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SUMMARY • This study investigates whether a visible hand disfigurement due to RA has an independent impact on psychological well being. • 49 RA patients with, and 32 with no visible hand disfigurement completed a booklet of psychosocial questionnaires • Those with an observable hand disfigurement scored higher on measures of functional disability and feelings of stigmatization. They also rate their appearance more negatively than those with no hand disfigurement. When controlling for functional disability, all significant differences disappeared. • Participants with an observable hand disfigurement were 2.62 times more likely to be clinically depressed than those with no observable hand disfigurement. Conversely those with no observable hand disfigurement were 1.68 times more likely to be clinically anxious. • Regression analysis revealed that high ideal appearance discrepancy, low optimism and low satisfaction with social support predict higher levels of anxiety. • High functional disability and low optimism predict a majority of the variance in depression. • Appearance-related social anxiety and avoidance is predicted by age and living status, as well as objective hand disfigurement and the psychological variables of valence, salience, functional disability, satisfaction with social support and social acceptance. • Visible hand disfigurement does not independently affect mood, but may contribute to feelings of appearance-related social anxiety and avoidance. • Findings suggest that it is not the observable nature of the hand disfigurement but the visible disability when moving which may have an effect on feelings of stigmatization and the participants’ evaluation of their own appearance. Therefore, the outward signs of physical impairment may be regarded as highly salient. 184
INTRODUCTION Rheumatoid arthritis (RA) is the single greatest cause of disability in the UK (Goff & Barasi, 1999). At present there is no treatment to either cure or prevent the disease, so the main aim is to reduce its impact on peoples’ lives by limiting symptoms, reducing disability and improving quality of life (Pollard, Choy & Scott, 2005). Disfigurement of the hands is a common and significant complication of RA and once these changes occur, they are not reversible medically and may require surgery. Despite a large amount of research looking at psychological impact of RA during the course of the disease, very little research has focused on the psychological effects of body image and disfigurement. Early research on body image and attractiveness in RA has produced somewhat mixed results with some suggesting no difference from the normal population (Cornwell & Schmidt, 1990) and others suggesting negative impacts on body image (Skevington, Blackwell & Britton, 1987). Rumsey, Clarke & Musa (2002) report higher levels of anxiety and depression in patients with rheumatic conditions including RA, compared with normative levels, as well as in comparison to people with burns, head and neck cancer and eye conditions. Those patients with rheumatic conditions experiencing higher levels of distress spoke of embarrassment, selfconsciousness and distress in relation to their appearance, with specific mention of the appearance of their joints. Concerns regarding the noticeability of the condition were also reported along with the use of avoidant and concealment behaviours. In a study on RA and lupus patients, Monaghan, Sharpe, Denton, Levy, Schrieber & Sensky (2007) found that perceived appearance and physical disability were predictive of depression but not anxiety in RA patients. Very few studies have focussed on the physical and psychological issues surrounding observable hand disfigurement in RA, despite this being the most overtly exposed area and the identification that hands are one of the areas most affected by the illness (Cornwell & Schmidt, 1990). Due to the lack of consistency in the results of previous research into appearance concerns this study investigates whether observer rated hand disfigurement due to RA has an independent impact on psychological well being. METHOD Participants 49 RA patients with hand disfigurement due to RA rated as visible by the researcher and 32 RA patients with no observable hand disfigurement were included in the study. The mean age was 58.64 years. Respondents were outpatients attending routine rheumatology clinics at University College London Hospital. Further demographics details are displayed in Table 12.1. 185
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Identifying the psychosocial factor
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Follow-on Studies: Emma Halliwell,
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Warwick Site (Lead: Dr. Rodger Char
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SECTION 3 Page OVERALL SYNTHESIS OF
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Study 3 3.1 Response rates for resp
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Introduction EXECUTIVE SUMMARY This
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The Impact of Appearance-Related Di
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Research Further investigation shou
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Participants were recruited from ho
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BACKGROUND & RATIONALE FOR THE RESE
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The challenge of developing compreh
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STAGE ONE (Inputs/Predisposing Fact
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In order to address the first aim o
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Role of the advisory panel in the r
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credit is due to Anjte Lindenmeyer,
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INTRODUCTION The largest part of th
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South West (via the Bristol site) a
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INPUTS/ PREDISPOSING FACTORS Age Ge
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Appearance-related processing Valen
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Anger/hostility The Refined Aggress
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RESULTS Due to the size of the data
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Figure 4.1(b) Comparative box-and-w
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Table 4.2 Correlation of quantitati
