Academic journal article Social Behavior and Personality: an international journal

The Moderating Role of Helplessness in Rheumatoid Arthritis, a Chronic Disease

Academic journal article Social Behavior and Personality: an international journal

The Moderating Role of Helplessness in Rheumatoid Arthritis, a Chronic Disease

Article excerpt

The role of psychosocial factors that contribute to the maintenance of health has been conceptualized in terms of a health-sustaining function (or direct-effects hypothesis), as well as a stress-reducing function (or moderating hypothesis). This study is concerned with the stress-reducing function of helplessness on Rheumatoid Arthritis (RA) health outcome. In a sample of 186 adult hospital RA patients of low socioeconomic status, helplessness measured by the Arthritis Helplessness Index (AHI; Nicassio, Wallston, Callahan, Herbert, & Pincus, 1985), was found to moderate the relationship between the following: swollen joint count and depression, number of tender joints and functional ability, tender joint count and pain experience, and tender joint count and perceived disability.

Keywords: learned helplessness, rheumatoid arthritis.

Rheumatoid Arthritis (RA) is a chronic and disabling disease with serious clinical, psychosocial and economic effects. The etiology of RA is unclear and it is reported that the usual age of onset is between the ages of 20 to 40 years, with about 1% to 2 % of the general population suffering from the disease. Female RA patients outnumber male RA patients by a ratio of 3:1 (Shearn & Hellman, 1990). These prevalence figures were found in studies conducted on Caucasians, but have led to generalizations globally (Shearn & Hellman). Since the early 1970s epidemiological studies have shown that the pattern of prevalence of RA throughout the world is not consistent with the figures commonly quoted (Del Puente, Knowler, & Pettitt, 1989). While the disease appears to be less prevalent in developing countries than in developed countries, within-country differences are also noticeable. In a developing country like South Africa, for example, a similar epidemiological pattern to the developed countries has been found among urban Africans, while for rural Africans the prevalence of RA is significantly less (Solomon, Robin, & Valkenburg, 1975).

There has been a proliferation of studies in developed countries on the medical and psychological aspects of RA. In South Africa numerous medically based studies have been conducted (e.g., Mody & Meyers, 1989; Mody, Shaw, & Ramchurren, 1988). In attempting to keep abreast of international research trends in the area of chronic illness, which is increasingly focussed on the importance of both sociodemographic and psychosocial factors in disease outcome (e.g., Holm, Rogers, & Kwoh, 1998), this South African study appears to be the first consisting of an investigation into the way in which psychosocial factors are associated with sociodemographic factors, disease factors, and health-related quality of life factors. In chronic illness, such as RA, health-related quality of life components comprise: (1) subjective experience of pain, (2) the presence and extent of disability and (3) affective components, including helplessness and depression.

The aim of this cross-sectional study was to test the stress-reducing or moderating function of the psychological variable learned helplessness in RA. DiMatteo and Martin (2002) state: "learned helplessness occurs when our efforts at control continually come to no avail and we are unable to change an intolerable situation" (p. 371). Seligman (1975) has conducted pioneering work on learned helplessness and proposed that when an individual is unable to control the events in his/her life, he/she learns that he/she cannot affect outcomes and, therefore, ceases to try. The reaction to repeated exposure to uncontrollable events that does not allow the individual to effect change is called learned helplessness. According to Maier and Seligman (1976), individuals become helpless in three specific areas, namely, motivational (when efforts to change the outcome cease), cognitive (when no new responses that could help us avoid aversive outcomes in the future are learned), and emotional (when depression sets in). …

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