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Rheumatology International

, Volume 34, Issue 12, pp 1671–1681 | Cite as

Illness perceptions and psychological distress associated with physical health-related quality of life in primary Sjögren’s syndrome compared to systemic lupus erythematosus and rheumatoid arthritis

  • Konstantinos Kotsis
  • Paraskevi V. Voulgari
  • Niki Tsifetaki
  • Alexandros A. Drosos
  • André F. Carvalho
  • Thomas Hyphantis
Original Article

Abstract

Notwithstanding that psychological distress and illness perceptions are important in determining outcomes in rheumatic diseases, few studies investigated these variables in primary Sjögren’s syndrome (pSS). We aimed to compare illness perceptions and psychological distress in patients with pSS, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and to test whether their associations with health-related quality of life (HRQoL) are similar in these groups of patients. In 57 patients with pSS, 75 with SLE and 199 with RA, we administered the Patient Health Questionnaire (PHQ-9), the Symptom Check-List and the Brief-Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short-Form to assess HRQoL. Hierarchical regression models determined the associations of psychological variables with HRQoL after adjusting for demographic variables and clinical parameters. The prevalence of clinically significant depressive symptoms (PHQ-9 ≥ 10) was 24.6 % in pSS, 29.3 % in SLE and 25.1 % in RA. Patients with pSS showed little understanding of their disease (comprehensibility) and attributed more symptoms to their illness (identity) compared with the other groups of patients. Illness perceptions and depressive symptoms were independently associated with physical HRQoL in a similar pattern in all three groups. In pSS, however, the patients’ worries about the consequences of their illness was a stronger correlate of physical HRQoL than pain. These findings indicate that psychological factors are important correlates of HRQoL in these disease groups and encourage the design of psycho-educational therapies targeting disease-related cognitions in pSS in an attempt to improve patient’s physical HRQoL.

Keywords

Sjögren’s syndrome Illness representations Patient reported outcomes B-IPQ Depression Anxiety Quality of life 

Notes

Conflict of interest

None.

