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Sense of coherence and self-sacrificing defense style as predictors of psychological distress and quality of life in rheumatoid arthritis: a 5-year prospective study

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Abstract

Individual differences in adjustment during a disease’s course determine psychological response and outcome. This study aimed to investigate prospectively whether coping with health stressors and self-sacrificing defense style could predict psychological adjustment and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). Seventy-four consecutive RA patients attending a rheumatology clinic were assessed for psychological distress (SCL-90-R), sense of coherence (SOC scale), self-sacrificing defense style (Defense Style Questionnaire-88), disease activity (DAS-28), pain, disability (Health Assessment Questionnaire) and HRQoL (World Health Organization Quality of Life Instrument, Short Form) at baseline and 5 years later. Multiple regression and moderator analyses were carried out. The results showed that disease activity (p < .001), pain (p = .005), psychological distress (p = .031), social relations HRQoL (p = .042) and environment HRQoL (p = .020) significantly improved over time. SOC was found an independent predictor of improvement in psychological distress (p = .003), overall general health (p = .002) and social relations HRQoL (p = .004); self-sacrificing independently predicted environment HRQoL (p = .042). The self-sacrificing defense style moderated the relationships between improvement in pain and improvement in overall general health (p = .024) and between improvement in pain and improvement in social relations HRQoL (p = .006). These findings indicate that, in RA, SOC predicts improvement in psychological distress and HRQoL over time, while a self-sacrificing defense style moderates the relationship of pain with HRQoL in the long term. These variables may partly explain inter-individual differences in adaptation to RA. Therefore, the design of psychotherapeutic trials targeting the patients’ defensive profiles and coping with health stressors capacities is an important research perspective.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Psychiatry, Medical School, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece

    Panagiota Goulia & Thomas Hyphantis

  2. Faculty of Medicine, Department of Internal Medicine, Rheumatology Clinic, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Paraskevi V. Voulgari, Niki Tsifetaki & Alexandros A. Drosos

  3. 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Elias Andreoulakis

  4. Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

    André F. Carvalho

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  1. Panagiota Goulia
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  2. Paraskevi V. Voulgari
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  3. Niki Tsifetaki
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  7. Thomas Hyphantis
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Correspondence to Thomas Hyphantis.

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Goulia, P., Voulgari, P.V., Tsifetaki, N. et al. Sense of coherence and self-sacrificing defense style as predictors of psychological distress and quality of life in rheumatoid arthritis: a 5-year prospective study. Rheumatol Int 35, 691–700 (2015). https://doi.org/10.1007/s00296-014-3134-8

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  • DOI: https://doi.org/10.1007/s00296-014-3134-8

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