The relationships between two personality characteristics (neuroticism, extraversion), three types of supportive transactions (emotional support, social companionship, instrumental support) and satisfaction with these transactions, and two aspects of mental health (feelings of anxiety and depressive mood) were studied among 280 patients with early rheumatoid arthritis. Structural equation modeling of the relevant variables showed that people with a more neurotic personality profile showed more anxiety and depressed feelings. Extraversion had no direct effect on depression or anxiety. Companionship, both transactions and satisfaction, had an independent positive effect on depression but not on anxiety. The effect of emotional support ran via social companionship: more emotional support (both transactions and satisfaction) was expressed in companionship leading to a less depressed mood. Finally, more depressed people received more instrumental supportive transactions while more satisfaction with this type of supportive transactions was related to less anxiety.Apart from the disturbing effect of a neurotic personality profile on mental health, the results once more underscore the importance of social companionship as a multifunctional activity for people's mental health. Maintaining this type of relationships despite a disabling condition gives people the opportunity to derive rewards that otherwise could not or only with more difficulty be achieved.

OBJECTIVE:First, to investigate the patterns of functional ability, depressive feelings, and social support in early stage rheumatoid arthritis (RA) patients. Second, to demonstrate the stress buffering effect of social support. Social support is thought to reduce the impact of chronic stress on psychological well-being; for patients without social support the impact of functional ability on depressive feelings will be stronger.METHODS:In 4 waves with an intervening period of 1 year, longitudinal data was collected of 264 Dutch RA patients, of which 65% was female. At T1, the mean age of these patients was 53 years, while their mean disease duration was 22 months. In an interview at the patients' homes, data was collected on functional ability, social support en psychological well-being. The buffering effect of social support was examined by testing the significance of the (computed) stressor by social support interaction term in a regression analysis on depressive feelings.RESULTS:Although large differences between subjects existed, the mean scores on functional ability, social support, and depressive feelings barely changed from year to year. Patients who deteriorated in functional ability during one year had the best chances to improve next year, and visa versa. Furthermore, the stress by support interaction terms had no significant effect on depressive feelings in a regression analysis.CONCLUSIONS:This study demonstrated clearly the fluctuating pattern of RA in the first years after onset. The patients' level of depressive feelings was linearly related to the level of functional ability. Like many other studies, also this study could not provide evidence for the stress buffering effect of social support.

BACKGROUND:The present study examined the structure and reliability of the Dutch version of the Patient Satisfaction Questionnaire III (PSQ III). The PSQ III was designed to measure technical competence, interpersonal manner, communication, time spent with doctor, financial aspects, and access to care. In the Dutch version, the financial items were left aside because these are not appropriate for the Dutch socialized system.OBJECTIVES:The main objectives were to assess response bias, the number of dimensions needed to describe the PSQ III items, and the reliability of the scales. In addition, distribution characteristics were examined and norm scores to interpret satisfaction scores in an oncological setting were presented.RESEARCH DESIGN:A cross-sectional survey study.SUBJECTS The study was comprised of 1594 cancer patients from eight hospitals.MEASURES:The Dutch version of the PSQ III.RESULTS:Approximately 14% of the respondents were found to demonstrate considerable response bias. Confirmative factor analyses were performed to test three theoretical models with a varying number of dimensions among those participants who did not demonstrate response bias. The original structure did not fit the data well, but support was found for a three-factor model (with interpersonal manner, communication, and time spent with doctor loading on one factor instead of separate factors) and a one-dimensional model.CONCLUSIONS:The PSQ III seems to be an appropriate measure of cancer patients' satisfaction, with the note that the number of dimensions may vary for different patient groups and/or care settings and that it is important to be aware of response bias.

This article presents results from a follow-up study in the Netherlands among 292 patients with early rheumatoid arthritis (RA). The main focus of this paper is on (changes in) personality characteristics, coping strategies and psychological status between the first and second wave (T1 and T2). On personality characteristics and psychological status RA patients are compared with a reference group (N=173) from the general community.The levels of self-esteem, neuroticism and social desirability of RA patients were significantly different when compared to those of control subjects. As far as the coping strategies 'emotional expression' and 'confrontation' were concerned, RA patients presented less favourable scores than subjects from the reference group. Along the same line, psychological status was also found to be significantly different in the groups. The results on personality characteristics and psychological status remained stable after 12 months (T2). The patients' functional status appeared to be rather strongly associated only with level of self-esteem. In addition, depression on TI could be explained mainly by personality-related aspects rather than functional status and tenderness. This pattern was also present in explaining the variance of T2 depression. However, in this latter regression analysis functional status did not contribute to depression. From the results it can be concluded that factors related to the disease process such as activity restrictions and tenderness, are not or only slightly related to the psychological status of RA patients. In addition, personality characteristics, especially the level of self-esteem, appeared to be an important determinant of depressive mood in patients with RA. These findings may contribute to the treatment of RA patients by explicitly paying attention to the relevance of personality-related aspects in (self-) management programmes.

