models, this review aimed to understand how pain-related SS has been conceptualized and measured and how its relationship with pain experiences has been investigated. Arksey and O'Malley scoping review framework guided the study. A database search (2000-2015) was conducted in PsycINFO, CINAHL, MEDLINE, and EMBASE using a combination of subject headings/keywords on pain and SS; 3864 citations were screened; 101 full texts were assessed for eligibility; references of 52 papers were hand searched. Fifty-three studies were included. Most studies were either a-theoretical or drew upon the operant conditioning model. There are several self-report measures and observational systems to operationalize pain-related SS. However, the Multidimensional Pain Inventory remains the most often used, accounting for the centrality of the concept of solicitousness in the literature. Most studies focused on individuals with chronic pain self-report of spousal pain-related SS and investigated its main effects on pain outcomes. Only a minority investigated the role of pain SS within the stress and coping process (as a buffer or mediator). Little is known about mediating pathways, contextual modulation of the effectiveness of SS exchanges, and there are practically no SS-based intervention studies. Drawing on general SS models, the main gaps in pain-related SS research are discussed and research directions for moving this literature beyond solicitousness are proposed.

Women's situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison

INTRODUCTION

The present study explored how women describe their use of situation-specific strategies when managing rheumatoid arthritis (RA). The aim was also to compare women's strategies with those of men, and see the extent to which they used the same strategies.

METHODS

The data were collected using semi-structured interviews based on the critical incident technique. The sample consisted of women with early rheumatic arthritis (n = 34), and the results were compared with data reported in a previous study on men (n = 25) from the same cohort. The patient-described participation restrictions due to RA were firstly linked to the domains of the International Classification of Functioning, Disability and Health (ICF). The different strategies used were then categorized. The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden.

RESULTS

The study found that women used four situation-specific strategies: adjustment, avoidance, interaction and acceptance. The same strategies had been found previously in interviews with men with RA. Women and men used these strategies to a similar extent in the ICF domains of mobility; major life arenas; domestic life; interpersonal interactions and relationships; and community, social and civic life. However, some differences were found, relating to the reported activities in self-care and domestic life, in which women reported using strategies to a greater extent than men.

CONCLUSIONS

Women and men used four types of situation-specific strategies in managing RA; adjustment, avoidance, interaction and acceptance. These situation-specific strategies provide useful knowledge, in terms of multidisciplinary rehabilitation and for patients' significant others.

The Role of Social Support in Coping with Daily Pain among Patients with Rheumatoid Arthritis

Using a daily process methodology, the current study examined the role of social support in coping and pain severity among patients with rheumatoid arthritis (RA). Seventy-three adults with RA completed a structured record twice daily for one week on pain severity, pain coping, satisfaction with support and disappointment in support. Findings suggested that support influenced pain indirectly, by encouraging the use of specific coping strategies, as well as impacting coping effectiveness. Satisfaction with support was associated with adaptive and maladaptive coping, while disappointment was associated with maladaptive coping. Findings highlight the importance of close others in promoting adaptive coping strategies.

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.

Coping strategies and health in a national sample of sexual minority women

Coping strategies have been shown to significantly influence mental and physical health among heterosexual and medically ill populations. These associations have not been thoroughly examined among sexual minority women, who are known to shoulder a high burden of disease. This study assesses the impact of adaptive and maladaptive coping on mental and physical health among 1,381 lesbian and bisexual women and examines the potential mediating role of maladaptive coping in explaining bisexual women's poorer health relative to lesbians. Participants completed a web-based survey that assessed demographic characteristics, social support, adaptive and maladaptive coping strategies, and mental and physical health. Maladaptive coping strategies, especially behavioral disengagement and self-blame, were significantly associated with mental and physical health. Coping was more strongly predictive of mental health than physical health, and maladaptive coping more strongly predictive of health outcomes than demographics, social support, and adaptive coping. Interactions between social support and coping were generally not significant. Additionally, bisexual women reported more adverse mental and physical health outcomes than lesbians, and maladaptive coping significantly mediated these relationships. Providers working with sexual minority women may wish to pay particular attention to maladaptive coping strategies, countering these with adaptive, empowerment-based interventions.

The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review

In general, social support from family members affects chronic illness outcomes, but evidence on which specific family behaviors are most important to adult patient outcomes has not been summarized. We systematically reviewed studies examining the effect of specific family member behaviors and communication patterns on adult chronic illness self-management and clinical outcomes. Thirty studies meeting inclusion criteria were identified, representing 22 participant cohorts, and including adults with arthritis, chronic cardiovascular disease, diabetes, and/or end stage renal disease. Family emphasis on self-reliance and personal achievement, family cohesion, and attentive responses to symptoms were associated with better patient outcomes. Critical, overprotective, controlling, and distracting family responses to illness management were associated with negative patient outcomes. Study limitations included cross-sectional designs (11 cohorts); however results from longitudinal studies were similar. Findings suggest that future interventions aiming to improve chronic illness outcomes should emphasize increased family use of attentive coping techniques and family support for the patient's autonomous motivation.

The roles of social support and coping strategies in predicting breast cancer patients' emotional well-being: testing mediation and moderation models

The goal of the current study was to examine how social support and coping strategies are related in predicting emotional well-being of women with breast cancer. In achieving this goal, we examined two hypothesized models: (1) a moderation model where social support and coping strategies interact with each other in affecting psychological well-being; and (2) a mediation model where the level of social support influences choices of coping strategies between self-blame and positive reframing. In general, the data from the current study were more consistent with the mediation model than the moderation model.

