CORRELATION BETWEEN PSYCHOLOGICAL FACTORS AND SELF-MANAGEMENT ABILITIES AMONG PATIENTS WITH RHEUMATOID ARTHRITIS
DOI:
https://doi.org/10.71000/q2z4d172Keywords:
anxiety, Rheumatoid arthritis, depression, self-management abilities, self-efficacy, , self-care., Psychological factorsAbstract
Background: Rheumatoid arthritis (RA) is a chronic, bilateral autoimmune disease that primarily affects small joints, leading to progressive bone erosion, joint deformities, and compromised musculoskeletal function. Its impact extends beyond physical disability, often causing early retirement, reduced quality of life, and severe psychological distress. Globally, up to 52% of RA patients report anxiety, while 80% suffer from depression. Despite this, limited research has explored the association between psychological factors and self-management abilities in RA patients, particularly in developing countries.
Objective: To determine the correlation between psychological factors (anxiety and depression) and self-management abilities among patients with rheumatoid arthritis.
Methods: A cross-sectional correlational study was conducted over six months, recruiting 385 diagnosed RA patients from the outpatient departments and inpatient wards of Lady Reading Hospital, Hayatabad Medical Complex, and Khyber Teaching Hospital in Peshawar. Participants aged ≥20 years, with a disease duration of over six months, were selected via consecutive sampling. Data were collected using validated and Urdu-translated versions of the Hospital Anxiety and Depression Scale (HADS) and the Arthritis Self-Efficacy Function Scale (ASEFS). The reliability scores for HADS and ASEFS were r=0.809 and r=0.80, respectively. Data analysis was performed using SPSS version 22, applying Spearman’s correlation to assess relationships between variables.
Results: Of the 385 participants, 197 (51.2%) were male and 188 (48.8%) female. Employment status revealed 131 (34%) were employed, while 254 (66%) were unemployed. Self-management abilities were high in 254 (66%) patients, moderate in 86 (22.3%), and mild in 45 (11.7%); no participant had low ability. Anxiety levels were abnormal in 289 (75.1%) and borderline in 82 (21.3%). Depression was abnormal in 346 (89.9%) and borderline in 39 (10.1%). A strong, statistically significant negative correlation was observed between psychological factors and self-management abilities (r = -0.731, p = 0.000).
Conclusion: Psychological factors are significantly and negatively associated with self-management abilities in RA patients. Routine screening and psychological support should be integrated into RA care to enhance patient self-efficacy and treatment outcomes.
References
Naqvi AA, Hassali MA, Naqvi SBS, Kachela B, Khan I. Estimation of direct cost of manaing rheumatoid arthritis treatment to Pakistani patients using real‐world follow‐up data. Int J Rheum Dis. 2020 Mar;23(3):325–33.
Xu and Wu - 2021 - Prevalence Trend and Disparities in Rheumatoid Art.pdf.
Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021 Oct 23;10(11):2857.
Nilsson et al. - 2021 - Influence of Age and Sex on Disease Course and Tre.pdf.
Almoallim H, Al Saleh J, Badsha H, Ahmed HM, Habjoka S, Menassa JA, et al. A Review of the Prevalence and Unmet Needs in the Management of Rheumatoid Arthritis in Africa and the Middle East. Rheumatol Ther. 2021 Mar;8(1):1–16.
Lin YJ, Anzaghe M, Schülke S. Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells. 2020 Apr 3;9(4):880.
Petrovská N, Prajzlerová K, Vencovský J, Šenolt L, Filková M. The pre-clinical phase of rheumatoid arthritis: From risk factors to prevention of arthritis. Autoimmun Rev. 2021 May;20(5):102797.
Lwin MN, Serhal L, Holroyd C, Edwards CJ. Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatol Ther [Internet]. 2020 Sep [cited 2022 Oct 28];7(3):457–71.
Rezaee M, Lotfi F, Gholami A, Azizpoor J, Aflaki E, Vazin A, et al. Economic Burden of Rheumatoid Arthritis in Iran: A Societal Perspective Economic Burden of R.A. [Internet]. In Review; 2022 Jan [cited 2022 May 12].
