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PSYCHOLOGICAL PROFILES IN AUTOIMMUNE DISEASE: RELATIONSHIP TO DEMOGRAPHIC, DIAGNOSTIC, DISEASE ACTIVITY
AND SOCIAL SUPPORT MEASURES
By REBECCA JUMP
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2005
TABLE OF CONTENTS Page
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
CHAPTER
1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Systemic Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Sj?gren's Syndrome, Scleroderma, and Polymyositis . . . . . . . . . . . . . . . . . . . . . . . . . 3 Antinuclear Antibody Positive Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Psychological Distress and Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Disease-Related Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Disease-Related Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Cluster Profiling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Illness Burden and the Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Social Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Study Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2 METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4 DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
BIOGRAPHICAL SKETCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
ii
LIST OF TABLES
Table
page
2-1 Diagnostic breakdown of demographic information . . . . . . . . . . . . . . . . . . . . . . 19
3-1 Description of response profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3-2 Crosstabulation matrix of response profiles across diagnostic categories . . . . . . 26
3-3 Values for biological markers of disease activities . . . . . . . . . . . . . . . . . . . . . . . 27
iii
LIST OF FIGURES
Figure
page
1-1 Preliminary four-cluster solution representing psychological profiles in autoimmune disease patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3-1 Replication four-cluster solution representing psychological profiles in autoimmune disease patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
iv
ABSTRACT
Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PSYCHOLOGICAL PROFILES IN AUTOIMMUNE DISEASE: RELATIONSHIP TO DEMOGRAPHIC, DIAGNOSTIC, DISEASE ACTIVITY
AND SOCIAL SUPPORT MEASURES By
Rebecca Jump August 2005 Chair: Michael E. Robinson Major Department: Clinical and Health Psychology Autoimmune diseases (AD) are characterized by chronic inflammation that can affect a variety of tissues in systemic or organ-specific forms. The challenges inherent to managing a chronic medical illness place individuals at greater risk for psychological distress, which could lead to deleterious effects on immune and neuroendocrine functioning and contribute to disease progression. Relatively little is known about variations in psychological function and the degree to which heterogeneity exists across a variety of autoimmune diseases. Further, the differential contributions of disease-related factors and psychological function to illness response remain unclear. Using a cluster analytic approach, this study determined homogenous psychological subgroups in a sample of 393 rheumatology outpatients referred to an autoimmune disease clinic for suspected AD. Participants included individuals diagnosed with an AD as well as individuals testing positive for anti-nuclear antibodies (ANA positive). Psychological subgroups were determined empirically based on visual analogue measures of depression, anxiety, anger, confusion, pain, and fatigue. Psychological response profiles
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