title: Invalidation in Patients with Rheumatic Diseases: Clinical and Psychological Framework.
abstract: The term "invalidation" refers to the patients' perception that their medical condition is not recognized by the social environment. Invalidation can be a major issue in patients' lives, adding a significant burden to symptoms and limitations while increasing the risk of physical and psychological disability. In this study in patients with rheumatic diseases, we investigated the relationship between invalidation and sociodemographic, clinical, psychological, and personality characteristics.
  
  
  
  This international cross-sectional study included 562 adults with rheumatoid arthritis (n = 124), spondyloarthritis (n = 85), systemic lupus erythematosus (n = 112), or fibromyalgia (FM; n = 241). Assessed were the family and health professionals subscales of the Illness Invalidation Inventory (3*I), happiness (Subjective Happiness Scale), personality (Ten-Item Personality Inventory), pain, and loneliness (numerical rating scales). Univariate and multivariate analyses were used to test different models.
  
  
  
  Invalidation occurred in all rheumatic diseases, but patients with FM reported the most invalidation. Including all correlated variables in the multivariate model, pain remained as a determinant of invalidation by health professionals, but not by family. Regarding psychological variables, loneliness remained as a determinant of invalidation by family, but not by health professionals. FM and low levels of happiness, agreeableness, and conscientiousness were associated with invalidation while taking account of other variables.
  
  
  
  Invalidation occurs in all rheumatic diseases and patients with FM experience the most invalidation. Psychological factors (happiness, agreeableness, and conscientiousness), loneliness, and pain intensity are associated with invalidation, irrespective of the rheumatic disease and may deserve dedicated interventions.
authors.affiliation: From the Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Psychology Department, Utrecht University, Utrecht, the Netherlands.|M.G. Santiago, MD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; A. Marques, RN, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; M. Kool, PhD, Psychology Department, Utrecht University; R. Geenen, PhD, Psychology Department, Utrecht University; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.
authors.forename: Mariana Galante
authors.initials: MG
authors.lastname: Santiago
authors.affiliation: From the Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Psychology Department, Utrecht University, Utrecht, the Netherlands.|M.G. Santiago, MD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; A. Marques, RN, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; M. Kool, PhD, Psychology Department, Utrecht University; R. Geenen, PhD, Psychology Department, Utrecht University; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.
authors.forename: Andréa
authors.initials: A
authors.lastname: Marques
authors.affiliation: From the Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Psychology Department, Utrecht University, Utrecht, the Netherlands.|M.G. Santiago, MD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; A. Marques, RN, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; M. Kool, PhD, Psychology Department, Utrecht University; R. Geenen, PhD, Psychology Department, Utrecht University; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.
authors.forename: Marianne
authors.initials: M
authors.lastname: Kool
authors.affiliation: From the Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Psychology Department, Utrecht University, Utrecht, the Netherlands.|M.G. Santiago, MD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; A. Marques, RN, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; M. Kool, PhD, Psychology Department, Utrecht University; R. Geenen, PhD, Psychology Department, Utrecht University; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.affiliation: From the Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Psychology Department, Utrecht University, Utrecht, the Netherlands. jdasilva@ci.uc.pt.|M.G. Santiago, MD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; A. Marques, RN, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra; M. Kool, PhD, Psychology Department, Utrecht University; R. Geenen, PhD, Psychology Department, Utrecht University; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra. jdasilva@ci.uc.pt.
authors.forename: José António P
authors.initials: JAP
authors.lastname: da Silva
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005356:Fibromyalgia / Q000523:psychology*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012931:Social Environment; D012944:Social Support; D025241:Spondylarthritis / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: FIBROMYALGIA; PAIN SYNDROMES; PATIENT PERSPECTIVE; PSYCHOLOGY; RHEUMATOID ARTHRITIS