The influence of disease severity, perceived stress, social support and coping in patients with chronic illness: A 1 year follow up

This study examined the extent to which psychological stress, social support and clinical disease indicators predict physical, social and psychological wellbeing in patients with rheumatoid arthritis. Participants were 59 women recruited at an outpatient clinic. Data were available for 52 of the sample at 1-year follow-up. A range of psychological measures was administered and disease status was assessed by physician ratings of joint involvement and blood assays of inflammatory indices. Findings from correlational and hierarchical regression analyses reveal a number of statistically significant relationships (p < 0.01), for example higher perceived stress and lower social support were associated with poor emotional adjustment. Partial correlations showed that while social support did not mediate the relationship between psychological stress and adjustment, the use of venting emotions as a coping strategy was a mediator of the association between stress and negative affect. Results demonstrated that disease status predicted illness related functioning but did not predict emotional or social adjustment. Perceived stress was a better predictor than disease of concurrent positive and negative emotionality with explained variance ranging from 14%-55%. Coping also predicted variance on these affective domains (10-19%). In longitudinal analyses, perceived stress accounted for variability in negative affect 1 year later and coping predicted positive affect over this time. Level of social support explained variance on social activity in cross-sectional and longitudinal analysis (10-14%). Results suggest that a cognitive behavioural intervention to facilitate patient adjustment could usefully include management of stress and its appraisal, the fostering of adaptive coping strategies and utilization of social support resources. In improving patient adjustment to rheumatoid arthritis it is envisaged that reliance on physicians for emotional rather than disease related problems will diminish.