References

  1. 1.
    Kassan SS, Moutsopoulos HM (2004) Clinical manifestations and early diagnosis of Sjögren syndrome. Arch Intern Med 164:1275–1284PubMedCrossRefGoogle Scholar
  2. 2.
    Thomas E, Hay EM, Hajeer A, Silman AJ (1998) Sjogren’s syndrome: a community-based study of prevalence and impact. Br J Rheumatol 37:1069–1076PubMedCrossRefGoogle Scholar
  3. 3.
    Mavragani CP, Moutsopoulos HM (2013) Sjögren’s syndrome. Annu Rev Pathol. doi: 10.1146/annurev-pathol-012513-104728 PubMedGoogle Scholar
  4. 4.
    Meijer JM, Meiners PM, Huddleston Slater JJ, Spijkervet FK, Kallenberg CG, Vissink A et al (2009) Health-related quality of life, employment and disability in patients with Sjogren’s syndrome. Rheumatology (Oxford) 48:1077–1082CrossRefGoogle Scholar
  5. 5.
    Segal B, Bowman SJ, Fox PC, Vivino FB, Murukutla N, Brodscholl J et al (2009) Primary Sjögren’s syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes 7:46PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Sutcliffe N, Stoll T, Pyke S, Isenberg DA (1998) Functional disability and end organ damage in patients with systemic lupus erythematosus (SLE), SLE and Sjögren’s syndrome (SS), and primary SS. J Rheumatol 25:63–68PubMedGoogle Scholar
  7. 7.
    Strömbeck B, Ekdahl C, Manthorpe R, Wikström I, Jacobsson L (2000) Health-related quality of life in primary Sjögren’s syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol 29:20–28PubMedCrossRefGoogle Scholar
  8. 8.
    Harboe E, Tjensvoll AB, Maroni S, Gøransson LG, Greve OJ, Beyer MK et al (2009) Neuropsychiatric syndromes in patients with systemic lupus erythematosus and primary Sjogren syndrome: a comparative population-based study. Ann Rheum Dis 68:1541–1546PubMedCrossRefGoogle Scholar
  9. 9.
    Segal B, Thomas W, Rogers T, Leon JM, Hughes P, Patel D et al (2008) Prevalence, severity, and predictors of fatigue in subjects with primary Sjogren’s syndrome. Arthritis Rheum 59:1780–1787PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Valtysdottir ST, Gudbjornsson B, Hallgren R, Hetta J (2000) Psychological well-being in patients with primary Sjogren’s syndrome. Clin Exp Rheumatol 18:597–600PubMedGoogle Scholar
  11. 11.
    Strombeck B, Ekdahl C, Manthorpe R, Jacobsson LT (2003) Physical capacity in women with primary Sjogren’s syndrome: a controlled study. Arthritis Rheum 49:681–688PubMedCrossRefGoogle Scholar
  12. 12.
    Katon W, Ciechanowski P (2002) Impact of major depression on chronic medical illness. J Psychosom Res 53:859–863PubMedCrossRefGoogle Scholar
  13. 13.
    Richards HL, Herrick AL, Griffin K, Gwilliam PD, Loukes J, Fortune DG (2003) Systemic sclerosis: patients’ perceptions of their condition. Arthritis Rheum 49:689–696PubMedCrossRefGoogle Scholar
  14. 14.
    Sharpe L, Sensky T, Allard S (2001) The course of depression in recent onset rheumatoid arthritis—the predictive role of disability, illness perceptions, pain and coping. J Psychosom Res 51:713–719PubMedCrossRefGoogle Scholar
  15. 15.
    Philip EJ, Lindner H, Lederman L (2009) Relationship of illness perceptions with depression among individuals diagnosed with lupus. Depress Anxiety 26:575–582PubMedCrossRefGoogle Scholar
  16. 16.
    Daleboudt GM, Broadbent E, McQueen F, Kaptein AA (2013) The impact of illness perceptions on sexual functioning in patients with systemic lupus erythematosus. J Psychosom Res 74:260–264PubMedCrossRefGoogle Scholar
  17. 17.
    Leventhal H, Nerenz DR, Steele DJ (1984) Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE (eds) Handbook of psychology and health, volume IV: social psychological aspect of health. Erlbaum, Hillsdale NJGoogle Scholar
  18. 18.
    Vitali C, Bombardieri Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE (2002) Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61:544–558CrossRefGoogle Scholar
  19. 19.
    Godaert GL, Hartkamp A, Geenen R, Garssen A, Kruize AA, Bijlsma JW et al (2002) Fatigue in daily life in patients with primary Sjögren’s syndrome and systemic lupus erythematosus. Ann N Y Acad Sci 966:320–326PubMedCrossRefGoogle Scholar
  20. 20.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725PubMedCrossRefGoogle Scholar
  21. 21.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  22. 22.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  23. 23.
    Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48PubMedCrossRefGoogle Scholar
  24. 24.
    Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640PubMedCrossRefGoogle Scholar
  25. 25.
    Kroenke KS, Robert L (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 32:509–515CrossRefGoogle Scholar
  26. 26.
    Hyphantis T, Kotsis K, Voulgari PV, Tsifetaki N, Creed F, Drosos AA (2011) Diagnostic accuracy, internal consistency and convergent validity of the Greek version of PHQ-9 in diagnosing depression in rheumatological disorders. Arthritis Care Res (Hoboken) 63:1313–1321CrossRefGoogle Scholar
  27. 27.
    Donias S, Karastergiou A, Manos N (1991) Standardization of the symptom checklist-90-R rating scale in a Greek population (in Greek with English abstract). Psychiatrike 2:42–48Google Scholar
  28. 28.
    Parker JC, Buckelew SP, Smarr KL, Buescher KL, Beck NC, Frank RG et al (1990) Psychological screening in rheumatoid arthritis. J Rheumatol 17:1016–1021PubMedGoogle Scholar
