Evaluation of coping strategies in established rheumatoid arthritis patients: emergence of concealment in an Asian cohort

摘要

Abstract Aim To evaluate coping strategies of Asian RA patients and their associations with health‐related quality of life ( HRQ oL). Methods A cross‐sectional sample of patients with established RA was evaluated using measures of coping (Coping in Rheumatoid Arthritis Questionnaire [C‐ RAQ ]; appraisal of coping effectiveness and helplessness), HRQ oL (Mental and Physical Components [ MCS / PCS ] of the Short Form 12v2; Rheumatoid Arthritis Impact of Disease score [ RAID ]) and clinical/laboratory assessments. Principal component analysis was conducted to identify coping strategies. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQ oL outcomes. Results The study sample comprised 101 patients, 81% female, 72.3% Chinese, mean age 54.2 ± 12.6 years. Five coping strategies were identified: Active problem solving ( E = 5.36), Distancing ( E = 2.30), Concealment ( E = 1.89), Cognitive reframing ( E = 1.55) and Emotional expression ( E = 1.26). Concealment was consistently associated with PCS ( r s = ?0.23, P = 0.049), MCS ( r s = ?0.24, P = 0.04) and RAID ( r s = 0.39, P 0.001), and was significant in the multivariate model to explain lower disease‐specific HRQ oL ( RAID ) even after adjusting for disease activity, coping effectiveness and helplessness (β = 0.20, P = 0.04). Emotional expression was associated with poorer physical HRQ oL ( PCS ), after adjusting for disease severity, body mass index, coping effectiveness, helplessness and Concealment (β = ?0.39, P 0.001). Perceived coping‐related helplessness was significant in multivariate correlates for PCS (β = ?0.25, P = 0.036), MCS (β = ?0.29, P = 0.02) and RAID (β = 0.53, P 0.001), after adjusting for covariates. Conclusion Concealment and Emotional expression are associated with lower disease‐specific HRQ oL and physical HRQ oL respectively, with the former coping strategy likely to be culture‐specific. Interventions should tailor psychosocial support needs to address not only coping strategies, but patients’ perception of their coping.