One day at a time: The impact of daily satisfaction with spouse responses on pain, negative affect and catastrophizing among individuals with rheumatoid arthritis

The majority of research on pain catastrophizing has focused on its negative consequences for adjustment to chronic pain, with few investigations of factors that influence catastrophizing or its detrimental effects. Using a daily process methodology, the current study examined, first, the extent to which a supportive social environment plays a role in reduced catastrophizing, and second, the extent to which support might protect against the detrimental effects of catastrophizing on well-being. Sixty-nine married individuals with rheumatoid arthritis took part in an initial background interview, followed by twice daily telephone interviews (regarding pain intensity, negative affect, catastrophizing and satisfaction with spouse responses) for 1 week. Multi-level modeling indicated several pathways through which satisfaction with spouse responses disrupts the vicious cycle of pain, negative affect and catastrophizing. Consistent with past research, catastrophizing was associated with increases in pain and negative affect. However, when individuals reported increases in satisfaction with spouse responses they were less likely to experience increases in negative affect due to catastrophizing. Satisfaction with spouse responses also reduced the likelihood of feeling overwhelmed and helpless in dealing with daily pain. The relationship between pain and catastrophizing was attenuated in the context of increases in satisfaction with spouse responses. Negative affect was associated with increases in catastrophizing, but only when individuals reported decreases in satisfaction with spouse responses. Overall, findings were consistent with a model in which satisfaction with spouse responses serves as a coping resource, and suggests the importance of involving close others in treatments to reduce pain and catastrophizing.

Arthritis and pain. Psychosocial aspects in the management of arthritis pain

The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent evidence for psychosocial approaches to managing arthritis pain. By definition, psychosocial factors refer to two dimensions of experience: the psychological (cognitive, affective) and social (interacting with others, engaging in life activities). Psychosocial factors influence the perception of pain and the presence of pain influences psychological well-being and social participation. After discussing the impact of arthritis pain on participation in work, family life, and leisure, evidence for psychosocial interventions is summarized, emphasizing reviews and studies published from January 2000 to August 2006.

Behavior change following a self-management intervention for housebound older adults with arthritis: an experimental study

BACKGROUND

This study examined the impact of a home-based self-management intervention for housebound older adults with arthritis on the adoption of health behaviors. The moderating role of socio-demographic, psychological, and physical characteristics in the process of behavior change was also investigated.

METHODS

Participants were 113 older adult women (n = 102) and men (n = 11) with osteoarthritis (OA) or rheumatoid arthritis (RA) who were randomly assigned to experimental (n = 68) or wait list control (n = 45) groups. Participants were interviewed using standardized questionnaires at baseline, pre-intervention, and post-intervention.

RESULTS

Adjusted multilevel modeling analyses indicated that from pre to post intervention, experimental participants significantly increased their weekly frequency of exercise and relaxation activities. Socioeconomic status and depression played a moderating role in this change for exercise with larger effects occurring among more privileged, non-depressed participants.

CONCLUSION

We conclude that a self-management intervention can successfully improve involvement in exercise and relaxation among housebound older adults with arthritis.

Well-being in rheumatoid arthritis: the effects of disease duration and psychosocial factors

This study examined the multivariate relationships of psychosocial factors with well-being in rheumatoid arthritis (RA). Fifty-five patients with early RA (<six months), 52 with intermediate RA (one-seven years) and 47 with established RA (>seven years) completed questionnaires on psychosocial factors and psychological and physical well-being. Illness perceptions related to worse depression and life satisfaction (especially in early RA) and to longer morning stiffness (especially in intermediate RA). Optimism related to lower pain in early and intermediate RA. Social support related to lower fatigue in established RA. Indications for interventions targeted by disease duration are discussed.

Coping Style as a Predictor of Health and Well-Being Across the First Year of Medical School

Medical students in their 1st year (N=71) were assessed prior to starting training and at year's end. Coping styles reported at baseline were strongly related to coping styles at the end of the year. Students' physical health and psychological well-being declined over the course of the year. The greater the students' use of both problem-focused coping and approach emotion-focused coping, the less their physical health deteriorated. Psychological well-being at year's end was more strongly related to baseline functioning, and coping style did not predict change. This study demonstrated the utility of measuring coping style and the predictive ability of coping on physical health in a healthy sample.

Coping strategies in patients with interstitial cystitis: relationships with quality of life and depression

PURPOSE

Previous research has demonstrated that interstitial cystitis patients experience depressive symptoms and decrements to quality of life. However, to our knowledge the extent to which patients may be able to influence quality of life and depressive symptoms through coping strategies has not been investigated in this population. In a number of other chronic conditions specific coping strategies have been associated with the degree of impairment beyond disease severity. Therefore, the association of coping strategies with depressive symptoms, quality of life and self-reports of pain was assessed in patients with interstitial cystitis.

MATERIALS AND METHODS

A total of 64 females with interstitial cystitis were recruited from a urology clinic at a tertiary medical center. Questionnaires assessing depression, quality of life, coping and symptom severity were completed and returned at a clinic appointment. Depression was also measured through a standardized semi-structured interview (Hamilton Rating Scale for Depression). All analyses controlled for age.

RESULTS

Patients coping by greater catastrophizing reported greater impairments in various domains, including depressive symptoms, general mental health, social functioning, vitality and pain. Greater venting was associated with greater depressive symptoms and poorer mental health. Seeking instrumental social support was associated with fewer depressive symptoms.

CONCLUSIONS

These findings suggest that maladaptive coping strategies are associated with higher levels of depressive symptoms and quality of life decrements in patients with this condition. Psychosocial interventions aimed at increasing adaptive coping may positively impact the female experience with interstitial cystitis.