Psychological characteristics of patients with rheumatoid arthritis with severe anxiety and depression

The negative impact of chronic disease on the psychological well-being and adaptation of patients with rheumatoid arthritis (RA) remains a common problem despite advances in its comprehensive treatment and rehabilitation. In this context, it is important to investigate the psychological factors that determine the extent of anxiety and depression in patients with RA.

Objective: to analyze the perception of the disease, mindfulness and self-compassion as psychological characteristics of patients with RA and marked anxiety-depressive manifestations.

Material and methods. A total of 180 patients (149 women and 31 men) with a confirmed diagnosis of RA were examined. Their mean age was 43.41±11.18 years, and the mean duration of the disease was 10.03±8.98 years. A package of psychodiagnostic methods was used to assess the level of anxiety and depression, characteristics of the disease perception, development of mindfulness skills, and components of self-compassion.

Results and discussion. Based on the study data, two patient groups were identified: patients with clinically significant anxiety and depressive manifestations and patients without them. The perception of the disease in patients with marked anxiety-depressive manifestations was characterized by the expectation of a threat from the disease, emotional apprehension and a decrease in the sense of personal control over the disease. In addition, in this group general and structural indicators of awareness and self-compassion were reduced.

Conclusion. The specificity of disease perception, diminished awareness and capacity for self-compassion can be considered as psychological characteristics of patients with RA who have marked anxiety and depressive manifestations. The study allowed us to gain new, more differentiated ideas about the goals of psychodiagnostics and psychological correction in RA.

1. Chichasova NV. Rheumatoid arthritis: problems of treatment at the present stage. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2018;12(4):65-70. (In Russ.). doi: 10.14412/1996-7012-2018-4-65-70.

2. Lila AM, Olyunin YuA, Gordeev AV. Assessing the status of patients with rheumatoid arthritis: modern tendencies. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2020;14(2):7-13. (In Russ.). doi: 10.14412/1996-7012-2020-2-7-13.

3. Abramkin AA, Lisitsyna TA, Vel'tishchev DYu, et al. Successful psychopharmacotherapy of anxiety and depressive disorders improve functional limitations in patients with rheumatoid arthritis. Terapevticheskii arkhiv. 2022;94(5):616-621. (In Russ.).

4. [Abrosimov IN, Yaltonsky VM, Sirota NA, et al. Immunoinflammatory rheumatic diseases: the role of the perception of the disease and coping with it in the psychological adaptation of the patient. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2022; 16(6):20–25. (In Russ.). doi: 10.14412/1996-7012-2022-6-20-25.

5. Сирота НА, Ялтонский ВМ, Абросимов ИН и др. Клиническая психология лечебного процесса. Москва: ГЭОТАР-Медиа; 2023. 400 с. [Sirota NA, Yaltonsky VM, Abrosimov IN, et al. Clinical psychology of the treatment process. Moscow: GEOTAR-media; 2023. 400 p.].

6. Abdrakhmanova AI, Zaripova FA, Amirov NB. Anxiety-depressive disorders in rheumatic diseases. Vestnik sovremennoi klinicheskoi meditsiny. 2020;13(1):61-65. (In Russ.).

7. Euesden J, Matcham F, Hotopf M et al. The relationship between mental health, disease severity, and genetic risk for depression in early rheumatoid arthritis. Psychosom Med. 2017 Jul/Aug;79(6):638-645. doi: 10.1097/PSY.0000000000000462.

8. Matcham F, Norton S, Scott DL, et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2016 Feb;55(2): 268-78. doi: 10.1093/rheumatology/kev306. Epub 2015 Sep 8.

9. Abramkin AA. Impact of comorbid mental disorders on the efficiency of therapy in patients with rheumatoid arthritis. NauchnoPrakticheskaya Revmatologiya. 2016;54(3): 339-345. (In Russ.).

10. Ang DC, Choi H, Kroenke K, Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol. 2005 Jun;32(6): 1013-9.

11. Bashkova IB, Tsyganova YuV, Vorob'eva TI. Prevalence of anxiodepressive disorders in rheumatoid arthritis in the chuvash republic: specifics of clinical picture and pharmacotherapy. Acta Medica Eurasica. 2018;(3): 1-8. (In Russ.).

12. Chadi N, Kaufman M, Weisbaum E, et al. In-Person Versus eHealth Mindfulness-based intervention for adolescents with chronic illness: protocol for a randomized controlled trial. JMIR Res Protoc. 2017 Nov 27;6(11):e241. doi: 10.2196/resprot.7700.

13. Neff K, Germer K. How to survive difficult moments in life. Healing self-compassion. Saint-Petersburg: Piter; 2021. 256 p.

14. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-81. doi: 10.1002/art.27584.

15. Morozova MA, Potanin SS, Beniashvili AG, et al. Validation of the Hospital Anxiety and Depression Scale Russian-language version in the general population. Profilakticheskaya meditsina. 2023;26(4):7 14. (In Russ.).

