Depression and pain in patients with rheumatoid arthritis: Mediating role of illness perception

Abstract

Illness perception is considered to be an important contributor in the relationship between physical and psychological factors in rheumatoid arthritis (RA). This study examined the mediational role of illness perceptions in the relationship between depression and pain in RA. Illness perception, depression and pain were assessed in 100 adults with RA (72 females and 28 males). Patients were asked to complete 4 questionnaires including socio-demographic data form, depression subscale of Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (Brief-IPQ) and Rheumatoid Arthritis Pain Scale (RAPS). Using the Baron and Kenny approach and Sobel tests, the mediation of illness perceptions in the relationship between depression and pain symptoms was examined. Sixty-six RA patients (66%) endorsed a clinically significant level of depression (HADS 12.94 ± 5.39). The mean RAPS was 41.97 ± 23.45 (range = 4–91.93). Depression symptoms were significantly associated with perceived pain (r = −0.57, p < 0.001). Three illness perceptions significantly mediated the relationship between depression and pain; consequences (z = 1.39, p < 0.05); personal control (z = 1.47, p < 0.05) and emotional response (z = 1.51, p < 0.05). Gender and education showed no significant effect on the presented results. Greater depression symptoms were associated with perceptions that pain negatively affected one’s life and emotions and was difficult to control. These negative illness perceptions were, in turn, related to greater pain symptoms. Illness perceptions helped explain the depression-pain link in RA patients. Results suggest that targeting illness perceptions in adults with RA and depression may help reduce pain symptoms.