Jerry C. Parker

Self-efficacy predicting outcome among fibromyalgia subjects

OBJECTIVES This study examined whether pretreatment self-efficacy and pre- to post-treatment changes in self-efficacy predict post-treatment tender point index, disease severity, pain, and physical activity. METHODS One hundred nine subjects with fibromyalgia were assessed before and after a 6-week training intervention. Measures included tender point index, physician ratings of disease severity, the visual analog scale for pain, the Physical Activities subscale of the Arthritis Impact Measurement Scales, and the Arthritis Self-Efficacy Scale. RESULTS Pretreatment self-efficacy significantly predicted post-treatment physical activity, with higher self-efficacy associated with better physical activity outcome. Changes in self-efficacy significantly predicted post-treatment tender point index, disease severity, and pain; improvements in self-efficacy were associated with better outcomes on each measure. CONCLUSIONS Higher levels of self-efficacy are associated with better outcome, and may mediate the effectiveness of rehabilitation-based treatment programs for fibromyalgia.

Self-efficacy and pain behavior among subjects with fibromyalgia

&NA; Given the lack of objective physical measures for assessing fibromyalgia syndrome (FS), the role of pain assessment is particularly important. The role of psychological factors is controversial among FS patients. This study was designed to better understand the relationship between pain behaviors and psychological variables. Specifically, this study(1) refined a pain behavior observation (PBO) methodology for use with FS patients,(2) determined whether stretching is a valid pain behavior,(3) assessed whether psychological variables including self‐efficacy and/or depression can predict pain behaviors after controlling for disease severity and age. The 73 FS subjects meeting the American College of Rheumatology classification system completed questionnaires measuring self‐efficacy, depression, and pain. Trained physicians conducted tender‐point examinations. Subjects were videotaped using a standardized procedure. Two trained raters independently coded all pain behaviors. Kappa coefficients and correlations among pain behaviors and self‐reported pain indicated that the PBO method was both reliable and valid. However, the newly defined pain behavior ‘stretching’ was found to be negatively associated with self‐reported pain. Hierarchical multiple regression (MR) analyses revealed that depression did not predict pain behavior over and above myalgic scores and age; however, in 3 separate MR analyses, self‐efficacy for function, pain, and other symptoms each predicted pain behavior over and above myalgic scores and age. This study indicated that the original pain behavior scoring methodology is appropriate for use with the FS population and should not be modified to include the pain behavior ‘stretching’. Self‐efficacy was related to pain behavior while depression was not among this FS sample.

Pain-Patient MMPI Subgroups: The Psychological Dimensions of Pain

Two-hundred-forty male pain patients were given the MMPI and an extensive pain history questionnaire. A hierarchical clustering procedure was used, and three distinct profiles emerged. One profile was essentially “normal,” while a second profile revealed the “hypochondriasis” configuration, and a third was highly elevated on scales which reflect a “psychopathological” type of profile. A discriminant analysis yielded functions correctly classifying over 90% of the subjects in each group. Although the three groups did not significantly differ on age, education, income, IQ, assertiveness, type of pain, or years of pain duration, they did differ on the pain history questions relating to pain severity and pain impact on their lives. The psychopathological group reported significantly more distress than the hypochondriasis group, and the hypochondriasis group reported significantly more distress than the normal group. The implications for pain treatment are discussed.

Age, depressive symptoms, and rheumatoid arthritis

OBJECTIVE To examine the relationship between age and depression in persons with rheumatoid arthritis (RA). METHODS Two separate outpatient cohorts of persons with RA were studied. In both studies, the Center for Epidemiological Studies Depression Scale was administered to all subjects, and the prevalence of depressive symptoms was determined by age group. In the second study, data on additional measures of disease activity, pain, life stress, and coping were collected for use in multiple linear regression analyses. RESULTS In both samples, a significant correlation between age and depression was found; younger persons (age < or = 45 years) with RA were significantly more depressed, even after controlling for potentially confounding variables such as sex, marital status, antidepressant medication, arthritis medication, functional class, and disease duration. CONCLUSION The findings show that younger persons with RA are at higher risk for depressive symptoms than their older counterparts.

NEGATIVE AFFECT AND PAIN IN ARTHRITIS

The experience of pain in arthritis conditions has important affective dimensions. This article reviews evidence for a relatively strong association between negative affect (i.e., depression, anxiety, and anger) and arthritis-related pain. Possible physiologic and psychologic mechanisms of the relationship between negative affect and pain are examined, and issues relevant to future research, particularly the need for biopsychosocial theoretical models are discussed. Finally, the article highlights the importance of biopsychosocial treatment approaches in managing arthritis-related pain and negative affect.