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Table 5.1(c) Frequency of number of
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Table 6.1(a) Frequency and percenta
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Table 7.1 summarises the degree of
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Figure 7.1(a): Scores on the DAS 24
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10.1 Appearance-related Social Anxi
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HADS Anxiety, and the relative magn
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10.4 Aggression When entering the v
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elatively small but statistically s
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11. Clinic Specific Data In order t
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Table 11.3: Percentage of participa
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anxiety was in the low to mild rang
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Visibility and areas of concern The
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affect and 46% for both anxiety and
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likely they are to have difficultie
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Information Attention Encoding/Stor
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such as shame, were omitted. Where
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RATIONALE In an attempt to offer pa
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FINDINGS Theme I. Descriptive Accou
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easts made her ‘flat chested’ a
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confidence to other people’s reac
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them noticing: ‘I try to hide my
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5.) Time Structures What was striki
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STUDY 3 LONGITUDINAL QUANTITATIVE S
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Table 3.1 Response rates for respon
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Table 3.4 Regression Model for DAS2
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Table 3.6 Regression Model for Depr
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Table 3.8 Regression Model for Posi
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0.016), and optimism (r = -0.183, n
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and follow up). However, focusing o
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SUMMARY • Twenty-six participants
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There were ten well adjusted stable
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Stage 1 - predisposing factors - ch
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Appearance schema - beliefs about o
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“I’m in charge ...I think that
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“Only when people don’t underst
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appearance anxiety and coping with
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114
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116
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SUMMARY • This study aimed to exp
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A focus group methodology was chose
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any situation. Strategies involved
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CONCLUSIONS Whereas previous resear
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SUMMARY • Nine focus group interv
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RESULTS Eight key themes were ident
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2e. Medical Interpretation There wa
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“I think I am nicer to a person w
Page 146 and 147: 6d. Generational differences Elders
Page 148 and 149: • The myths about the foetal diso
Page 150 and 151: SUMMARY • Vitiligo is a condition
Page 152 and 153: identified themselves as South Asia
Page 154 and 155: “…my parents would have been de
Page 156 and 157: 2a. Appearance shame and disgust Ma
Page 158 and 159: much…sometimes I just want to bec
Page 160 and 161: For respondents like AA (described
Page 162 and 163: study 6, that in addition to indivi
Page 164 and 165: AIMS The aims of this study were to
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Page 168 and 169: SUMMARY • Participants (n=38) too
Page 170 and 171: leaving 82 invitations not responde
Page 172 and 173: The vignettes alternated between de
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Page 176 and 177: SUMMARY • The study involved the
Page 178 and 179: METHOD Participants Student sample
Page 180 and 181: Clinic attendees On the anxiety sub
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Page 184 and 185: SUMMARY • Semi-structured intervi
Page 186 and 187: Seven key themes were identified an
Page 188 and 189: “I've heard tell that a lot of pe
Page 190 and 191: 4. Physical adaptation From so smal
Page 192 and 193: 6. Emotional impact & Emotional sup
Page 194 and 195: 182
Page 198 and 199: Table 12.1 Demographic data by grou
Page 200 and 201: variance in anxious mood was accoun
Page 202 and 203: appearance of younger people (Harri
Page 204 and 205: SUMMARY • This study is recruitin
Page 206 and 207: METHOD Participants GPs from across
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Page 210 and 211: The results of each study have been
Page 212 and 213: Others expressed dissatisfaction wi
Page 214 and 215: Age Gender Ethnicity Relationship s
Page 216 and 217: Whilst the main thrust of this rese
Page 218 and 219: a strong evidence base in other are
Page 220 and 221: Nurses in a counseling role, clinic
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Page 224 and 225: This series of studies represents t
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Page 228 and 229: Ben-Tovim, D.I. and Walker, M.K. (1
Page 230 and 231: Crocker, J., Voelkl, K., Testa, M.
Page 232 and 233: Greenberg, L. S. and Safran, J. D.
Page 234 and 235: Macgregor, F., Abel, T.M., Brut, A.
Page 236 and 237: Pollard, L., Choy, E.H. and Scott,
Page 238 and 239: Scheier, M.F., Carver, C.S. and Bri
Page 240 and 241: Wright, G.E., Parker, J.C., Smarr,
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