Objective: Individual differences in adjustment during a disease's course determine psychological response and outcome. We aimed to investigate prospectively whether coping with health stressors capacity and self-sacrificing defense style could predict psychological adjustment and health-related quality of life (HRQoL) in patients with Rheumatoid Arthritis (RA).
Methods: 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 self-sacrificing defense style moderated the relationships between improvement in pain and improvement in overall general health (p=0.024) and improvement in social relations HRQoL (p=0.006), which means that pain improvement predicted improvement in overall general health and social relations HRQoL only in those RA patients who did not adopt a self-sacrificing defense style (Figure 1).
These findings indicate that, in RA, the patients’ capacities to cope with the illness (sense of coherence) 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.