PHILADELPHIA—A spouse’s coping skills affect his or her partner’s ability to manage the chronic pain and disability of rheumatoid arthritis (RA), according to Tracey A. Revenson, PhD.
Dr. Revenson, professor of psychology at the Graduate Center of City University of New York, said that how well a patient copes with the pain and disability of RA also affects his or her spouse’s well-being and the integrity of their marriage.
“It is time for us to start doing research on couples and families where one person has rheumatoid arthritis,” she said in her ARHP Daltroy Memorial Lecture titled “Something’s Gotta Give: Couples Coping with Chronic Pain,” presented here at the 2009 ACR/ARHP Annual Scientific Meeting. “We need to move toward including the larger social context into the study of coping with rheumatoid disease.”
Dr. Revenson noted that much of the research into coping behavior related to RA has focused on strategies used by the patients with the disease. Little has been directed to their spouses, who are also greatly affected by their partner’s pain and disability. “Relatively few studies have investigated coping as a relational phenomenon; for example, how family members cope with an illness stressor, how they mutually influence each other, how they help and hurt,” she said.
“Most coping efforts take place within an interpersonal context,” she continued. “When one family member experiences stressors of illness, other family members are affected,” she said. The family members must learn to adjust to living an unpredictable life, one that includes pain and unexpected flares.
The resulting stress affects marital communication and satisfaction, with chronic stress leading to a higher probability of divorce. Chronic stress affects physical functioning, immune function, and mental health. “When you see your partner in pain and feel unable to help, that correlates with emotional distress,” Dr. Revenson said.
Spouses play a dual role in the coping process. They give help to the ill person, but they also need help themselves. “They are expected to provide help to their partner while also coping with their own stress and rearranging their daily life,” she said.
Stressors for Partners
Rheumatoid arthritis can have several effects on the spouse of the patient. Compared to spouses married to healthy partners, these partners are at greater risk of depression, experience greater loneliness, and have a high prevalence of psychological disturbance, Dr. Revenson said.
She outlined several stressors that affect the spouses of people with RA. The top stressor is seeing their partner in pain and feeling helpless to do anything about it. Another is the frustration with a partner’s physical limitations that can change from one day to the next. The negative changes in the patient’s mood can lead to depression in the spouse. Partners also have feelings of fear and uncertainty about their spouse’s future health, along with worries about what that may mean for their marriage. And, finally, a major stressor is the inevitable reduction in pleasurable activities, such as sex, socializing with friends, and “just having fun,” she said.
