Abstract
Partners play a crucial role in patients’ adaptation to a chronic illness, yet very little is known about the impact of partners’ representations on rheumatic patients’ coping behaviors. The aim of the present cross-sectional study was to examine the relation of partners’ representations of control/cure, consequences and emotional representations to patients’ coping behaviors through patients’ representations, and to assess the impact of the potential interactions between patients’ and partners’ representations. The study was conducted at the Rheumatology Clinic, University of Crete Hospital in Heraklion, Greece. One hundred three heterosexual patients with Rheumatoid Arthritis (RA) or Systemic Lupus Erythematosus (SLE) and their spouses (patients’ mean age = 53.87 years; SD = 9.6; partners’ mean age = 51.23; SD = 7.2; 91.3% women) participated in the study. All of them completed the Revised Illness Perception Questionnaire. Patients’ behaviors were assessed with the Coping with Health Injuries and Problems Scale. Structural Equation Modeling and mediation analysis were conducted. Partners’ illness representations were only indirectly related to patients’ coping behaviors through patients’ representations (χ2 = 20.39, df = 16, p < 0.05). Furthermore, the negative relation of patients’ representations of personal control to palliative coping was stronger when partners perceived the rheumatic disease as less controllable (b = −0.07, t(82) = −2.36, p < 0.05). The findings emphasize the importance of partners’ representations for patients’ coping process and provide support to the need for partners to participate in relevant interventions.
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The data generated and analyzed in the present study are available from the corresponding author on request.
References
Adamichou, C., & Bertsias, G. (2017). Flares in systemic lupus erythematosus: Diagnosis, risk factors and preventive strategies. Mediterr J Rheumatol, 28, 4–12. https://doi.org/10.31138/mjr.28.1.4
Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham 3rd, C. O., et al. (2010). 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European league against rheumatism collaborative initiative. Arthritis & Rheumatology, 62, 2569–2581. https://doi.org/10.1002/art.27584
Badr, H., Carmack, C. L., Kashy, D. A., Cristofanilli, M., & Revenson, T. A. (2010). Dyadic coping in metastatic breast cancer. Health Psychology, 29, 169–180. https://doi.org/10.1037/a0018165
Bermas, B. L., Tucker, J. S., Winkelman, D. K., & Katz, J. N. (2000). Marital satisfaction in couples with rheumatoid arthritis. Arthritis Care and Research, 13, 49–155.
Bodenmann, G., Pihet, S., & Kayser, K. (2006). The relationship between dyadic coping and marital quality: A 2-year longitudinal study. (2006). Journal of Family Psychology, 20, 485–493. https://doi.org/10.1037/0893-3200.20.3.485
Branco, J. C., Rodrigues, A. M., Gouveia, N., et al. (2016). Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: Results from EpiReumaPt- a national health survey. RMD Open, 2, e000166. https://doi.org/10.1136/rmdopen-2015-000166
Creed, F. (1990). Psychological disorders in rheumatoid arthritis: A growing consensus? Annals of Rheumatic Diseases, 49, 808–812. https://doi.org/10.1136/ard.49.10.808
Cross, M., Smith, E., Hoy, D., Camona, L., Wolfe, F., Vos, T., Williams, B., Gabriel, S., Lassere, M., Johns, N., Buchbinder, R., Woolf, A., & March, L. (2010). The global burden of rheumatoid arthritis: Estimates from the global burden of disease 2010 study. Annals of Rheumatic Diseasees, 73, 1316–1322. https://doi.org/10.1136/annrheumdis-2013-204627
Diamantopoulos, A., & Siguaw, J. A. (2000). Introducing LISREL. Sage Publications.
Dickens, C., Jackson, J., Tomenson, B., Hay, E., & Creed, F. (2003). Association of depression and rheumatoid arthritis. Psychosomatics, 44, 209–215. https://doi.org/10.1176/appi.psy.44.3.209
Dimitraki, G., & Karademas, E. C. (2014). The association of type 2 diabetes patient and spouse illness representations with their well-being: A dyadic approach. International Journal of Behavioral Medicine, 21, 230–290. https://doi.org/10.1007/s12529-013-9296-z
Dures, E., Almeida, C., Caesley, J., Peterson, A., Ambler, N., Morris, M., Pollock, J., & Hewlett, S. (2014). A survey of psychological support provision for people with inflammatory arthritis in secondary care in England. Musculoskeletal Care, 12, 173–181. https://doi.org/10.1002/msc.1071
Endler, N. S., Parker, J. D. A., & Summerfeldt, L. J. (1998). Coping with health problems: Developing a reliable and valid multidimensional measure. Psychological Assessment, 10, 195–205. https://doi.org/10.1037/1040-3590.10.3.195
Fekete, E. M., Stephens, M. A. P., Mickelson, K. D., & Druley, J. A. (2007). Couples' support provision during illness: The role of perceived emotional responsiveness. Families, Systems & Health, 25(2), 204–217. https://doi.org/10.1037/1091-7527.25.2.204
Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology and Health, 18, 141–184. https://doi.org/10.1080/088704403100081321
Hammond, L. D., & Hirst-Winthrop, S. (2016). Proposal of an integrative model of adjustment to chronic conditions: An understanding of the process of psychosocial adjustment to living with type 2 diabetes. Journal of Health Psychology. https://doi.org/10.1177/1359105316664131
Hays, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford.
