Antonia C. Lyons

Well-being in Rheumatoid Arthritis: The Effects of Disease Duration and Psychosocial Factors

This study examined the multivariate relationships of psychosocial factors with well-being in rheumatoid arthritis (RA). Fifty-five patients with early RA (< six months), 52 with intermediate RA (one-seven years) and 47 with established RA (> seven years) completed questionnaires on psychosocial factors and psychological and physical well-being. Illness perceptions related to worse depression and life satisfaction (especially in early RA) and to longer morning stiffness (especially in intermediate RA). Optimism related to lower pain in early and intermediate RA. Social support related to lower fatigue in established RA. Indications for interventions targeted by disease duration are discussed.

Psychological well‐being across 1 year with rheumatoid arthritis: Coping resources as buffers of perceived stress

OBJECTIVES Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well-being among rheumatoid arthritis (RA) patients. DESIGN A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year. METHODS Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well-being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for. RESULTS Perceived stress had the strongest relationship with psychological well-being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well-being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months. CONCLUSIONS Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.

Critical Health Psychology

Health psychology is concerned with applying psychological knowledge to all aspects of physical health and illness. Traditionally dominated by positivist approaches, in recent years critical perspectives have been increasingly employed. These focus on understandings of health and illness as socially, culturally, politically and historically situated and contributing to enhanced health and well-being. Critical health psychology approaches are sensitive to issues of power and benefit from theoretical and methodological pluralism. Key areas in critical health psychology include exploring people’s experiences of health and illness; working with people in marginalised or vulnerable groups to provide insights; achieving change and social justice in communities through interventions and activism; engaging with arts-based approaches to researching health and illness; examining how health is understood in everyday life; and highlighting how the physical, psychosocial and economic environments in which we live dramatically influence our health.

Food Allergy in Young Adults: Perceptions and Psychological Effects

Although food allergy can have serious health consequences, little is currently known about people’s perceptions of food allergy. The present study examined the differences in awareness and perceptions of food allergy and anxiety between young people with and without a food allergy. Participants completed a questionnaire which asked about their perceptions and knowledge of allergies, perceived health competence and anxiety. Of the 162 participants 24 reported they were allergic to at least one food; these people perceived that their allergy had significantly less of an impact on their lives than others believed it would. Allergy status interacted with perceived health competence to affect anxiety. People with an allergy and with high health competence reported the greatest anxiety levels. Very few of the sample knew the meaning of the term ‘anaphylaxis’. Findings are discussed in terms of health education implications and possibilities.

‘Hardcore Drinking’: Portrayals of Alcohol Consumption in Young Women’s and Men’s Magazines

Young adults and young women in particular are drinking more alcohol than ever before, with implications for risky behaviours and long-term health. This study explored the ways in which alcohol and drinking were represented in six monthly UK magazines (three targeted at young men, three at young women) across a threemonth period (18 magazines). We identified three main discourses across the texts, namely the drug alcohol; masculinity and machismo; and drinking as normality. These discourses constructed women’s and men’s drinks and drinking behaviours in sharp contrast. Drinking was aligned with traditional masculine images, although new kinds of drinks were aligned with traditional feminine images—and derided in men’s magazines. Findings highlight how gender, constructed in relation to the other, is an important aspect of representations of drinking patterns in young adults.

Youth drinking cultures, social networking and alcohol marketing: implications for public health

Alcohol consumption and heavy drinking in young adults have been key concerns for public health. Alcohol marketing is an important factor in contributing to negative outcomes. The rapid growth in the use of new social networking technologies raises new issues regarding alcohol marketing, as well as potential impacts on alcohol cultures more generally. Young people, for example, routinely tell and re-tell drinking stories online, share images depicting drinking, and are exposed to often intensive and novel forms of alcohol marketing. In this paper, we critically review the research literature on (a) social networking technologies and alcohol marketing and (b) online alcohol content on social networks, and then consider implications for public health knowledge and research. We conclude that social networking systems are positive and pleasurable for young people, but are likely to contribute to pro-alcohol environments and encourage drinking. However, currently research is preliminary and descriptive, and we need innovative methods and detailed in-depth studies to gain greater understanding of young people’s mediated drinking cultures and commercial alcohol promotion.

