Psychosocial Aspects of Rheumatological Disorders
The effective care and management of those with chronic rheumatological disorders requires that all health professionals involved in their management understand the psychological, emotional and social impact and problems of the disorders. All types of chronic conditions have the potential for a severe impact on all aspects of patient’s lives. Issues for those with a chronic rheumatological disease include the uncertainty about the disease process, their loss of control over the disease process, their altered body image, a loss of independence, fear, anxiety and depression.
The experience of the impact of a chronic disease on an individual is an interaction of their personality, life experiences, home and work environment, their social support and cultural beliefs – all of these interact illness experience. Social network characteristics and pain-coping strategies have been shown to be predictive of functional outcomes in those with rheumatoid arthritis . Those living with rheumatoid arthritis have reported disrupted leisure activities, limitations in employment and half report lost social relationships .
Those with a diagnosis of any chronic illness go through a series of adaptations seen in life threatening illnesses (ie shock, anger, denial, resignation and finally, acceptance) the degree that each stage affects individuals will depend on severity and how much they impact on lifestyle. Time will be needed to adjust to alterations in everyday functions. Coping is the individuals attempts to limit the effect of stressors, such as having a diagnosis of “arthritis”. The strategies used can involve behaviours such as seeking further information, expressing anger or going into denial.
The fear of being disabled psychological problems (eg frustration, depression) that may require intervention. Chronic pain is an important influencing factor in psychological problems. To cope with the physical aspects of rheumatological disease, individuals are likely to use a number of coping mechanisms the use of these coping mechanisms will influence the use of interventions that may be needed.
Depression is associated with rheumatoid arthritis and most other chronic illnesses. Those with rheumatoid arthritis are twice as likely as the general population to have signs of a depressive illness. This will increase the burden of the illness, affect the way they function and interact socially. Depression can affect pain levels and disability – pain levels and disability can affect depression. Social factors and social support are also associated with depression.
Social support is the process in which interpersonal relationships mediate, protect people from declining health and promote good health protective behaviours. In many studies in many illnesses, good social support has been shown to reduce morbidity and mortality. The family is often the main source of social support. For the family, there may be one of three effects when a family member has a diagnosis of ‘arthritis’ :
1) It brings the family closer together
2) The family experiences minimal alterations in their roles
3) There is a negative effect on family relationships
importance of role of family in social support, but also the affect that family relationships may have on the person with rheumatological disease.
Some disorders have neuropsychiatric manifestations (eg SLE).
Psychological, psychosocial and educational interventions and support can be beneficial – especially from the use of patient support groups.
Enabling people with a rheumatological disease to develop effective coping strategies include :
• providing information specific to individual needs
• ascertaining patients’ perceptions of their conditions and confidence in proposed interventions before negotiating a treatment plan
• enabling patients to decide on their treatment
• identifying perceived barriers to treatment
• arranging regular evaluation, so that if treatment is not working it can be modified
• arranging individual or group education to develop self management techniques
The provision of information to those with a rheumatological disease can be problematic – a lot of information given in a consultation is not recalled immediately afterwards and in a rheumatology clinic only 40% of the information given was recalled, but 48% of this was misconstrued or imagined . This points to the need to elicit the beliefs that those with a disease have about the disease, so information can be targeted more appropriately – if information given by the health professional does not concur with the patients beliefs, they tend to reject it or modify it . Eliciting these beliefs can help ensure that health professionals can provide information that is relevant and in a form that can have meaning for them in the context of their beliefs .