Chronic anxiety, depression, alexithymia,post traumatic stress of chronic disease and mental resilience in patients suffering from rheumatoid arthritis and systemic lupus erythematosus

Postgraduate Thesis uoadl:2943540 130 Read counter

Unit:
Κατεύθυνση Προαγωγή ψυχικής υγείας - Πρόληψη ψυχιατρικών διαταραχών
Library of the School of Health Sciences
Deposit date:
2021-04-22
Year:
2021
Author:
Tzarima Sofia
Supervisors info:
Ρίζος Εμμανουήλ, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχόπουλος Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δουζένης Αθανάσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Το χρόνιο άγχος, η κατάθλιψη, η αλεξιθυμία, το ψυχοτραυματικό στρες της ασθενείας και η ψυχική ανθεκτικότητα σε ασθενείς που πάσχουν από ρευματοειδή αρθρίτιδα και συστηματικό ερυθηματώδη λύκο
Languages:
Greek
Translated title:
Chronic anxiety, depression, alexithymia,post traumatic stress of chronic disease and mental resilience in patients suffering from rheumatoid arthritis and systemic lupus erythematosus
Summary:
Introduction: Given the characteristics of chronicity, pain, functional disability, and deformity by the disease, more behaviors of depression, anxiety and stress can occur in a considerable proportion of patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), often reflecting the difficulties of these patients in coping with a chronic debilitating disorder. The recent studies investigate the presence of alexithymia in patients suffering from RA and SLE. Alexithymia is a disorder of the regulatory mechanism of the emotion elaboration; it is characterized by difficulties in differentiating and describing feelings. Patients experiencing chronic diseases have been studied with regard to depression, anxiety and alexithymia, but negligible attention has been given to the post traumatic stress potential of chronic disease. Many patients of severe chronic illness have traumatic memories such as nightmares, panic or pain which can be associated with the development of post-traumatic stress. Yet, evidence of other chronic diseases such as cardiovascular disease suggests that the post traumatic stress of chronic diseases, may produce maladaptive illness coping and worsen the prognosis of disease. Resilience as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma can be an important factor in (mental and physical) health promotion.
Purpose of the study: The aim of this study is to identify the prevalence of anxiety (as chronic stress) in people with rheumatoid arthritis and systemic lupus erythematosus. Other variables such as depression, anxiety, post traumatic stress of chronic disease and resilience were also studied. This study examines if these variables were correlated with socioeconomic and demographic characteristics, disease activity, medication adherence, and life- related habits (exercise, smoking, drinking alcohol).
Materials and Methods: The study population consists of 106 patients diagnosed with RA or SLE at the Rheumatology Department of the University General Hospital of Athens “ATTIKON”, patients suffering from SLE (n=64) and patients suffering from RA (n=42). Τhe majority of participants were women (93.4%), with a mean age of 50.8 years and 64.2% were married. 44.3% were diagnosed 3 to 7 years ago and according the onset of the first symptoms, 52.8% have experienced them for more than 7 years. A proportion of 66% have visited a psychiatrist or psychologist at least once. Regarding their working condition, 71.7% do not work.
The data collected during their visit to the rheumatology clinic of the Attiko General Hospital. The research took place over the period from September 2020 to November 2020.
Demographic and socio-economic data and informations about life- related habits (exercise, smoking, drinking alcohol) were recorded via questionnaires from the patients who took part in the research. The “Hospital Anxiety and Depression Scale” (HADS) used to assess depressive and anxiety symptoms. Alexithymia was screened using the 20-item version of “The Toronto Alexithymia Scale”, (TAS-20). Levels of post traumatic stress were estimated using an administered self-report questionnaire, “The Impact of Event Scale—Revised” (IES-R). Also, subjects were evaluated by using “The Connor‐Davidson resilience scale” (CD‐RISC), an instrument for measuring resilience. For the purpose of investigating the disease activity, the research tools were the Disease Activity Score 28 (DAS28) for RA patients and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for SLE patients.
