Self-Reported Psychological Impact and Coping Strategies of Men with RA

Caroline Flurey¹, Sarah Hewlett², Karen Rodham³, Alan White⁴, Robert Noddings⁵ and John Kirwan⁶, ¹Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom, ²Academic Rheumatology, University of West of England, Bristol, United Kingdom, ³Psychology, Sport and Exercise, Staffordshire University, Stoke on Trent, United Kingdom, ⁴Centre for Men's Health, Leeds Beckett University, Leeds, United Kingdom, ⁵Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, United Kingdom, ⁶University of Bristol, Bristol, United Kingdom

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Coping skills, Rheumatoid arthritis (RA), self-management and sex bias, Support and Education Groups

Session Information

Date: Sunday, November 13, 2016

Title: ARHP II: Healthcare Disparities and and Psychosocial Impact on Rheumatic Disease

Session Type: ARHP Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Current RA research reflects the preponderance of women with the condition (30% male). Research in other conditions suggests men need their own health strategy. Our previous Q-methodology study (qualitative and quantitative approach to grouping people according to subjective opinion) found a sample of men with RA (n=30) formed two groups (termed ‘Factors’ in Q-methodology): Factor 1 (“accept and adapt”) take control of other areas of their lives to enable them to accept and adapt to their RA. However, Factor 2 (“struggling to match up”) try to continue masculine activities without accepting physical help or emotional support. The aim is to investigate the existence, distribution, coping strategies and psychological impact of these two groups in the wider male RA population.

Methods: Q-survey methods investigated the distribution of the Q-methodology factors from our previous study in the wider male RA population. Men with RA completed numerical rating scales (NRS) of the statements that define each factor and were assigned to a factor based on a weighted averaging of their scores². Validated scales were used to measure disease severity (Patient-based DAS: PDAS), coping strategies; acceptance of illness; perceived stress; anxiety; depression and emotional well-being. The survey was sent to a random sample of 620 men with RA. Chi², ANOVA and t-tests were used to compare responses between the factors (groups) of men.

Results: 293/620 male patients (47%): mean age 66yrs (SD 10.9), dis dur 14yrs (SD 11.3), HAQ 0.56 (SD 0.57), PDAS 4.13 (SD 1.10) Of the 293 men, 12 had missing data, thus 281 were included in the analysis. Of these 61 (22%) were assigned to Factor 1 (“accept and adapt”) and 120 (43%) were assigned to Factor 2 (“struggling to match up”) and 99 (35%) were unassigned due to insufficient difference (<1SD) between the weighted averaged NRS scores The two factors differed significantly on measures of disease status, coping strategies and psychological status. Factor 2 reported higher scores on PDAS, confrontation, avoidance and resignation coping strategies; and perceived stress. Factor 2 had significantly more cases or borderline cases of anxiety and depression than Factor 1. Factor 1 reported higher scores on acceptance of illness and mental well-being (Table 1).

Conclusion: Some men seem able to accept and adapt to their RA, but others (43%) report severe disease, poor coping and poor psychological status. Future research needs to identify effective and appealing support for men with RA, particularly for those who seem to be struggling (Factor 2). References: ¹Flurey et al. (In Press) Identifying different typologies of experiences and coping strategies in men with rheumatoid arthritis: A Q-methodology study. BMJ Open. ²Baker et al (2010) Connecting Q and surveys: Three methods to explore factor membership in large samples. Operant Subjectivity. 34 (1): 38-58

Variable	Factor 1: “Accept and adapt” Mean (SD) / % n=61	Factor 2: “Struggling to match up” Mean (SD) / % n=120	Unassigned Mean (SD) / % n=99
Age	68 (10.1) yrs	64 (10.9) yrs	67 (11.0) yrs
Disease duration	15 (10.1) yrs	15 (11.1) yrs	14 (12.2) yrs
Co-morbidities	61%	71%	68%
Marital status	69% married	77% married	77% married
Employment status	66% retired	54% retired	62% retired
Patient Global	18.32 (17.3)	51.02 (25.0)^a	35.2 (26.3)
MHAQ	0.17 (0.33)	0.85 (0.57)^a	0.49 (0.54)
PDAS	3.29 (0.62)	4.70 (1.00)^a	4.02 (1.07)
DMARDs	79%	83%	80%
Biologics	18%	40%^b	29%
Steroids	26%	28%	31%
No medication	8%	4%	5%
Confrontation coping	15.98 (3.39)	17.28 (3.41)^c	17.09 (3.71)
Avoidance coping	13.48 (3.31)	15.74 (3.04)^a	14.5 (3.54)
Resignation coping	7.25 (1.03)	8.83 (1.67)^a	7.74 (1.52)
Acceptance of illness	35.03 (5.23)	21.55 (6.66)^a	28.93 (7.01)
Depression	2% case 2% borderline	22% case^a 23% borderline^a	12% case 14% borderline
Anxiety	2% case 2% borderline	22% case^a 23% borderline^a	13% case 15% borderline
Perceived stress	2.48 (2.75)	6.64 (3.30)^a	4.33 (3.13)
Mental well-being	27.74 (4.92)^a	21.74 (4.25)	25.07 (5.12)

^aP=<.000; ^bp=.010; ^cp=.015

Disclosure: C. Flurey, Arthritis Research UK, 2; S. Hewlett, None; K. Rodham, None; A. White, None; R. Noddings, None; J. Kirwan, None.

To cite this abstract in AMA style:

Flurey C, Hewlett S, Rodham K, White A, Noddings R, Kirwan J. Self-Reported Psychological Impact and Coping Strategies of Men with RA [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/self-reported-psychological-impact-and-coping-strategies-of-men-with-ra/. Accessed .

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