Heijmans, M., de Ridder, D., & Bensing, J. (1999). Dissimilarity in patients’ and spouses’ representations of chronic illness: Explorations of relations to patient adaptation. Psychology and Health, 14, 51–466. https://doi.org/10.1080/08870449908407340
Hochberg, M. C. (1997). Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis & Rheumatology, 40, 1725. https://doi.org/10.1002/art.1780400928
Homer, D. (2005). Addressing psychological and social issues of rheumatoid arthritis within the consultation: A case report. Musculoskeletal Care, 3, 54–59. https://doi.org/10.1002/msc.26
Hresko, A., Lin, T. C., & Solomon, D. H. (2018). Medical care costs associated with rheumatoid arthritis in the US:A systematic literature review and meta-analysis. Arthritis Care & Research, 70, 1431–1438. https://doi.org/10.1002/acr.23512
Joreskog, K. G., & Sorbom, D. (2006). LISREL 8.80 for windows. Scientific Software International, Inc..
Karademas, E. C., Zarogiannos, A., & Karamvakalis, N. (2010). Cardiac patient–spouse dissimilarities in illness perception: Associations with patient self-rated health and coping strategies. Psychology and Health, 25, 451–463. https://doi.org/10.1080/08870440802652089
Karademas, E. C., Dimitraki, G., Thomadakis, C., & Giannousi, Z. (2019). The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer. Journal of Psychosocial Oncology, 37, 145–159. https://doi.org/10.1080/07347332.2018.1508534
Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical psychology (Vol. 2, pp. 7–30). Pergamon.
Leventhal, H., Nerenz, D. R., & Steele, D. J. (1984). Illness representations and coping with health threats. In A. Baum, S. E. Taylor, & J. E. Singer (Eds.), Handbook of psychology and health: Social psychological aspects of health (Vol. 4, pp. 219–252). Erlbaum.
Leventhal, H., Halm, E., Horowitz, C., Leventhal, E. A., & Ozakinci, G. (2005). Living with chronic illness: A contextualized, self-regulation approach. In S. Sutton, A. Baum, & M. Johnston (Eds.), The SAGE handbook of Health Psychology (pp. 197–240). Sage.
Leventhal, H., Phillips, L. A., & Burns, E. (2016). The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39, 935–946. https://doi.org/10.1007/s10865-016-9782-2
Mallinckrodt, B., Abraham, W. T., Wei, M., & Russell, D. W. (2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53, 372–378. https://doi.org/10.1037/0022-0167.53.3.372
Manne, S. L., & Zautra, A. J. (1989). Spouse criticism and support: Their association with coping and psychological adjustment among women with rheumatoid arthritis. Journal of Personality and Social Psychology, 56, 608–617. https://doi.org/10.1037//0022-3514.56.4.608
Markusse, I.M., Dirven, L., Gerards, A.H., van Groenendael, J. H. L. M., Karel Ronday, H., Kerstens, P. J. S. M., Lems,W. F., Huizinga, T. W. J., & Allaart, C. F. (2015). Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthritis Research & Therapy, 17, 232. https://doi.org/10.1186/s13075-015-0730-2.
Martire, L. M., Schulz, R., Keefe, F. J., Starz, T. W., Osial, T. A., Dew, M. A., et al. (2003). Feasibility of a dyadic intervention for management of osteoarthritis: A pilot study with older patients and their spousal caregivers. Aging and Mental Health, 7, 53–60. https://doi.org/10.1080/1360786021000007045
Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., & Cameron, L. D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology & Health, 17, 1–16. https://doi.org/10.1080/08870440290001494
Nezu, A. M., Nezu, C. M., Felgoise, S. H., McClure, K. S., & Houts, P. S. (2003). Project genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. Journal of Consulting and Clinical Psychology, 71, 1036–1048. https://doi.org/10.1037/0022-006x.71.6.1036
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. https://doi.org/10.3758/brm.40.3.879
Richardson, E. M., Schuz, N., Sanderson, K., Scott, J. L., & Schuz, B. (2017). Illness representations, coping, and illness outcomes in people with cancer: A systematic review and metaanalysis. Psychooncology, 26, 724–737. https://doi.org/10.1002/pon.4213
Riemsma, R. P., Taal, E., & Rasker, J. J. (2000). Perceptions about perceived functional disabilities and pain of people with rheumatoid arthritis: Differences between patients and their spouses and correlates of well-being. Arthritis Care and Research, 13, 255–261.