Results: Anxiety (M=8.57) found to be mild. There was a statistically significant relation between anxiety and dose omission (p=0.004), subjective experience of worsening of chronic symptoms in the last two weeks (p <0.001), severity of the pain experienced by patients in the last week (p =0.001), disease activity in rheumatoid arthritis (p=0.008), and resilience (r=-0.337, p<0.05). Depression (M=8.09) was also found to be mild. There was a statistically significant relationship between depression and dose omission (p=0.018), subjective experience of worsening of chronic symptoms in the last two weeks (p =0.023), severity of the pain experienced by patients in the last week (p <0.001), diagnosis from 3 to 7 years (p =0.029), disease activity in rheumatoid arthritis (p=0.008), age of diagnosis (r=0.218, p <0.05), and resilience (r=-0.399, p<0.05). The overall mean score of TAS-20 indicated possible alexithymia (M=54.89). There was a statistically significant relation between the total TAS20 score and age (r=0.284, p-value<0.05), level of education (p =0.003), not work (Μ = 57.42 vs. M = 48.47, p <0.001), age of diagnosis (r=0.277, p <0.05), and resilience (r=-0.254, p- <0.05). A statistically significant relationship was found between the difficulty identifying feelings and age (r=0.196, p <0.01), not work (Μ= 21.16 vs. M = 18.10, p =0.028), disease activity in rheumatoid arthritis (p=0.003), age of diagnosis (r=0.221, p <0.01), and resilience (r=-0.223, p <0.01). A statistically significant relation was observed between the difficulty of describing feelings and level of education (p =0.002), not work, and resilience (r=-0.217, p <0.01). A statistically significant relation was found between the externally oriented thinking and age (r=0.349, p <0.05), level of education (p<0.001), not work (Μ = 20.87 vs. M = 18.50, p =0.012), and age of diagnosis (r=0.328, p <0.05). The overall mean score of IES-R indicated high post traumatic stress (M=4.89). A statistically significant relationship was found between the total IES-R score and subjective experience of worsening of chronic symptoms in the last two weeks (p <0.001), and severity of the pain experienced by patients in the last week (p =0.004). A statistically significant relationship was found between hyperarousal as a symptom of post-traumatic stress and dose omission (p=0.007), subjective experience of worsening of chronic symptoms in the last two weeks (p <0.001), and severity of the pain experienced by patients in the last week (p =0.002), and disease activity in rheumatoid arthritis (p=0.034). There was a statistically significant relation between intrusion of the traumatic event as a symptom of post-traumatic stress and subjective experience of worsening of chronic symptoms in the last two weeks (p <0.001), and severity of the pain experienced by patients in the last week (p =0.007). The total mean score of CD-RISC 25 was equal to 66.80±15.55. Exercise was associated with resilience (p=0.014). No statistically significant differences were found between patients with RA and SLE.
Conclusions: Anxiety (chronic stress) in our sample appeared to be mild and positively correlated with dose omission, subjective experience of worsening of chronic symptoms in the last two weeks, severity of the pain experienced by patients in the last week, disease activity in rheumatoid arthritis, and resilience. We can conclude that when health states are negative and patients enter a consequent negative state, then the evolution of physical and mental health is declining. These chronic health burdens cause more anxiety and less well being. This study confirms the psychological effects (anxiety, depression, alexithymia, and post- traumatic stress) of chronic diseases, rheumatoid arthritis and systemic lupus erythematosus. For this reason, it is necessary to develop preventive interventions that allow protective factors for resilience to be developed, which could improve the outcomes in health.
Main subject category:
Health Sciences
Keywords:
Chronic Anxiety, Depression, Alexithymia, Post Traumatic Stress Of Chronic Disease, Μental Resilience, Rheumatoid Arthritis, Systemic Lupus Erythematosus
Index:
No
Number of index pages:
0
Contains images:
No
Number of references:
711
Number of pages:
336
Tzarima Sofia MSc.pdf (3 MB) Open in new window