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Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis

机译：类风湿关节炎的社会心理风险和长期预后

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This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8-year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8-year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.
机译：这项研究检查了人口统计学因素和自我报告的症状严重程度随时间变化后，心理社会风险模式与类风湿关节炎（RA）的长期预后有独特关联的程度。在1995年进行的UCSF RA小组研究中，从561名患有RA的个体中收集了为期8年的数据。每年，通过全面的结构化电话访谈对小组成员进行访谈。评估的社会心理因素包括精通，对社会支持是否足够的看法，RA的影响以及自我评估应对RA的能力以及对健康和功能的满意度。社会心理因素的聚类分析确定了三种独特的社会心理风险模式/水平（高，中和低风险）。使用生长曲线分析，评估了社会心理风险状况对抑郁症状，基本功能限制，总体疼痛等级和平均每年8次就诊次数的独特影响。对人口统计学因素（性别，婚姻/伴侣状态，教育程度，年龄和种族），疾病的持续时间和年份以及自我报告的症状随时间变化的严重程度（早晨僵硬，关节肿胀，合并病情，关节外RA症状和关节外观变化），以及随时间推移自行报告的药物（抗疾病风湿病药物[DMARDS]和泼尼松）。总体而言，完全评估的模型占抑郁症状总方差的32.4％，其中12.9％与社会心理风险状态唯一相关。基本功能限制的总差异的一半（50.0％）得到了解释，其中12.1％的差异是由社会心理风险状态唯一预测的。社会心理风险状况占总体疼痛评估的总解释方差相对较小（总计= 38.6％，增量= 3.2％）和年平均总医生就诊次数（总计= 10.9％，增量= 1.5％）。因此，随着时间的流逝，社会心理危险因素与抑郁症状和功能更加紧密相关。全球性的痛苦和利用似乎与疾病因素更紧密相关。

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