Riemsma, R. P., Taal, E., & Rasker, J. J. (2003). Group education for patients with rheumatoid arthritis and their partners. Arthritis and Rheumatism, 49, 556–566. https://doi.org/10.1002/art.11207
Segui, J., Ramos-Casals, M., Garcia-Carrasco, M., de Flores, T., Cervera, R., Valdes, M., Font, J., & Ingelmo, M. (2000). Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: A longitudinal study of active and inactive stages of the disease. Lupus, 9, 584–588. https://doi.org/10.1191/096120300678828730
Stanton, A. L., Revenson, T. A., & Tennen, H. (2007). Health psychology: Psychological adjustment to chronic disease. Annual Review of Psychology, 58, 565–592. https://doi.org/10.1146/annurev.psych.58.110405.085615
Steiger, J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences, 42, 893–898. https://doi.org/10.1016/j.paid.2006.09.017
Sterba, K. R., DeVellis, R. F., Lewis, M. A., DeVellis, B. M., Jordan, J. M., & Baucom, D. H. (2008). Effect of couple illness perception congruence on psychological adjustment in women with rheumatoid arthritis. Health Psychology, 27(2), 221–229. https://doi.org/10.1037/0278-6133.27.2.221
Tan, E. M., Cohen, A. S., Fries, J. F., Masi, A. T., McShane, D. J., Rothfield, N. F., et al. (1982). The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatology, 25, 1271–1277. https://doi.org/10.1002/art.1780251101
Walsh, J. D., Blanchard, E. B., Kremer, J. M., & Blanchard, C. G. (1999). The psychosocial effects of rheumatoid arthritis on the patient and the well partner. Behaviour Research and Therapy, 37, 259–271. https://doi.org/10.1016/S0005-7967(98)00128-4
Zangi, H. A., Ndosi, M., Adams, J., et al. (2015). EULAR recommendations for patient education for people with inflammatory arthritis. Annals of the Rheumatic Diseases, 74, 954–962. https://doi.org/10.1136/annrheumdis-2014-206807
Acknowledgements
We are very grateful to the medical and nursing staff at the Rheumatology Clinic, University of Crete Hospital in Heraklion for the co-operation in the study. We would, also, like to thank the Arthritis Foundation of Crete for their support and especially, Katerina Koutsogianni and Ioannis Papadakis. We would like to extend our gratitude to the patients and their partners who devoted considerable time and effort to take part in this study.
Funding
This study was funded in part by a grant to PS entitled “Cognitive, psychosocial, and physiological aspects of patient adaptation and well-being in autoimmune chronic diseases: A longitudinal study of multiple sclerosis and rheumatoid arthritis”, implemented under the “ARISTEIA” Action of the “OPERATIONAL PROGRAMME EDUCATION AND LIFELONG LEARNING” and supported by the European Social Fund (ESF) and National Resources (Grant number 212).
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Conceptualization: Dimitraki Georgia; Methodology: Dimitraki Georgia, Karademas C. Evanggelos; Formal analysis and investigation: Dimitraki Georgia, Karademas C. Evanggelos; Writing original draft preparation: Dimitraki Georgia; Writing –review and editing: Dimitraki Georgia, Karademas C. Evanggelos, Simos Panagiotis, Emmanouil Papastefanakis, Georgia Ktistaki, Antonis Fanouriakis, Christina Adamichou, Nikolaos Kougkas, Argyro Repa, Nestor Avgoustidis, George Bertsias, Prodromos Sidiropoulos, Alexandros N. Vgontzas; Funding acquisition: Simos Panagiotis; Resources: Karademas C. Evanggelos, Simos Panagiotis; Supervision: Karademas C. Evanggelos.
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Approval was obtained from the ethics committee of the University General Hospital of Heraklion. All procedures followed were accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Dimitraki, G., Papastefanakis, E., Ktistaki, G. et al. The relation of partners’ illness representations to the coping behaviors of patients with inflammatory rheumatic diseases through patients’ illness representation: A dyadic regulation process. Curr Psychol 42, 16923–16931 (2023). https://doi.org/10.1007/s12144-022-02937-y
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DOI: https://doi.org/10.1007/s12144-022-02937-y