La pobresa i la caritat

Some of the previous research has cited that RA has a negative influence on people’s Quality of Life (QoL, Borman, et al., 2007). Past researchers have assumed that individuals with RA are forced to face up to the condition, which involves an unpredictable and painful future. Consequently, considering its serious consequences, the related effects of RA on QoL are important topics for research (Sivas, et al., 2004). On the other hand, the present research proposed that psychological factors might be essential in sustaining psychological well-being. Furthermore, positive illness perception might be linked to the coping strategies used by RA people in order to be able to re-evaluate the impact of their condition and find a positive change in RA. Therefore, those who present a positive impact from RA may be psychologically well-adapted to the condition and presume positive outcomes on their life as a result of RA. Thus, it is assumed that the level of PPC positively correlates with ratings of its impact on the QoL. The expectation was that RA might have a positive impact on the perception of people in their appraisal of life; hence the more people experience PPC, the more they evaluate their life as having positive change. By this means, the research has used a well-known measurement (Danao et al., 2001, QoLRA Scale) to examine this topic. Unexpectedly, the present study findings demonstrate that there was no relationship between the target variables. It is recognised that a possible reason for this finding might be the nature of the concept, as QoL is an indefinable, multidimensional factor that has produced a large amount of research, yet it has been operationally defined in a variety of ways by previous investigators (Coons, Rao, Keininger, & Hays, 2000).

Furthermore, past research showed that people with RA had poorer scores on functional disability, depression and pain (Baykara, et al., 2013). Thus the association of RA with QoL might lead to a significant decrease in functional capacity and QoL, as well as an increase in pain and depression. Therefore, further research looking into the sensitivity of QoL in considering both positive and negative change in people with RA is recommended to avoid further worsening of the psychological impact of RA.

4.3.2.7. Depression

It was predicted that the PPC score on the SLQ negatively correlates with the level of mood, presenting the depression, on the AIMS-2 scores. Contradictory to what was expected no

association has been found between the level of PPC and depression. Some of the past research indicates that psychological distress is connected to both functional disability and disease activity, as such those with RA experience more activity losses which might lead to depression and anxiety (e.g. Affleck et al., 1999; Treharne et al., 2005). In turn, mental or emotional impairment also might lead to an impact on functional limitation, which eventually could increase the overall impact of the illness and potentially might result in disability.

The present thesis, at the start, predicted that the more an individual with RA experiences PPC, the greater the adverse impact on experiencing mental health symptoms such as low mood and depression. Interestingly, no associations have been found between the level of PPC and depression as measured by the AIMS-2. The main focus here is on the possibilities of PPC as a consequence of RA, which typically might prompt disagreeable psychological reactions such as depression and anxiety. Thus, it seems appropriate to consider that individuals with RA face psychological distress, in particular for sets of circumstances that threaten the person’s independency, which in turn might impact negatively on psychological well-being. Reaction to the diagnosis of RA and further living with the condition for a long period typically includes a general desire for things to be different. Thus, it was predicted that general feelings of negative emotions, such as depression, might frequently be observed in people dealing with RA; however, no association has been found based on the present study’s data. Considering the current findings it can be argued that the extent of PPC is less likely to vary as a consequence of people’s experiences.

In addition, this might be because of the nature of the condition in which the range of PPC and psychological distress often exist concurrently. Thus, the more someone experiences positive change, the more they are able to control the adverse impact of depression and anxiety. It is also worth considering that this study is the first to identify PPC in persons with RA, therefore the findings from this study highlight the central role of PPC and suggest that PPC is best understood in terms of the repetition of these findings. Accordingly, future studies are essential to understand the nature of this association and to evaluate how PPC alters over time and interacts with depression.

4.3.2.8. Level of tension

It was expected that the PPC score on the SLQ would negatively correlate with the level of tension rating score on the AIMS-2. Unexpectedly, this finding was inconsistent with those

reported by some of the past studies, for example Ho et al., (2011) and Matcham et al., (2013).

Given that the earlier literature revealed the relationship between mental health factors and RA, it is likely that other factors not mentioned here are compatible with this finding or could influence the consequences of the survey study. This finding suggests that, together, both positive and negative changes might be critical in totally understanding individual differences in adjusting to RA. However, the role of possible constructive thinking to adapt to RA has received far less attention, and there is a general lack of supporting its beneficial and health promoting effects. With this in mind, the replication of this finding is recommended.

4.4. Aim four: Predictors of Positive Psychological Change in people with Rheumatoid