Recently, a new instrument was developed to measure social support. It consists of two parts; the Social Support Questionnaire for Transactions (SSQT) and the Social Support Questionnaire for Satisfaction with the supportive transactions (SSQS). The SSQT measures the number of supportive interactions and has proved to have good psychometric properties. From the taxonomy that was used for the present study, it results that social support in general consists of two aspects. These are, on the one hand, actual supportive transactions and, on the other hand, the perception of being supported or the satisfaction with the social support provided. In the present study, two research questions were addressed. The first concerned the psychometric properties of the SSQS, measuring the individual's satisfaction with the supportive interactions provided. Secondly, the relative contribution of both supportive interactions (the SSQT) and the satisfaction with the support provided (the SSQS) were assessed, in explaining the level of health related quality of life outcome. The data of 744 rheumatoid arthritis (RA) patients from four different countries (116 French, 238 Norwegian, 98 Swedish and 292 Dutch patients) were used in the present study. At the entry of the study, all patients fulfilled four out of seven American Rheumatism Association (ARA) criteria and had a disease duration of 4 years or less. The results of the study indicate that the SSQS has good psychometric properties across countries. Cronbach's α for the emotional support scales was 0.80 or more, and for the instrumental support subscales around 0.60. The standardized regression coefficients demonstrated that, compared to supportive interactions, support satisfaction was more relevant in explaining health related quality of life measures, although it is recommended that the SSQT and SSQS be used to complement each other.

Objective. To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied.Methods. In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between TI and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences.Results. The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are >0.91 for both instruments. For patients who improved between T1 and T2, measured by the Ritchie Articular Index, the standardized response mean of the HAQ and the GARS were moderate, whereas for patients who worsened, the standardized response means were small. The results based on the relative efficiency were ambiguous. Furthermore, the mean score for women on the HAQ was 0.25 higher in contrast to scores for men. The GARS did not yield different scores for women and men.Conclusion. The internal consistency of the GARS and the HAQ are comparable. The HAQ has yielded different results for women and men. Therefore, when the HAQ is used, sex differences should be taken into account. With respect to sensitivity to change, the GARS and the HAQ obtained much better results for patients who improved in contrast to patients who worsened. The GARS was found to be more sensitive to change for patients who improved.

As part of an international European research project, a longitudinal study was started by the end of 1990 in the northern part of The Netherlands. The study concentrated on recently diagnosed RA patients (N=292), i.e., incident cases up to four years. According to the duration of the disease, five groups of patients had been formed. The early influence of rheumatoid arthritis on medical parameters, on functional status, on physical condition and on psychological well-being was evaluated. From the results, an overall statistically significant pattern related to the duration of the disease could not be distingiushed. However, patients recently diagnosed did face activity restrictions, a decline in physical condition and social functioning. On medical parameters this deterioration is less profound. Furthermore, across and within the five patient groups, it seems that males and females respond differently to the influence of early RA. Based on cross-sectional data from the five onset cohorts, the present findings do not significantly suggest a steady worsening in medical, physical and psychological condition.

Social support is supposed to have a beneficial effect on the health and wellbeing of people. It is a central concept in the ‘EUropean Research on Incapacitating DIseases and Social Support’ (EURIDISS). In general, two main distinctions concerning social support are made in the literature, providing four basic dimensions or types of social support: a social-emotional vs an instrumental type of social support, and a ‘crisis’ or ‘problem-oriented’ vs ‘everyday’ or ‘daily’ type of social support. Based on these types of social support, a series of items were formulated to measure actual supportive interactions or exchanges of resources. The items were spread over five scales. The social-emotional type of social support comprised three scales: daily emotional support; problem-oriented emotional support; and social companionship, while the instrumental type of social support consisted of two scales: the daily instrumental support and the problem-oriented instrumental support. Together, these items and scales constitute the so-called ‘Social Support Questionnaire for Transactions’ (SSQT). The main objective of this paper is to investigate whether one and the same instrument, i.e. the SSQT, allows for meaningful comparisons between patients with rheumatoid arthritis from different countries. More specifically, the dimensionality and invariance of the dimensions across countries of the SSQT are explored. To this end, patients from four different European countries (France, Norway, The Netherlands and Sweden) were asked to fill in the SSQT. The analysis of the data using principal component analysis (PCA) and simultaneous component analysis (SCA), did yield the intended scales, although the internal consistency of one of them, the daily instrumental support scale, is questionable. It is concluded that, particularly in the area of social-emotional support, the SSQT is a useful instrument for international comparative research.

