Effects of illness perception on negative emotions and fatigue in chronic rheumatic diseases: Rumination as a possible mediator

Abstract

BACKGROUND

Illness perception has long been hypothesized to be linked to psychological well-b eing in patients with rheumatic diseases, although substantial evidence is lacking, and the contribution of ruminative coping style to this relationship is unclear.

AIM

To investigate the roles of illness perception and rumination in predicting fatigue and negative emotions in patients with chronic rheumatic diseases.

METHODS

Illness perception, rumination, fatigue and negative emotions (i.e. depression, anxiety and stress) were assessed by the Illness Perception Questionnaire-Revised, Stress Reactive Rumination Scale, Multidimensional Assessment of Fatigue, and the Depression, Anxiety and Stress Scale respectively. Multivariate regression analysis, the Sobel test, and the bootstrap were used to identify the mediating effect of rumination.

RESULTS

All five subscales of illness perception, including perceived illness identity, chronicity, cyclical nature, consequences and coherence of illness, were significantly associated with fatigue and negative emotions. In mediational analysis, rumination was found to mediate three components of illness perception (the identity, cyclical nature and consequences of illness) and negative emotions/fatigue.

CONCLUSION

Perceived identity, cyclical nature, and consequences of illness are significantly associated with fatigue and negative emotions in patients with chronic rheumatic diseases and these associations are mediated by rumination. Our findings suggest that psychological intervention should target rumination to improve physical and emotional well-being of patients with chronic rheumatic diseases.

Keywords: Fatigue; Illness perception; Negative emotions; Rheumatoid arthritis; Rumination; Systemic lupus erythematosus

Core Tip: The present study investigated the association of multiple components of illness perception and psychological outcomes (fatigue and negative emotions) in patients with chronic rheumatic diseases, as well as the potential mediating role of rumination in this relationship. The results showed that perceived identity, chronicity and consequences of illness were significantly associated with fatigue and negative emotions, and these associations were mediated by rumination. Identification of the mediating role of rumination has important implications clinically for developing cognitive interventions for patients with rheumatoid arthritis and systemic lupus erythematosus.