16. Yaltonskii VM, Yaltonskaya AV, Sirota NA, Moskovchenko DV. Psychometric characteristics of the Russian version of the Brief Illness Perception Questionnaire. Psikhologicheskie issledovaniya. 2017;10(51):1. (In Russ.).

17. Yumartova NM, Grishina NV. Mindfulness. Psychological characteristics and measurement tools. Nauchnye issledovaniya vypusknikov fakul'teta psikhologii SPbGU. 2013;(1):267- 273. (In Russ.).

18. Chistopol'skaya KA, Osin EN, Enikolopov SN, et al. The сoncept of self-compassion: a russian adaptation of the scale by Kristin Neff. Kul'turno-istoricheskaya psikhologiya. 2020;16(4):35-48. (In Russ.).

19. Yaltonskii VM, Sirota NA, Abrosimov IN, Sednev AYu. Types of perception of the disease in patients with pituitary adenomas. Endokrinnaya khirurgiya. 2023;17(4):116. (In Russ.).

20. Lisitsyna TA, Vel'tishchev DYu, Gerasimov AN, et al. Perception of pain in rheumatoid arthritis: relation to inflammation, psychic disorders, functional status, and quality of life. Klinicheskaya meditsina. 2013;91(3): 54-61. (In Russ.).

21. Hagger M, Orbell S. The common sense model of illness self-regulation: A conceptual review and proposed extended model. Health Psychol Rev. 2022 Sep;16(3):347-377. doi: 10.1080/17437199.2021.1878050. Epub 2021 Feb 1.

22. Kabat-Zinn J. Wherever you go, you are already there. Mindfulness Meditation in Everyday Life. Moscow: Eksmo; 2023. 256 p.

23. Abrosimov IN. Mindfulness and self-compassion in psychological support of patients with chronic diseases. In: Sirota NA, editor. Clinical psychology of the treatment process. Moscow: GEOTAR-media; 2023. P. 297-306.

24. Preece DA, Mehta A, Petrova K, et al. Alexithymia and emotion regulation. J Affect Disord. 2023 Mar 1:324:232-238. doi: 10.1016/j.jad.2022.12.065. Epub 2022 Dec 23.

25. Vadacca M, Bruni R, Terminio N, et al. Alexithymia, mood states and pain experience in systemic lupus erythematosus and rheumatoid arthritis. Clin Rheumatol. 2014;33(10): 1443-50. doi: 10.1007/s10067-014-2593-3. Epub 2014 Apr 11.

26. Margiotta DP, Vadacca M. Alexithymia in systemic lupus erythematosus: a tight relation with mood states. Rheumatology: Current Research. 2016;6(2):192. doi:10.4172/2161-1149.1000192.

27. Luskova YuS, Grigor'ev PE. Mindfulness as a mental resource. In: Zhuravlev AL, Kholodnaya MA, Sabadosh PA, editors. Human abilities and mental resources in a world of global change. Moscow: Institute of Psychology of the Russian Academy of Sciences; 2020. P. 1701-1710.

28. Kabat-Zinn J. Lessons from Medicine. Mindfulness (N Y). 2020;11(7):1818-1822. doi: 10.1007/s12671-020-01369-8. Epub 2020 Apr 30.

29. Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2023 Jan 1;80(1):13-21. doi: 10.1001/jamapsychiatry.2022.3679.

30. Reangsing C, Rittiwong T, Schneider JK. Effects of mindfulness meditation interventions on depression in older adults: A metaanalysis. Aging Ment Health. 2021 Jul;25(7): 1181-1190. doi:10.1080/13607863.2020. 1793901. Epub 2020 Jul 15.

31. Zhou B, Wang G, Hong Y, et al. Mindfulness interventions for rheumatoid arthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2020 May:39:101088. doi: 10.1016/j.ctcp.2020.101088. Epub 2020 Jan 11.

32. Slagter L, Demyttenaere K, Verschueren P, De Cock D. The effect of meditation, mindfulness, and yoga in patients with rheumatoid arthritis. J Pers Med. 2022 Nov 15;12(11):1905. doi: 10.3390/jpm12111905.

33. MacBeth A, Gumley A. Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clin Psychol Rev. 2012 Aug;32(6):545-52. doi: 10.1016/j.cpr.2012.06.003. Epub 2012 Jun 23.

34. Pinto-Gouveia J, Duarte C, Matos M, Fraguas S. The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clin Psychol Psychother. 2014 Jul-Aug; 21(4):311-23. doi: 10.1002/cpp.1838. Epub 2013 Mar 25.

35. Edwards KA, Pielech M, Hickman J, et al. The relation of self-compassion to functioning among adults with chronic pain. Eur J Pain. 2019 Sep;23(8):1538-1547. doi: 10.1002/ejp.1429. Epub 2019 Jun 11.