Social Participation of Rheumatoid Arthritis Patients: Does Illness Perception Play a Role?

Objective: Social participation is an important aspect associated with health-related outcomes in chronic diseases. However, little is known about the factors that may affect participation in patients with rheumatoid arthritis (RA). We aimed to examinewhether pain, fatigue, anxiety, depression, and illness perception are associated with social participation in patients with RAwhen controlled for clinical and sociodemographic variables.We also analysed the mediating role of illness perception in the association between physical and psychological variables on social participation. Method: We included 157 RA patients (84.7% females; mean age 56.4+13.9 years) who completed the Participation Scale, Brief Illness Perception Questionaire, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, 36-item Short Form Health Survey, and the Visual Analogue Scale.Multiple linear regressions and mediation analyses were used to analyze the data. Results: In the final regression models, illness perception (β=.42; p≤.001) and functional disability (β=.21; p≤.05) were associated with social participation. Income (β=−.18; p≤.05) lost its significance when physical variables were added to the model, and pain (β=.24; p≤.05) and fatigue (β=−.24; p≤.05) when psychological distress was added. No significant role of anxiety, depression, disease activity, or age was identified using regression analyses. Illness perception mediated the association of pain, fatigue, anxiety, and depression with social participation, and the indirect effect varied from 65% to 98%. Conclusions: Illness perceptions may significantly diminish the impacts of pain, fatigue, anxiety, and depression on social participation in individual RA patients. Therefore, RA patients could benefit from psychological interventions aimed at tackling negative illness perceptions.