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Research on work-related stress

Rheumatoid arthritis (RA) is a chronic disease with no known cause or cure that typically follows an unpredictable course. The present article provides a comprehensive review of the psychological literature related to etiology, effects, and treatment of RA. A brief summary of the relevant medical as

https://psycnet.apa.org/journals/bul/98/2/358.pdf

Rheumatoid arthritis: Review of psychological factors related to etiology, effects, and treatment.

Rheumatic diseases are a group of painful and often disabling systemic diseases that usually become chronic. The most frequent problems reported by those affected are complaints connected with the musculoskeletal system. From the wide range of rheumatic diseases, rheumatoid arthritis (RA), ankylosing spondylitis, fibromyalgia syndrome (FS), and psoriatric arthritis have the highest prevalence, with almost 1% to 2% of the total population affected by each of them. Because of the fact that these illnesses are usually chronic and disabling, they represent a major social and economic burden. RA, ankylosing spondylitis, and psoriatric arthritis are especially known to be immune-related diseases. Their etiology still remains unclear. Most commonly, multiple factors are suspected to be responsible for the initiation of these illnesses. Lack of knowledge as to the causes of most rheumatic diseases meant that a wide range of different approaches evolved. One of them is the field of stress and personality research. As early as 1909, the first article suggesting an association between factors in everyday life like anxiety and worry and the provocation of RA was published. 63 Some years later, the personality of the RA patient was also taken into consideration as a possible risk factor for increased susceptibility to RA. 18 In 1939, Cobb et al 25 summarized speculations dating back to 1880 that there is a relation between environmental or emotional factors on the one hand and the onset and exacerbation of RA on the other hand. Alexander 10 classified RA as one of the seven classic psychosomatic diseases. Since the beginning of this field of research, a large number of articles focusing on stress and personality traits as provoking, predisposing, or modulating factors have been published. The results were often equivocal and caused considerable controversy. This article reviews the role of psychologic stress as a factor that may precipitate or exacerbate rheumatic diseases. The most common and effective strategies for coping employed by patients with rheumatic diseases and the value of stress-reducing therapies are discussed.

Stress and rheumatic diseases

Previous reviews of psychological factors in arthritis have emphasised the methodological weaknesses of many studies, especially those attempting to measure personality after years of disabling disease. To make sense of the published reports three factors need to be considered separately: previous personality, social stresses, and current mental state. Each can now be measured reliably and independently of symptoms which might be directly attributable to the arthritis. There is a growing consensus that the normal range of personality is represented among patients with early arthritis, that the prevalence of depression is similar to that of patients with other medical conditions, and that social stress is more closely related to depression than activity and the disabling effect of arthritis. Longitudinal studies are now required to examine which social stresses can be attributed to the disabling effect of arthritis. Depression and social stress often manifest themselves to the rheumatologist as excessive complaints of pain and frequent clinic attendances so appropriate psychosocial treatments may reduce this behaviour.

https://ard.bmj.com/content/annrheumdis/49/10/808.full.pdf

Psychological disorders in rheumatoid arthritis: a growing consensus?

This study had 3 aims: to determine whether rheumatoid arthritics had certain personality traits; to examine the relationship between psychological factors and the presence of rheumatoid factor in blood serum; and to explore the prognostic significance of psychological factors in the management of rheumatoid arthritis. Within a few days of discharge, 129 in-patient rheumatoid arthritics were clinically and psychologically assessed and allocated at random to 1 of 3 forms of follow-up care. The psychological assessment included measures of personality, non-psychotic psychiatric disturbance, and attitudes and beliefs. A year later all patients were reassessed. It was found that rheumatoid arthritics were more neurotic in personality, more likely to give socially desirable responses, and more prone to psychiatric disturbance, than the general population. Seropositive patients were less susceptible to psychiatric disturbance than seronegative patients. None of the psychological variables predicted disease activity, but those patients who rated themselves as 'slow, dependent, and weak' lost more time off work in the subsequent year.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700039702

Psychological aspects of rheumatoid arthritis.

In a prospective study of rheumatoid disease (RD) clinical, serological, radiological, and biochemical factors were assessed on 102 patients and scores obtained on the Middlesex Hospital Questionnaire (MHQ). Patients with early RD had MHQ scores closely resembling those in the normal population. Using a new clinical prognostic index, patients who develop severe RD tended to have low scores at initial testing on the MHQ. Patients whose serum was positive for rheumatoid factor also tended to have low scores on the MHQ. Together these findings suggest a possible subclassification of RD into a less severe form in which psychosocial factors may be important, and a more severe form in which heredity or some other constitutional factor (or factors) may be important, rheumatoid factor acting as a ‘marker’.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700056671

Anthony Fleming

Papers

Aspects of the psychology and epidemiology of rheumatoid disease.