title: Distress, misperceptions, poor coping and suicidal ideation in psoriatic arthritis: a qualitative study.
abstract: PsA is associated with significant distress and can be life-ruining. Reducing distress can improve quality of life and disease outcomes. Quality of life measures broadly identify the extent to which PsA impacts on people's lives but do not enable clinicians to address PsA-specific distress in the setting of the clinic. The aim of this study was to explore people's illness beliefs, emotions and behaviours that relate to living with PsA and account for the distress experienced by those living with this condition.
  
  
  
  Semi-structured individual interviews were conducted in the UK with adults with PsA. Interview questions were theoretically informed by the Common-Sense Self-Regulation Model (CS-SRM). Two stages of data analysis, in line with thematic and framework analysis principles, involved coding pre-determined CS-SRM components and identifying any additional emergent themes. Constant comparison techniques allowed for patterns across CS-SRM components to emerge inductively from the data.
  
  
  
  Twenty-four people with PsA participated (54% male; aged 27-71; time since onset ranged between 4 months and 29 years). Four core themes comprising clusters of illness beliefs, emotions and related behaviours emerged accounting for patient distress: restrictions, role of others, resentment and resignation. Suicidal ideation in the sample was commonly expressed and patients feared exponential degeneration of their condition. Patients reported the condition being dismissed or belittled by others and therefore hiding their distress from people around them.
  
  
  
  People with PsA experience significant disease-related distress, including suicidal ideation. Misperceptions, ineffective coping styles (e.g. avoidance/blocking) and negative emotions should be actively identified and addressed with people with PsA.
authors.affiliation: Manchester Centre for Dermatology Research, Manchester Centre for Dermatology Research, anna.chisholm@manchester.ac.uk.
authors.forename: Anna
authors.initials: A
authors.lastname: Chisholm
authors.affiliation: Manchester Centre for Dermatology Research, Manchester Centre for Dermatology Research.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Pearce
authors.affiliation: Manchester Centre for Dermatology Research.
authors.forename: Hector
authors.initials: H
authors.lastname: Chinoy
authors.affiliation: Manchester Centre for Dermatology Research, Manchester Centre for Dermatology Research.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warren
authors.affiliation: Manchester Centre for Dermatology Research, Manchester Centre for Dermatology Research.
authors.forename: Christine
authors.initials: C
authors.lastname: Bundy
keywords: coping; distress; illness beliefs; long-term condition; psoriasis; psoriatic arthritis; psychology; qualitative; quality of life