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e significant. This suggests a close association between stigma, appearance valence and
functional ability.
The lower levels of appearance satisfaction in the disfigured group to some degree reflect the
work of other researchers (Skevington, et al., 1987). But these results contrast with other
studies that have found that body image concerns for RA patients and healthy controls
approximate each other (Cornwell & Schmidt, 1990) or do not differ (Ben-Tovim & Walker,
1995). The variability in these results may reflect the differences in measurement techniques.
A participant with an observable hand disfigurement was almost three times more likely to be
clinically depressed than a participant those with no visible hand differences. This greater
likelihood is noteworthy, but may to be due to the associated differences in functional disability
rather than the disfigurement itself. The percentage of RA patients with no observable hand
disfigurement meeting caseness levels of depression are comparable to levels reported in many
other RA studies (Pincus, et al, 1996; Værøy, et al., 2005). Conversely, those with no
observable hand disfigurement were almost twice as likely to be clinicaly anxious. One may
speculate that this may be associated with the unpredictability of RA. Those who have hand
involvement and resulting disability may feel things can get no worse while those with lower
levels of disability (i.e. no hand involvement) may be anxious about future deterioration. Those
with no visible hand disfigurement exhibited either lower or comparable levels of clinical anxiety
to that reported in other studies (Söderlin, et al., 2000; El-Miedany & El-Rasheed, 2002).
RA patients with high levels of ideal discrepancy, low optimism and lower satisfaction with social
support had higher levels of anxious mood. Optimism was the most significant independent
predictor of anxiety and the same variable was found to be the best predictor of depression. The
significant contribution of satisfaction with social support to anxiety highlights the need for
quality social networks which provide the resources necessary for successful adaptation. This
has been demonstrated in research for both recently diagnosed and long term RA sufferers
(Evers, Kraaimaat, Geenen & Bijlsma, 1997).
In common with other studies, the multivariate analysis demonstrated that, as well as lower
levels of optimism, higher levels of functional disability were also predictive of depressed mood.
Wright, Parker, Smarr, Schoenfeld-Smith, Buckelew, Slaughter Johnson, and Hewett (2005)
found that a high degree of physical disability was one of the 3 best predictors of depression in
RA. Persons with a high degree of disability meet more obstacles in everyday life and are more
likely to be forced to give up valued activities. In addition, Katz and Yelin (1995) have shown
that the loss of valued activities is strongly associated with the development of depression in
RA. This contributed to the suggestion that functional disability is a risk factor for depression.
This may be due to feelings of isolation which may occur due to the subsequent restriction in
social activities.
The multivariate analysis of social anxiety and avoidance showed a number of the variables
studied to be significant. Notably, participants of a younger age were more likely to avoid and be
anxious about social situations, confirming the relatively higher importance attached to
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