Stress and Coping in the Context of Meaning-Making in Patients with Rheumatoid Arthritis

Abstract

Meaning-making is important for those with chronic illness because adjustment to threatening situations is partially determined by the individual‟s ability to find meaning in adverse circumstances. An integrative theoretical and empirical approach to meaning-making has been proposed, outlining how people respond to stressful events. Numerous different meanings can be made including the sense of having „made sense‟, acceptance, re-attributions and casual understanding, perceptions of growth or positive life changes, and integration of the stressful experience into identity. The relationship between rheumatoid arthritis (RA) and stress supports a link between stressors and vulnerability factors such as illness perceptions and coping responses on the course of RA disease activity. Further, both the HPA axis and SAM physiological stress systems are associated with RA appearing to mediate the relationship between environmental stressors and RA. The general aim of this study was to investigate stress, coping strategies and illness perceptions in the context of „meaning-making‟ in relation to a range of psychosocial outcome measures in a patient population suffering from RA. More specifically, the study sought to determine whether there were associations between how RA patients ascribe meaning to their illness and their quality of life, post-traumatic growth, perceived stress, anxiety, depression, acceptance and illness identity. This study also investigated whether different causal attributions, specifically stress and non-stress, are associated with a variety of psychosocial health outcomes. In adopting an illness perceptions model to investigate psychosocial outcomes in the context of meaning-making, monitoring and blunting coping strategies were also assessed to determine whether they were associated with positive or negative psychological and physiological health outcomes. The research employed a correlational design using emotional expression, illness perceptions, coping strategies as well as several health outcome measures. Forty seven participants with RA, recruited via Arthritis New Zealand, consented to participate in the study. They completed a questionnaire and expressive writing task assessing whether they had found meaning, their coping strategies with medical threat, illness perceptions, post-traumatic growth, perceived stress, anxiety, depression, acceptance, illness identity and quality of life. Significant differences were found between the Seeking Meaning and Found Meaning groups on the Quality of Life physical health subscale, indicating that seeking meaning is associated with lower self-reported physical health than having found meaning. Significant differences were also found between the Seeking Meaning and Found Meaning groups in the HADS Anxiety and Quality of Life environment subscales, indicating that seeking meaning is associated with higher levels of anxiety among RA participants and also that the process of seeking meaning is associated with poorer environments, effecting the quality of life of patients with RA. Differences were found between the Stress and Non-stress groups on the post-traumatic growth strength subscale and on the physical health subscale of the WHO quality of life measure. These findings suggest that those RA participants that consider stress among their top 3 causal attributions have improved self-reported physical health in the area of quality of life and also strength from post-traumatic growth than do those RA participants who did not attribute stress as a significant cause of their RA. Scores on the Monitoring scale were significantly associated with post-traumatic growth scores, indicating that those participants that adopt a monitoring approach to coping with RA report improved overall post-traumatic growth. There was also an association between Monitoring scores and HADS Anxiety, indicating that those participants that adopt a monitoring approach to coping with RA report high levels of anxiety. Finally, a significant association was found between Blunting scores and the PTGI Spiritual subscale, indicating that those RA participants high in Blunting were more likely to report greater post-traumatic growth in the spiritual domain. Findings from this study underscore the significance of stress, coping strategies and illness perceptions across a range of health outcome measures in the context of meaning-making in patients with RA. Results should be interpreted cautiously however, taking into account considerations of statistical analysis such as low sample size and possible sampling bias.