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Gender-Specific Effects of Depression on Functional Disability in Rheumatoid Arthritis: A Prospective Study

  • Published:
International Journal of Rehabilitation and Health

Abstract

We examined the prospective impact of depression on objective ratings of disability as a function of gender in a sample of persons with rheumatoid arthritis. Forty-two individuals from an outpatient rheumatology clinic completed measures of depression, disability, and pain over the course of 1 year. A physician's assistant completed objective measures of functional disability following a routine physical examination. Results demonstrated a significant main effect for gender on Time 2 objective ratings of disability (after controlling for disease variables and self-report indices of pain and disability), indicating that physician assistants rated female participants as more disabled than male participants. Importantly, the interaction of gender and Time 1 depression contributed significant variance to Time 2 disability. Findings suggest that women, relative to men, may experience greater declines in functional capacity over time, independent of self-perceptions of pain and disability, and that depression plays a significant role in this process. Discussion focuses on treatment considerations for health care teams, with particular focus on women's adjustment of to RA.

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REFERENCES

  • Allaire, S. H., Meenan, R. F., and Anderson, J. J. (1991). The impact of rheumatoid arthritis on the household work performance of women. Arth. Rheum. 34(6): 669–678.

    Google Scholar 

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.), APA, Washington, DC.

    Google Scholar 

  • Arnett, F., Edworthy, S., Bloch, D., McShane, D., Fries, J., Cooper, N., Healy, L., Kaplan, S., Liang, M., Luthra, H., Medsger, T., Jr., Mitchell, D., Neustadt, D., Pinals, R., Schaller, J., Sharp, J., Wilder, R., and Hunder, G. (1988). The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arth. Rheum. 31: 315–324.

    Google Scholar 

  • Bhatia, S. C., and Bhatia, S. K. (1999). Depression in women: Diagnostic and treatment considerations. Am. Family Phys. 60(1): 225–234, 239–240.

    Google Scholar 

  • Callahan, L. F., Brooks, R. H., and Pincus, T. (1988). Further analysis of learned helplessness in rheumatoid arthritis using a Rheumatology Attitudes Index. J. Rheumatol. 15: 418–426.

    Google Scholar 

  • Chaney, J. M., Mullins, L. L., Uretsky, D. L., Doppler, M. J., Palmer, W. R., Wees, S. J., Klein, H. S., Doud, D. K., and Reiss, M. J. (1996a). Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control. Rehab. Psychol. 3: 205–223.

    Google Scholar 

  • Chaney, J. M., Uretsky, D. L., Mullins, L. L., Doppler, M. J., Palmer, W. R., Wees, S. J., Klein, H. S., Doud, D. K., and Reiss, M. J. (1996b). Differential effects of age and illness duration on pain-depression and disability-depression relationships in rheumatoid arthritis. Int. J. Rehab. Health 2(2): 101–112.

    Google Scholar 

  • Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334.

    Google Scholar 

  • Dowdy, S. W., Dwyer, K. A., Smith, C. A., and Wallston, K. A. (1996). Gender and psychological well-being of persons with rheumatoid arthritis. Arth. Care Res. 9(6): 449–456.

    Google Scholar 

  • Fifield, J., Tennen, H., Reisine, S., and McQuillan, J. (1998). Depression and the long-term risk of pain, fatigue, and disability in patients with rheumatoid arthritis. Arth. Rheum. 41(10): 1851–1857.

    Google Scholar 

  • Frank, R. G., Chaney, J. M., Clay, D. L., and Kay, D. R. (1991). Depression in rheumatoid arthritis: A re-evaluation. Rehab. Psychol. 36: 219–230.

    Google Scholar 

  • Frank, R. G., Chaney, J. M., Clay, D. L., Shutty, M. S., Beck, N. C., Kay, D. R., Elliott, T. R., and Grambling, S. (1992). Dysphoria: A major symptom factor in persons with disability or chronic illness. Psychiatry Res. 3: 231–241.

    Google Scholar 

  • Fries, J. F., Spitz, P., Kraines, R. G., and Holman, H. R. (1980). Measurement of patient outcome in arthritis. Arth. Rheum. 23(2): 137–145.

    Google Scholar 

  • Gerber, L. (1988). Outcome measures in rheumatic disease. In Hicks, J., Nichols, J., and Sweezy, R. (eds.), Handbook of Rehabilitative Rheumatology, American Rheumatism Association, Atlanta, pp. 9–19.

    Google Scholar 

  • Hollingshead, A. (1957). Two Factor Index of Social Position, Author, New Haven, CT.

    Google Scholar 

  • Hommel, K. A., Chaney, J. M., Mullins, L. L., Palmer, W., Wees, S., and Klein, H. (1998). The relative contributions of attributional style and arthritis helplessness to depression in rheumatoid arthritis: A longitudinal investigation. Int. J. Rehab. Health 4(1): 59–67.

    Google Scholar 

  • Katz, P. P., and Yelin, E. H. (1994). Life activities of persons with rheumatoid arthritis with and without depressive symptoms. Arch. Care Res. 7(2): 69–77.