PURPOSE:Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well-being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well-being. The focus of the present study is on the main effect versus the buffering effect of social support.METHODS:Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home.RESULTS:Receiving more daily emotional support positively related to greater psychological well-being; whereas problem-oriented emotional support negatively related to some aspects of psychological well-being. People receiving more social companionship turned out to be less depressed.CONCLUSION:The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.

OBJECTIVESThe Groningen Activity Restriction Scale (GARS) is a non-disease-specific instrument to measure disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). It was developed in studies of Dutch samples consisting of elderly or chronically ill people. The psychometric properties of the GARS demonstrated in these studies were highly satisfactory. This paper addresses the psychometric properties of the GARS across countries.METHODSData of 623 patients with recently diagnosed rheumatoid arthritis from four European countries were analyzed by means of a principal components analysis and a Mokken scale analysis for polychotomous items.RESULTSThe results of the analyses were highly satisfactory: there was one strong and reliable general factor representing one underlying dimension of disability in ADL and IADL, and there was a clear hierarchical ordering of the items included in the GARS. The validity of the GARS was strongly suggested by the pattern of associations of the GARS with age, sex, and other existing health status measures.CONCLUSIONSThe psychometric characteristics of the GARS, which measures disability in ADL and IADL simultaneously, make this instrument very useful for comparative research across countries.

The present study addresses the relationship between early rheumatoid arthritis and an element of personality i.e. the self-esteem, as an intervening variable on psychological well-being. From a sample of 292, more or less recently diagnosed RA-patients, the relationships between disease parameters, self-esteem and psychological well-being were studied. Five subgroups of patients have been formed according to the duration of the disease: from four years disease duration up to incident cases. Disease parameters such as the duration of RA or the sedimentation rate is not associated with patients' self-esteem. The self-esteem of RA-patients is negatively related to the level of joint tenderness. Also, the lower the self-esteem of patients, the lower the level of psychological well-being. Joint tenderness with the patients' level of self-esteem explain 34% of the scoring on psychological well-being.

In recent years, medical technology has improved considerably and the possibilities to replace destructed parts of the body that have been affected by rheumatoid arthritis (RA), have grown also. However, the availability and application of advanced techniques does not automatically entail an improvement of quality of life of individuals. Although the physical (dis)ability of RA patients very often leads to certain restrictions, it is not the only element in the evaluation of life-as-a-whole. The way in which the RA-patient copes with the uncertainty of tomorrow and the management of pain and fatigue is another important element in evaluating quality of life. Beside personality factors, social network and social support are regarded to play an important role in this respect and subsequently in the well-being of individuals in general, and especially where it concerns individuals suffering from a chronic disease. Today, a growing number of evidence of the beneficial impact of social support is available of which some of them are discussed.

The objective was to investigate the relationship of stressful life events and disability in early rheumatoid arthritis (RA), taking into account a possible stress-buffering effect of the social network. As part of a European study (EURIDISS), 337 early RA patients in France and The Netherlands (mean disease duration = 2.3 years) were interviewed for life events which had occurred in the past year. The social network composition was assessed using a standardized interview schedule and described by network density and proximity characteristics. Disability was assessed with the Health Assessment Questionnaire (HAQ) cross-culturally adapted to the French and Dutch languages. Subjects reported a median of 2 significant life events over the past year. On average they had 20 persons in their social network. The disability was significantly higher when the number of life events experienced was higher (r = 0.11; p<0.05) and when the number of social network members in monthly contact with the subjects was lower (r = −0.13; p<0.05). Controlling for country, the HAQ score increased significantly with the disease duration, disease activity variables, number of life events related to RA or to another health problem and decreased with the number of social network members. A significant (number of health-related life events)x(number of social network members) cross-product term entered the model which fitted the data better (R 2 =0.51). Factors associated with disability are disease duration, disease activity, number of health-related life events and number of social network members in monthly contact. The results suggest a stress-buffering effect of the social network in coping with stressful life events in early RA.

The current study presents data on reliability and validity of the Relationship Beliefs Inventory (RBI), a 40-item questionnaire which was designed to assess beliefs people hold about intimate relationships. The RBI was administered to clinical and non-clinical couples along with measures of marital functioning, communication, and irrational beliefs. The RBI-scales are relatively unaffected by social desirability and have adequate internal consistency and test-retest reliability. Evidence was provided for its construct validity, but discriminant validity is poor.