The stress process in rheumatoid arthritis

Objective:  To evaluate the Stress Process Model proposed by Pearlin and colleagues by examining the role of personal and social resources in mediating the relationship between the rheumatoid arthritis (RA) related stressors of functional disability, pain, and flares, and the outcome of depressive symptoms.

Methods:  Data are from 285 patients who participated in a study of the natural history of RA, comorbidity and depression. Measures include the Center for Epidemiologic Studies-Depression (CES-D) scale, the Arthritis Impact Measurement Scale Functioning and Pain scales, the Lubben Social Network scale, and items indicating sociodemographic status, health status and personal resources. A series of hierarchical regression analyses with multiplicative interaction terms were conducted.

Results:  Substantial consistency between the Stress Process Model and relationships observed in the data was demonstrated.

Conclusion:  Although no claim is made to having demonstrated that the observed relationships are causal, the fact that the data are consistent with the model invites a prospective analysis in which the ordering of the variables over time can be established unambiguously. Because of the implications of the Stress Process Model for the design of psychosocial interventions, such a test is especially important.