Abbasi MK, Bhatti SH, Tunio ZH. Frequency of Vitamin D-3 Deficiency in Rheumatoid Arthritis patients at a tertiary care hospital, Gambat, Khairpur, Sindh, Pakistan. 2021;46(3):4.
Katchamart W, Narongroeknawin P, Chanapai W, Thaweeratthakul P, Srisomnuek A. Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: A multicenter prospective cross‐sectional study. Int J Rheum Dis. 2020 Mar;23(3):302–8.
DiRenzo DD, Craig ET, Bingham CO, Bartlett SJ. Anxiety impacts rheumatoid arthritis symptoms and health-related quality of life even at low levels. 2021;13.
Martinez-Calderon J, Meeus M, Struyf F, Luque-Suarez A. The role of self-efficacy in pain intensity, function, psychological factors, health behaviors, and quality of life in people with rheumatoid arthritis: A systematic review. Physiother Theory Pract. 2020 Jan 2;36(1):21–37.
Nikiphorou E, Santos EJF, Marques A, Böhm P, Bijlsma JW, Daien CI, et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis. 2021 Oct;80(10):1278–85.
Juárez-Rojop IE, Nolasco-Rosales GA, Pérez-Mandujano A, González-Castro TB, Tovilla-Zárate CA, López-Narváez ML, et al. Prevalence for and Factors Associated with Depression and Anxiety Symptoms in Mexican Patients With Rheumatoid Arthritis. JCR J Clin Rheumatol. 2020 Oct;26(7S): S111–5.
Pamukcu M, İZci̇ Duran T, Ulusoy H, Altinbaş K. Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients. Turk J Med Sci. 2021 Dec 13;51(6):3008–16.
Nilsson J, Andersson M, Hafström I, Svensson B, Forslind K, Ajeganova S, et al. Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis. Open Access Rheumatol Res Rev. 2021 May; Volume 13:123–38.
Bąk E, Młynarska A, Marcisz C, Bobiński R, Sternal D, Młynarski R. Factors that affect the assessment of the quality of life of rheumatoid arthritis patients depending on the prevalence of frailty syndrome. Health Qual Life Outcomes. 2020 Dec;18(1):216.
Singh G, Mahajan N, Abrol S, Raina A. Anxiety and depression are common in rheumatoid arthritis and correlate with poor quality of life in Indian patients. Reumatologia/Rheumatology. 2021;59(6):386–93.
Alaujan SS, Almalag HM, Alshehri SM, Alkendi JM, Almansour MA, Alanizy LN, et al. Anxiety, Depression, Disease Disability, and Health‑Related Quality of Life in Rheumatoid Arthritis Patients during the Coronavirus Disease 2019 Pandemic: A Cross‑Sectional Study. 2022;5(4):9.
Fragoulis GE, Cavanagh J, Tindell A, Derakhshan M, Paterson C, Porter D, et al. Depression and anxiety in an early rheumatoid arthritis inception cohort. associations with demographic, socioeconomic and disease features. RMD Open. 2020 Oct;6(3): e001376.
Jahan S, Tabassum H, Meer Y, Manzoor S, Tariq A, Khan FM. Association of depression and disability with health-related quality of life in patients with rheumatoid arthritis. Found Univ J Rehabil Sci. 2022 Jul 28;2(2):35–9.
Zhang C, Wu X, Yuan Y, Xiao H, Li E, Ke H, et al. Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study. Front Psychol. 2022;13:939586.
Wu Z, Zhu Y, Wang Y, Zhou R, Ye X, Chen Z, et al. The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Front Psychiatry. 2022;13:848427.
Sweeney M, Carpenter L, de Souza S, Caton E, Galloway J, Cope A, et al. Self-management behaviors do not affect remission but mediate between mental health and disease outcomes in a longitudinal study of rheumatoid arthritis. Rheumatol Int. 2025;45(2):31.
Liu T, Geng Y, Han Z, Qin W, Zhou L, Ding Y, et al. Self-reported sleep disturbance is significantly associated with depression, anxiety, self-efficacy, and stigma in Chinese patients with rheumatoid arthritis. Psychol Health Med. 2023;28(4):908-16.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Islam , Matiullah, Mumtaz Ali, Hamza Khan, Uzair Ahmed (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.