title: Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort.
abstract: OBJECTIVE
  As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA). The aim of the current study was to identify distinct trajectories of psychological distress over 10 years in a cohort of RA patients recruited very early in the course of the disease.
  
  
  METHODS
  Psychological distress as measured by the Hospital Anxiety and Depression Scale total score was assessed annually in a subgroup of 784 patients enrolled in a multi-centre RA inception cohort (Early RA Study). A latent growth mixture modelling (GMM) approach was used to identify distinct psychological distress patterns.
  
  
  RESULTS
  Four distinct psychological distress trajectories were observed: low-stable (68%), high-stable (12%), high-decreasing (9%) and low-increasing (11%). Symptoms of pain, stiffness and functional impairment were significantly associated with levels of psychological distress at the time of diagnosis and after 3 years; serological markers of disease activity (ESR and CRP) were not.
  
  
  CONCLUSIONS
  Although the majority of individuals developing RA experience little or no impact of the effects of the disease on their psychological well-being, a significant proportion experience high levels of distress at some point which may be related to their subjective appraisal of their condition. Assessment and treatment of psychological distress should occur synchronously with somatic symptoms.
authors: Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, UK. s.j.norton@herts.ac.uk
authors: Sam
authors: S
authors: Norton
authors: Amanda
authors: A
authors: Sacker
authors: Adam
authors: A
authors: Young
authors: John
authors: J
authors: Done
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology*