Psychological Aspects of Rheumatoid Arthritis

The main research described in this book is concerned with assessing the interrelationship of psychological adjustment, compliance with medical advice and use of unorthodox treatments in a sample of rheumatoid arthritic out-patients. Basically this research is comprised of four components: two pilot studies; the development and postal administration of an illness knowledge assessment questionnaire; and a 'follow-up' correlational study. pilot study 1, which involved interviews with 18 patients, was a 'question seeking' study - the aim being to develop research questions of relevance to the Subject sample. The findings of this study suggested that poor illness knowledge and consequent misconceptions was contributing to psychological distress and affecting health behaviour among patients. In pilot study 2 a sample of 17 patients were questioned in detail - but using open-ended questions - about their understanding of their condition and treatment. The results of this study supported the impression gained in pilot study 1, that patients were typically ill-informed about their illness and tended, in the absence of correct information, to overestimate "the risks associated with rheumatoid arthritis and underestimate the value of treatments.

1 Introduction.- Rheumatoid Arthritis.- Psychological Issues in Rheumatoid Arthritis.- Plan of the Book.- 2 Psychological Distress in Rheumatoid Arthritis.- Incidence and Nature of Distress.- Explaining Psychological Distress in Rheumatoid Arthritis ― Response or Antecedent?.- Predictors of Psychological Distress in Rheumatoid Arthritis.- Demographic and Disease Related Factors.- Coping.- Control.- Illness Knowledge.- Positive Reactions to Illness.- 3 Compliance with Medical Advice.- Incidence of Non-Compliance.- Problems with Compliance Research.- Factors Associated with Compliance.- Health Beliefs.- Knowledge.- The Doctor-Patient Relationship.- Health Locus of Control.- Patient Knowledge.- The Adequacy of Patient Knowledge.- Why Do Patients Know So Little?.- 4 Unorthodox Treatment Use.- Limitations of Research on Unorthodox Treatment Use.- Why Do People Turn To Unorthodox Treatments?.- The Sophistication Hypothesis.- The Legitimisation and Psychological Needs Theories.- Dissatisfaction with Conventional Medical Care.- The Pulling Power of Unorthodox Treatments.- The Dimensionality of Unorthodox Treatment Use.- 5 Pilot Study 1 ― An Exploration of Psychological Issues in Rheumatoid Arthritis.- Method.- Subjects.- Results and Discussion.- Emotional Reactions to Illness.- Effects on Life.- Pain.- Role and Effects of Stress.- Reactions of Families.- The Doctor-Patient Relationship.- Knowledge and Misconceptions.- 6 Patients’ Knowledge and Misconceptions about their Illness.- Pilot Study 2.- Subjects.- Results and Discussion.- (1) The Disease Process and General Knowledge about Rheumatoid Arthritis.- (2) Knowledge about Treatments.- (3) Prognosis.- Conclusions.- Postal Questionnaire Study.- Subjects.- Analysis and Results.- (1) Patients’ Knowledge and Misconceptions about Rheumatoid.- Arthritis as Assessed by the Questionnaire.- (2) The Questions Patients Asked.- 7 Methodology of the Main Correlational Study.- Subjects.- Interview Schedule.- Compliance.- Use of Unorthodox Treatments.- Exercise Habits.- Medical Treatment.- Emotional Reactions to Rheumatoid Arthritis.- Demographic Details and Illness History.- Questionnaires.- Beliefs about Pain Control Questionnaire (BPCQ).- General Health Questionnaire (GHQ -60).- McGill Pain Questionnaire (MPQ).- Pain Assessment Questionnaire (PAQ).- Disability Index of the Health Assessment Questionnaire.- Statistical Analyses.- Interpretation of Factors.- 8 Psychological Distress ― Results and Discussion.- Incidence, Severity and Nature of Psychological Distress.- The Dimensionality of Distress.- Relationship of Adjustment and Demographic Variables.- Disease Variables and Adjustment.- Control and Adjustment.- Illness Knowledge and Adjustment.- Feelings about Conventional Medical Treatment and Adjustment.- Positive Effects of Illness.- Summary.- 9 Compliance with Conventional Medical Treatment ― Results and Discussion.- Incidence of Non-Compliance.- The Dimensionality of Compliance.- Pain Locus of Control and Compliance.- Psychological Adjustment and Compliance.- Demographic Variables and Compliance.- Illness Knowledge, Health Beliefs and Compliance.- Summary.- 10 Use of Unorthodox Treatments ― Results and Discussion.- Amount and Type of Use.- The Reasons Patients Gave for Trying Unorthodox Treatments.- The Dimensionality of Unorthodox Treatment Use.- Disease Variables and Unorthodox Treatment Use.- Psychological Distress and Use of Unorthodox Treatments.- Positive Effects of Illness and Unorthodox Treatment Use.- Pain Locus of Control and Unorthodox Treatment Use.- Conventional Medical Treatment and Unorthodox Treatment Use.- The Sophistication Hypothesis of Unorthodox Treatment Use.- Demographic Variables and Unorthodox Treatment Use.- Summary.- 11 Conclusions.- References.