Medication adherence in rheumatoid arthritis: effects of psychosocial factors

Several demographic and psychosocial factors have been shown to predict adherence to medication for different chronic illnesses, including age, satisfaction with medical consultations, social support, optimism, and perceptions of medications. However, little is known about how these factors relate to adherence in people living with rheumatoid arthritis (RA). Cross-sectional predictors of medication adherence were investigated among 85 outpatients with RA (75% women; mean age 58.88 years; mean disease duration 10.29 years). Participants completed questionnaire measures of psychosocial factors and adherence, while details of medication consumption, comorbidity and objective measures of disease activity (inflammation) were recorded from medical files. Results demonstrated that holding stronger beliefs about the necessity of medications, and believing that medications are generally not overused, predicted higher reported adherence to RA medications (over and above relevant demographic and medical factors). Adherence was also higher in people taking higher numbers of medications. These findings highlight the important role perceptions regarding medications play in terms of adhering to specific medication(s) and may prove beneficial in educational interventions for people with RA and health professionals who care for them.

Encompassing experience: Meanings and methods in health psychology

Abstract Health psychology is limited by its almost exclusive use of a positivist quantitative research paradigm, and the adoption and use of qualitative methods by health psychologists will provide increased understandings of health and illness. Qualitative methods provide a means to incorporate the social world into our research, and furnish ways to investigate the meanings of health and illness experience. We present a brief consideration of the qualitative paradigm and some important underlying issues related to its use. We describe three qualitative approaches - grounded theory, narrative analysis, and discourse analysis - chosen for their relevance and diversity. We provide illustrations of the use of each in health research, and suggest how these approaches could be utilised by health psychologists to enrich understanding in the health field. We conclude that health psychologists have a great deal to gain from joining other social science health researchers in adopting qualitative approaches in the...

Predictors of fatigue over 1 year among people with rheumatoid arthritis

Fatigue is a systemic feeling of exhaustion that is a common symptom of many chronic illnesses, including the autoimmune inflammatory disease rheumatoid arthritis (RA). We examined predictors of levels of fatigue among people with RA using Leventhals Common-Sense Model (CSM), which states that cognitive representations of an illness spur (or halt) peoples efforts to cope and thereby influence outcomes of the illness. Our use of the CSM was designed in the light of evidence in the literature specific to fatigue in RA. Current fatigue was reported on a 100 mm visual analogue scale (with anchors “No fatigue” and “Unbearable fatigue”) by 114 people (73.7% women) with RA at baseline and 1 year later. Baseline employment status, pain, impact of disability, sleep disruption frequency, depressed mood, perceptions of consequences, arthritis self-efficacy and attempts to cope by praying/hoping were also self-reported. Duration of RA and a haematological measure of systemic inflammation (erythrocyte sedimentation rate; ESR) were obtained from hospital records. Unexpectedly, RA duration did not predict fatigue after 1 year, although lower baseline inflammation did (controlling for baseline fatigue and other disease impact variables). This may be due to sampling flares of RA at baseline. Baseline perceptions that RA has severe consequences and is uncontrollable also predicted greater fatigue after 1 year but this relationship was not mediated by praying/hoping. Targeted psychological care to modify perceptions of severe consequences may therefore improve later fatigue for people with RA even when the condition is longstanding, but the mechanisms of any benefit require further investigation.

‘Concealing the Evidence’: The Importance of Appearance Concerns for Patients with Systemic Lupus Erythematosus

Outwardly visible signs associated with systemic lupus erythematosus (SLE) can include facial rashes, alopecia and weight gain. We sought to understand the concerns of SLE patients about their appearance and the recognition of this by healthcare professionals. Semi-structured interviews were carried out with 10 women aged 26-68 years diagnosed with SLE for one to 12 years. Data were analysed with Interpretative Phenomenological Analysis (IPA); this seeks to describe and provide understanding of people’s experience of a phenomenon by studying in-depth a small number from a relatively homogeneous group (women with SLE in the present study). Analysis revealed three themes concerning appearance issues. Participants described public self-consciousness after the onset of SLE. Cosmetics and clothing were used skilfully to appear ‘normal’, hide the ‘self’ and assert control but could increase feelings of difference and isolation. Self-imposed isolation was also described and may relate to depression. The understanding of family, friends, colleagues and healthcare providers was also important. Awareness of the psychosocial concerns of SLE patients with life-changing skin disease may enable multidisciplinary healthcare teams to offer a more sensitive, practical service. The physical and emotional needs of SLE patients need to be ascertained and appropriate educational and psychological services are required.