Depressive symptoms in rheumatoid arthritis : the quantitative and qualitative assessment of self-esteem
Self-esteem was defined as the cognitive process in which an individual perceives characteristics of themselves, as well as their behavioural and affective reactions to those characteristics. It was measured by the Southampton Self-Esteem and Sources of Self-Esteem scale (SSESS). The purpose of the three studies within this thesis was to assess quantitative and qualitative aspects of self-esteem, and symptoms of depression in homogeneous groups of the diverse RA population. The first study was a cross-sectional between-group analysis of elderly adults with RA and an non-RA control group. The elderly RA participants had significantly higher self-reports of depressive symptoms and lower self-esteem than control participants. In addition, the length of RA disease duration was positively correlated with depressive symptoms. This indicates that for older adults longer RA duration was associated with increased reports of depressive symptoms. The second cross-sectional study evaluated depressive symptoms, self-esteem and other variables including perceptions of RA pain, coping strategies and functional ability reported by individuals with amyloidosis as a potentially fatal consequence of RA in comparison with an RA-only group. Although there was no significant difference between the groups' depressive symptom scores, the amyloid participants reported significantly lower scores of self-esteem and lower RA pain reports than the RA-only participants. The third study was longitudinal in design with two assessments separated by six-months. Prior reports of RA pain, helplessness beliefs, passive coping strategies and low self-esteem significantly distinguished participants with elevated symptoms of depression from non-depressed participants. Regression analyses of this study suggested that self-esteem was a direct antecedent and a direct consequence of functional ability as a behavioural aspect of RA.