Objectives Few data are available on the role of emotional distress as a possible mediator of the relationship between coping strategies and the Patient Global Assessment (PGA). This study aims to investigate, in a large cohort of patients affected by Rheumatoid Arthritis (RA), the relationship between specific copying strategies and PGA, and the role of emotional distress as a mediator. Methods 490 patients with RA completed a set of standardized assessments including the self-reported PGA, the Coping Orientation to the Problems Experienced (COPE-NVI) and the Hospital Anxiety and Depression Scale (HADS). A mediation analysis was conducted to investigate the role of emotional distress. Results The effect of coping strategies on the PGA score was significantly mediated by the emotional distress for religious (total effect mediated 42.0%), planning (total effect mediated 17.5%), behavioral disengagement (total effect mediated 10.5%), and focus on and venting of emotions (total effect mediated 9.8%). Seven coping strategies (acceptance, positive reinterpretation and growth, active coping, denial, humor, substance use-mental disengagement) resulted directly associated to PGA total score, but no mediation effect was found. The remaining four coping strategies were not associated to the PGA score. Conclusion This study suggests that coping strategies could be an important factor in the perceived disease severity. Consequently, in order to reduce PGA in patients with RA, a useful tool could be represented by the implementation of psychological interventions aiming to modify the specific coping styles. Moreover, to prevent or treat emotional distress seems to further reduce PGA.

中文翻译：

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类风湿性关节炎患者队列的应对策略、情绪困扰和感知疾病严重程度：中介分析

目标 关于情绪困扰作为应对策略与患者整体评估 (PGA) 之间关系的可能中介的作用的可用数据很少。本研究旨在调查大量受类风湿性关节炎 (RA) 影响的患者，特定复制策略与 PGA 之间的关系，以及情绪困扰作为中介的作用。方法 490 名 RA 患者完成了一套标准化评估，包括自我报告的 PGA、对所经历问题的应对取向 (COPE-NVI) 和医院焦虑和抑郁量表 (HADS)。进行了调解分析以调查情绪困扰的作用。结果 应对策略对 PGA 评分的影响由宗教情绪困扰显着介导（总效应介导 42.0%），计划（总效应介导 17.5%），行为脱离（总效应介导 10.5%），以及关注和发泄情绪（总效应介导 9.8%）。七种应对策略（接受、积极的重新解释和成长、积极应对、否认、幽默、物质使用-心理脱离）与 PGA 总分直接相关，但未发现中介效应。其余四种应对策略与 PGA 评分无关。结论 这项研究表明，应对策略可能是感知疾病严重程度的一个重要因素。因此，为了减少 RA 患者的 PGA，可以通过实施旨在改变特定应对方式的心理干预来代表一种有用的工具。此外，预防或治疗情绪困扰似乎可以进一步降低 PGA。