title: Evaluation of coping strategies in established rheumatoid arthritis patients: emergence of concealment in an Asian cohort.
abstract: OBJECTIVE
  To evaluate coping strategies of Asian RA patients and their associations with health-related quality of life (HRQoL).
  
  
  METHODS
  A cross-sectional sample of patients with established RA was evaluated using measures of coping (Coping in Rheumatoid Arthritis Questionnaire [C-RAQ]; appraisal of coping effectiveness and helplessness), HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12v2; Rheumatoid Arthritis Impact of Disease score [RAID]) and clinical/laboratory assessments. Principal component analysis was conducted to identify coping strategies. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes.
  
  
  RESULTS
  The study sample comprised 101 patients, 81% female, 72.3% Chinese, mean age 54.2 ± 12.6 years. Five coping strategies were identified: Active problem solving (E = 5.36), Distancing (E = 2.30), Concealment (E = 1.89), Cognitive reframing (E = 1.55) and Emotional expression (E = 1.26). Concealment was consistently associated with PCS (rs= -0.23, P = 0.049), MCS (rs= -0.24, P = 0.04) and RAID (rs= 0.39, P < 0.001), and was significant in the multivariate model to explain lower disease-specific HRQoL (RAID) even after adjusting for disease activity, coping effectiveness and helplessness (β = 0.20, P = 0.04). Emotional expression was associated with poorer physical HRQoL (PCS), after adjusting for disease severity, body mass index, coping effectiveness, helplessness and Concealment (β = -0.39, P < 0.001). Perceived coping-related helplessness was significant in multivariate correlates for PCS (β = -0.25, P = 0.036), MCS (β = -0.29, P = 0.02) and RAID (β = 0.53, P < 0.001), after adjusting for covariates.
  
  
  CONCLUSIONS
  Concealment and Emotional expression are associated with lower disease-specific HRQoL and physical HRQoL respectively, with the former coping strategy likely to be culture-specific. Interventions should tailor psychosocial support needs to address not only coping strategies, but patients' perception of their coping.
authors.affiliation: Department of Psychology, National University of Singapore, Singapore, Singapore.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chew
authors.affiliation: Department of Psychology, National University of Singapore, Singapore, Singapore.
authors.forename: Konstadina
authors.initials: K
authors.lastname: Griva
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Division of Rheumatology, National University Hospital, Singapore, Singapore.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Cheung
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology*; D044466:Asian People / Q000523:psychology*; D002681:China / Q000208:ethnology; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D004644:Emotions; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D010465:Perception; D025341:Principal Component Analysis; D011788:Quality of Life; D012650:Self Disclosure; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Asian; coping; health-related quality of life; impact of disease; rheumatoid arthritis