    Google Scholar 

  • Kroenke, K., and Spitzer, R. L. (1998). Gender differences in the reporting of physical and somatoform symptoms. Psychosom. Med. 60: 150–155.

    Google Scholar 

  • Lorish, C. D., Abraham, N., Austin, J., Bradley, L. A., and Alarcon, G. S. (1991). Disease and psychosocial factors related to physical functioning in rheumatoid arthritis. J. Rheumatol. 18(8): 1150–1157.

    Google Scholar 

  • Maier, W., Gansicke, M., Gater, R., Rezaki, M., Tiemens, B., and Urzua, R. F. (1999). Gender differences in the prevalence of depression: A survey in primary care. J. Affect. Disord. 53(3): 241–252.

    Google Scholar 

  • Murphy, H., Dickens, C., Creed, F., and Bernstein, R. (1999). Depression, illness perception and coping in rheumatoid arthritis. J. Psychosom. Res. 46: 155–164.

    Google Scholar 

  • Nicassio, P., Wallston, K., Callahan, L., Herbert, M., and Pincus, T. (1985). The measurement of helplessness in rheumatoid arthritis: The development of the Arthritis Helplessness Index. J. Rheumatol. 12: 462–467.

    Google Scholar 

  • Novy, D. M., Nelson, D. V., Averill, P. M., and Berry, L. A. (1996). Gender differences in the expression of depressive symptoms among chronic pain patients. Clin. J. Pain 12: 23–29.

    Google Scholar 

  • Parker, J. C., and Wright, G. E. (1995). The implications of depression for pain and disability in rheumatoid arthritis. Arth. Care Res. 8(4): 279–283.

    Google Scholar 

  • Pease, C. T., Bhakta, B. B., Devlin, J., and Emery, P. (1999). Does the age of onset of rheumatoid arthritis influence phenotype?: A prospective study of outcome and prognostic factors. Rheumatology 38(3): 228–234.

    Google Scholar 

  • Peck, J. R., Smith, T. W., Ward, J. R., and Milano, R. (1989). Disability and depression in rheumatoid arthritis: A multi-trait, multi-method investigation. Arth. Rheum. 32(9): 1100–1106.

    Google Scholar 

  • Pincus, T., Summey, J., Soraci, S., Wallston, K., and Hummon, N. (1983). Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arth. Rheum. 26: 1346–1353.

    Google Scholar 

  • Robinson, M. E., Wise, E. A., Riley, J. L., and Atchison, J. W. (1998). Sex differences in clinical pain: A multisample study. J. Clin. Psychol. Med. Sett. 5(4): 413–424.

    Google Scholar 

  • Smith, T. W., Peck, J. R., Milano, R. A., and Ward, J. R. (1988). Cognitive distortion in rheumatoid arthritis: Relation to depression and disability. J. Consult. Clin. Psychol. 56(3): 412–416.

    Google Scholar 

  • Smith, C., Wallston, K., and Dwyer, K. (1995). On babies and bathwater: Disease impact and negative affectivity in the self-report of persons with rheumatoid arthritis. Health Psychol. 14: 64–73.

    Google Scholar 

  • Weissman, M. M. (1984). The epidemiology of depression: An update on sex differences in rates. J. Affect. Disorders 7(3–4): 179–188.

    Google Scholar 

  • Wilder, R. (1993). Rheumatoid arthritis. In Schumacher, H. R., Jr., Klippel, J. H., and Koopman, W. J. (eds.), Primer on the Rheumatic Diseases: Tenth Edition, Arthritis Foundation, Atlanta, GA, pp. 86–89.

    Google Scholar 

  • Wool, C. A., and Barsky, A. J. (1994). Do women somatize more than men? Gender differences in somatization. Psychosomatics 35: 445–452.

    Google Scholar 

  • Zimmerman, M., and Coryell, W. (1987). The Inventory to Diagnose Depression: A self-report scale to diagnose major depressive disorder. J. Consult. Clin. Psychol. 55: 55–59.

    Google Scholar 

  • Zimmerman, M., and Coryell, W. (1988). The validity of a self-report questionnaire for diagnosing major depressive disorder. Arch. Dis. Unrelated Psychiatry 45: 738–740.

    Google Scholar 

  • Zimmerman, M., and Coryell, W. (1994). Screening for major depressive disorder in the community: A comparison of measures. Psychol. Assess. 6: 71–74.

    Google Scholar 

  • Zimmerman, M., Coryell, W., Wilson, S., and Corenthal, C. (1986). Evaluation of symptoms of major depressive disorder: Self-report vs. clinician ratings. J. Nerv. Ment. Dis. 174: 150–153.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, 74078

    Kevin A. Hommel

  2. Department of Psychology, Oklahoma State University, USA

    Janelle L. Wagner, John M. Chaney & Larry L. Mullins

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  1. Kevin A. Hommel
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  2. Janelle L. Wagner
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  3. John M. Chaney
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  4. Larry L. Mullins
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Hommel, K.A., Wagner, J.L., Chaney, J.M. et al. Gender-Specific Effects of Depression on Functional Disability in Rheumatoid Arthritis: A Prospective Study. International Journal of Rehabilitation and Health 4, 183–191 (1998). https://doi.org/10.1023/A:1022958730413

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