  29. 29.
    Broadbent E, Petrie KJ, Main J, Weinman J (2006) The brief illness perception questionnaire. J Psychosom Res 60:631–637PubMedCrossRefGoogle Scholar
  30. 30.
    Ginieri-Coccossis M, Triantafillou E, Tomaras V, Soldatos C, Mavreas V, Christodoulou G (2012) Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: incorporating new culture-relevant items. Psychiatrike 23:130–142PubMedGoogle Scholar
  31. 31.
    Bai M, Tomenson B, Creed F, Mantis D, Tsifetaki N, Voulgari PV et al (2009) The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Scand J Rheumatol 38:419–430PubMedCrossRefGoogle Scholar
  32. 32.
    Taylor WJ, Myers J, Simpson RT, McPherson KM, Weatherall M (2004) Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF): score distributions and psychometric properties. Arthritis Rheum 51:350–357PubMedCrossRefGoogle Scholar
  33. 33.
    Miles J, Shevlin M (2003) Applying regression and correlation. Sage, London, pp 126–132Google Scholar
  34. 34.
    Westhoff G, Dorner T, Zink A (2012) Fatigue and depression predict physician visits and work disability in women with primary Sjogren’s syndrome: results from a cohort study. Rheumatology (Oxford) 51:262–269CrossRefGoogle Scholar
  35. 35.
    Segal BM, Pogatchnik B, Holker E, Liu H, Sloan J, Rhodus N et al (2012) Primary Sjogren’s syndrome: cognitive symptoms, mood, and cognitive performance. Acta Neurol Scand 125:272–278PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Iannuccelli C, Spinelli FR, Guzzo MP, Priori R, Conti F, Ceccarelli F et al (2012) Fatigue and widespread pain in systemic lupus erythematosus and Sjögren’s syndrome: symptoms of the inflammatory disease or associated fibromyalgia? Clin Exp Rheumatol 30:117–121PubMedGoogle Scholar
  37. 37.
    Bradley LA, Alberts KR (1999) Psychological and behavioral approaches to pain management for patients with rheumatic disease. Rheum Dis Clin North Am 25:215–232PubMedCrossRefGoogle Scholar
  38. 38.
    Carlisle AC, John AM, Fife-Schaw C, Lloyd M (2005) The self-regulatory model in women with rheumatoid arthritis: relationships between illness representations, coping strategies, and illness outcome. Br J Health Psychol 10:571–587PubMedCrossRefGoogle Scholar
  39. 39.
    Husson O, Thong MS, Mols F, Oerlemans S, Kaptein AA, van de Poll-Franse LV (2013) Illness perceptions in cancer survivors: what is the role of information provision? Psycho-oncology 22:490–498PubMedCrossRefGoogle Scholar
  40. 40.
    Malterud K, Hollnagel H (2004) Positive self-assessed general health in patients with medical problems. A qualitative study from general practice. Scand J Prim Health Care 22:11–15PubMedCrossRefGoogle Scholar
  41. 41.
    Hyphantis T, Goulia P, Carvalho AF (2013) Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J Psychosom Res 75:362–369PubMedCrossRefGoogle Scholar
  42. 42.
    Chaturvedi SK, Maguire GP (1998) Persistent somatization in cancer: a controlled follow-up study. J Psychosom Res 45:249–256PubMedCrossRefGoogle Scholar
  43. 43.
    Bowman SJ, Booth DA, Platts RG, UK Sjögren’s Interest Group (2004) Measurement of fatigue and discomfort in primary Sjogren’s syndrome using a new questionnaire tool. Rheumatology (Oxford) 43(6):758–764CrossRefGoogle Scholar
  44. 44.
    Hyphantis T, Palieraki K, Voulgari PV, Tsifetaki N, Drosos AA (2011) Coping with health-stressors and defence styles associated with health-related quality of life in patients with systemic lupus erythematosus. Lupus 20:893–903PubMedCrossRefGoogle Scholar
  45. 45.
    Inal V, Kitapcioglu G, Karabulut G, Keser G, Kabasakal Y (2010) Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome. Mod Rheumatol 20:588–597PubMedCrossRefGoogle Scholar
  46. 46.
    Lendrem D, Mitchell S, McMeekin P, Bowman S, Price E, Pease CT et al on behalf of the UK primary Sjögren’s Syndrome Registry (2013) Health-related utility values of patients with primary Sjogren’s syndrome and its predictors. Ann Rheum Dis. doi: 10.1136/annrheumdis-2012-202863
  47. 47.
    Alamanos Y, Tsifetaki N, Voulgari PV, Venetsanopoulou AI, Siozos C, Drosos AA (2006) Epidemiology of primary Sjögren’s syndrome in north-west Greece, 1982–2003. Rheumatology (Oxford) 45:187–191CrossRefGoogle Scholar
  48. 48.
    Bijsterbosch J, Scharloo M, Visser AW, Watt I, Meulenbelt I, Huizinga TW et al (2009) Illness perceptions in patients with osteoarthritis: change over time and association with disability. Arthritis Rheum 61:1054–1061PubMedCrossRefGoogle Scholar
  49. 49.
    Abourazzak F, El Mansouri L, Huchet D, Lozac’hmeur R, Hajjaj-Hassouni N, Ingels A et al (2009) Long-term effects of therapeutic education for patients with rheumatoid arthritis. Joint Bone Spine 76:648–653 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Konstantinos Kotsis
    • 1
  • Paraskevi V. Voulgari
    • 2
  • Niki Tsifetaki
    • 2
  • Alexandros A. Drosos
    • 2
  • André F. Carvalho
    • 3
  • Thomas Hyphantis
    • 1
  1. 1.Department of Psychiatry, Medical SchoolUniversity of IoanninaIoanninaGreece
  2. 2.Department of Internal Medicine, Medical School, Rheumatology ClinicUniversity of IoanninaIoanninaGreece
  3. 3.Department of Clinical Medicine, Faculty of MedicineFederal University of CearáFortalezaBrazil

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