Enfrentamento, ansiedade e depressão na artrite reumatoide: um modelo explicativo

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease that can cause joint deformities, intense pain, and psychosocial impairments. In the long term, RA can be a stressful condition that, when not well managed, may lead to negative outcomes such as anxiety and depression. This study aims to propose an explanatory model that relates pain, functionality, coping strategies, and mental health to understand how functional coping can minimize symptoms of anxiety and depression while improving treatment adherence. The study was structured into four interdependent studies. Study 1 is a theoretical study that aimed to deepen the transactional theory of coping by Lazarus and Folkman and to understand how individuals deal with stress, highlighting cognitive appraisal and continuous adaptation as central elements. This theory emphasizes that coping is highly dynamic, involving primary appraisal (analyzing the meaning of an event) and secondary appraisal (evaluating the available resources to handle it). The model categorizes strategies into problem-focused coping, which aims to modify the source of stress, and emotion-focused coping, which seeks to regulate emotional responses. In the health context, especially in chronic conditions, this theory provides a broad understanding of coping by identifying the most effective strategies and explaining how, in each situation, patients may achieve better outcomes. The flexibility and continuous reappraisal proposed by Lazarus are particularly relevant in healthcare settings, where stressors often involve prolonged and complex factors. Study 2 aimed to analyze the literature on the relationship between coping, anxiety, and depression in RA patients. The method used was a scoping review incorporating 36 articles, following the Joanna Briggs Institute guidelines and the Prisma Scr Checklist. The studies highlighted the relationship between pain, physical disability, and psychological symptoms. However, there is a lack of longitudinal studies and RA-specific instruments that could provide a better understanding of the disease’s progression. The review also identified gaps, suggesting the need for more comprehensive and comparative studies, as well as the exploration of other aspects of coping with the disease. Studies 3 and 4 sought to test an explanatory model between coping strategies, anxiety (Study 3), depression (Study 4), pain, and functionality. The sample consisted of 425 women diagnosed with RA, with a mean age of 51 years, recruited through a nationwide online survey. The instruments used included sociodemographic data, the HAQ-20 for functionality, the B-PCS for pain, the GAD-7 (Study 3) for anxiety symptoms, and the PHQ-9 (Study 4) for depressive symptoms. Data were analyzed using binomial logistic regression via the Jamovi software.

In Study 3, the model explained nearly 20% of the variance, with pain being the main predictive variable for anxiety (p < 0.001), while positive reappraisal emerged as a protective factor (p = 0.007). The analysis revealed that as positive reappraisal increased, the likelihood of experiencing anxiety symptoms decreased, whereas higher pain levels were associated with more severe anxiety. The relevance of positive reappraisal suggests that interventions focused on modifying dysfunctional beliefs and promoting more adaptive interpretations may benefit RA patients.

Study 4, which validated the explanatory model for depression in RA, had an explanatory variance of nearly 39% and identified pain and hygiene as risk factors for depression, whereas confrontational coping functioned as a protective factor. These findings emphasize the importance of psychological interventions aimed at strengthening confrontation strategies and pain management. They also highlight the significance of a multidisciplinary approach, behavioral pain management strategies, and behavioral activation to reduce depressive symptoms and enhance patients’ quality of life.

Finally, the proposed objectives were achieved, and the studies demonstrated that pain was the primary predictor of anxiety and depression, while hygiene was one of the predictors for depression. In contrast, coping strategies emerged as protective factors, thus fulfilling the study’s objectives.