A biopsychosocial model of disability in rheumatoid arthritis

OBJECTIVE To test and cross-validate a model using disease activity, pain, and helplessness to predict future psychological and physical disability in persons with rheumatoid arthritis (RA) across time. METHODS Measures of disease activity, pain, helplessness, psychological function, and physical function were collected from 63 males with RA at baseline, 3 months, and 6 months. Path analytic methods were used to examine longitudinal relationships among these variables. RESULTS Path analysis revealed that pain and helplessness were significant mediators of the relationship between disease activity and future disability in RA; the predictive model withstood two cross-validations. CONCLUSION The findings suggest that pain and helplessness are key biopsychosocial variables that affect the development of disability in RA.

Risk factors for depression in rheumatoid arthritis

OBJECTIVE To identify risk factors for the development of depression in persons with rheumatoid arthritis (RA). METHODS Subjects were divided into depressed versus nondepressed groups on the basis of the Center for Epidemiologic Studies-Depression Scale; a range of psychological, pain-related, disease-related, and demographic variables were analyzed to predict depression. Both cross-sectional and longitudinal predictive models were examined. RESULTS A series of analyses, including multiple logistic regression, found that the optimal predictors of depression in RA were average daily stressors, confidence in ones ability to cope, and degree of physical disability. The model was successfully cross-validated on separate data sets (i.e., same subjects at different time points). CONCLUSION All of the identified risk factors for depression in RA are preventable to some extent and, therefore, should be addressed in comprehensive, rheumatology team care.

Stress Management in Rheumatoid Arthritis: What Is the Underlying Mechanism?

OBJECTIVE To test whether change in cognitive-behavioral variables (such as self-efficacy, coping strategies, and helplessness) is a mediator in the relation between cognitive behavior therapy and reduced pain and depression in persons with rheumatoid arthritis (RA). METHODS A sample of patients with RA who completed a stress management training program (n = 47) was compared to a standard care control group (n = 45). A path analysis testing a model including direct effects of comprehensive stress management training on pain and depression and indirect effects via change in cognitive-behavioral variables was conducted. RESULTS The path coefficients for the indirect effects of stress management training on pain and depression via change in cognitive-behavioral variables were statistically significant, whereas the path coefficients for the direct effects were found not to be statistically significant. CONCLUSION Decreases in pain and depression following stress management training are due to beneficial changes in the arenas of self-efficacy (the belief that one can perform a specific behavior or task in the future), coping strategies (an individuals confidence in his or her ability to manage pain), and helplessness (perceptions of control regarding arthritis). There is little evidence of additional direct effects of stress management training on pain and depression.

A confirmatory factor analysis of the center for epidemiologic studies depression scale in rheumatoid arthritis patients: Additional evidence for a four‐factor model

OBJECTIVE To examine the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in a sample of patients with rheumatoid arthritis (RA), testing all of the alternative models suggested by the previous evidence. METHODS The CES-D was administered to a group of RA patients (n = 685) during a structured telephone interview. The telephone interview was repeated 6 months later (n = 537) and 12 months later (n = 453). Confirmatory factor analyses were conducted to test alternative models. RESULTS The correlated 4-factor model and the second-order 4-factor model were the best fitting models. CONCLUSION The factor structure of the CES-D previously found in the general population was replicated in an RA sample. The results are consistent with previous evidence of criterion contamination in the CES-D when used in an RA sample and provide support for the view that a single summary score may not be the most informative index of the CES-D.

Mental status outcomes following carotid endarterectomy: A six-month analysis

Fifty-one male and two female patients were divided into the following three groups: (a) patients with symptomatic carotid artery disease who received carotid endarterectomies, (b) patients with symptomatic carotid artery disease who either declined or were not candidates for carotid endarterectomies, and (c) patients who received a surgical procedure unrelated to cerebral functioning. The three groups were not significantly different in terms of age or educational level. The subjects were examined using the WAIS, Wechsler Memory Scale, Halstead-Reitan Neuropsychological Battery, Sickness Impact Profile, and Profile of Mood States. The assessments were conducted presurgery and repeated at a 6 month follow-up. The results of two-way analyses of variance revealed a significant trials effect for a majority of the variables, including the average impairment rating and the full scale WAIS IQ. However, significant group x trials interactions were not found for either the neuropsychological measures or the quality of life indices. The results did not support the conclusion of improved mental status or increased psychosocial well-being in patients who received carotid endarterectomies.