Health Status, Cognitive Coping, and Depressive Symptoms: Testing for a Mediator Effect

MATTHEW P. MARTENS, JERRY C. PARKER, KAREN L. SMARR, JAMES E. HEWETT, BIN GE, KATHLEEN DONOVAN HANSON, JAMES R. SLAUGHTER, and SARA E. WALKER

ABSTRACT.

Objective. Research has established a link between health status and symptoms of depression in persons with rheumatoid arthritis (RA), but the effects of "cognitive coping" variables have not been extensively studied. We examined the mediator effect of a cognitive coping variable (Pain Control and Rational Thinking factor score from the Coping Strategies Questionnaire) over the course of a pharmacological intervention.

Method. Data were analyzed from 54 persons with RA, all of whom met diagnostic criteria for major depression. Measures of depression, health status, and cognitive coping were collected at 4 different stages of a pharmacological (antidepressant) study as follows: (1) at baseline, (2) postintervention, (3) 6 month followup, and (4) 15 month followup.

Results. Results indicated that a direct relationship existed between health status and depression at all 4 time periods. However, this relationship was mediated by cognitive coping only at the postintervention and the 6 month followup.

Conclusion. A cognitive coping variable was found to mediate the relationship between health status and depression, but only at moderate levels of depression. (J Rheumatol 2005;32:1584-8)

Key Indexing Terms:

HEALTH STATUS
PAIN
DEPRESSION
MEDIATOR EFFECT
RHEUMATOID ARTHRITIS

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From the Research Service, Harry S Truman Memorial Veterans' Hospital; Department of Physical Medicine and Rehabilitation; Department of Psychiatry; Department of Family and Community Medicine; Department of Immunology and Rheumatology, University of Missouri-Columbia, Columbia, Missouri; Department of Educational and Counseling Psychology, State University of New York, University at Albany, Albany, New York; and Department of Institutional Research, Buena Vista University, Storm Lake, Iowa, USA.

Supported in part by grants from the National Institute on Disability and Rehabilitation Research (NIDRR) of the US Department of Education under grant H133B30039; and from Pfizer, Inc. Support was also received from the Medical Research Service of the Department of Veterans Affairs.

M.P. Martens, PhD, Assistant Professor, Department of Educational and Counseling Psychology, State University of New York, University at Albany; J.C. Parker, PhD, Associate Chief of Staff, Research and Development, Harry S Truman Memorial Veterans' Hospital, Clinical Professor, Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Missouri-Columbia; K.L. Smarr, PhD, Clinical Assistant Professor, Department of Psychiatry, University of Missouri-Columbia, Staff Psychologist, Harry S Truman Memorial Veterans Hospital; J.E. Hewett, MA, Director of Institutional Research, Buena Vista University; B. Ge, MD, MA, Statistician; K. Donovan Hanson, MEd, Research Associate; J.R. Slaughter, MD, Clinical Associate Professor, Family and Community Medicine; S.E. Walker, MD, Professor, Department of Medicine, Department of Immunology and Rheumatology, University of Missouri-Columbia.

Address reprint requests to Dr. J.C. Parker, Research Service, Harry S Truman Memorial Veterans' Hospital, 800 Hospital Drive, Columbia, MO 65201. E-mail: parkerjc@health.missouri.edu

Accepted for publication March 31, 2005.

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