title: The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility.
abstract: OBJECTIVE
  Due to their disease, patients with polyarthritis face the task of reconciling their threatened personal goals with their capabilities. Previous cross-sectional research on patients with chronic disease related higher levels of goal management strategies to lower levels of distress and higher levels of well-being. This study was the first to focus longitudinally on goal management patterns that combined strategies originating from different goal management theories. Our first study objective was to identify patterns that consisted of various strategies of goal management among patients with polyarthritis. Subsequently, the cross-sectional and longitudinal relationships between these patterns and the psychological health of the patients were studied.
  
  
  METHODS
  A longitudinal questionnaire study with three measurements of goal management and psychological health was conducted among 331 patients with polyarthritis. Stability of goal management over time was analysed with ANOVAs. Patterns were identified using cluster analysis at baseline, based on the following strategies: Goal maintenance, goal adjustment, goal disengagement, and goal reengagement. Longitudinal relationships between the patterns and psychological health (specifically: Depression, anxiety, purpose in life, positive affect, and social participation) were analysed using a generalized estimating equations analysis.
  
  
  RESULTS
  Three goal management patterns were found: 'Moderate engagement', 'Broad goal management repertoire', and 'Holding on'. Patients with the 'Broad goal management repertoire' pattern had the highest level of psychological health. The 'Holding on' pattern was identified as the most unfavourable in terms of psychological health. Over time, stable differences in levels of psychological health between the patterns were found.
  
  
  CONCLUSIONS
  This study was the first to reveal patterns of several goal management strategies and their longitudinal relationship to psychological health. Psychosocial support for arthritis patients with lower psychological health should focus on helping patients to become familiar with a broad range of goal management strategies when dealing with threatened goals.
  What is already known on this subject? Polyarthritis is a collective term for a variety of disorders associated with autoimmune pathologies that may affect all aspects of a person's physical, psychological, and social functioning. Patients often experience difficulties in maintaining and achieving goals in several domains of life due to disease symptoms. The process of emotional adaptation to polyarthritis is characterized by searching equilibrium between desires and constraints and reacting constructive to stressors. Goal management strategies are ways to minimize the perceived disparity between the actual and the preferred situation with regard to personal goals and are applied both consciously and unconsciously. Cross-sectional, higher levels of goal management strategies have been related to lower levels of distress and higher levels of well-being both in patients with polyarthritis and in other patient groups. What does this study add? Contributes to our understanding of how combinations of goal management strategies relate to psychological health. Identifies patterns of goal management that are longitudinally related to psychological health. Provides clear guidance for improving psychological health of people with polyarthritis.
authors.affiliation: Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.
authors.forename: Roos Y
authors.identifier: http://orcid.org/0000-0002-7854-1371
authors.initials: RY
authors.lastname: Arends
authors.affiliation: Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.
authors.forename: Christina
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Taal
authors.affiliation: Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.|Department for Rheumatology and Clinical Immunology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology*; D001168:Arthritis / Q000150:complications / Q000523:psychology*; D001294:Attitude to Health; D002908:Chronic Disease; D016000:Cluster Analysis; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006040:Goals; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011788:Quality of Life / Q000523:psychology; D012919:Social Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: adaptation; chronic disease; coping; goal management; quality of life; rheumatoid arthritis