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In the latest issue of "Arthritis Care and Research", there is finally a longitudinal study demonstrating an association between spouse depressive symptoms and disability and disease course in individuals with rheumatoid arthritis.
Of course, past studies have shown a correlation between the moods of partners in the face of chronic illness; and therefore it would not be unreasonable to assume that such findings are representative of a contagion of sorts: A partner's negative distress and demoralization impacts the other's mood. However, this study is different in that the study design was able to dismiss initial similarity between partners' moods, as it is most likely that these couples became romantically involved before the onset of significant rheumatoid arthritis disease activity and disability-which of course would affect the mood of the ill partner.
Unfortunately, this latest study defers to the future the explanation of any underlying behavioral mechanisms which may exist; instead, the focus is on care giving and support processes in a relationship. We all may-or certainly should-assume that intimate couples are interdependent when it comes to social and physical roles played out in both the relationship and society. Tensions occur in relationships when the restrictions caused by rheumatoid arthritis, for example, impact the emotional and physical duties of the well partner. In addition, the existence of a chronic illness with its associated pain and disability can cause deterioration in the quality of spousal social support; perceived hostility by the partner affected by rheumatoid arthritis can in turn impact that individual's social and emotional functionality, and also impact physical manifestations of an inflammatory illness. Other researchers have found a demonstrable negative effect on disease activity in the face of marital hostility, with increased inflammation and deleterious effects on immune function. It would be very nice indeed to see complete measurements of stress hormones and markers of immunity, to correlate with the partners' behavioral displays.
Counseling for couples will in many cases be as important as the drugs prescribed to the individuals suffering from rheumatoid arthritis. When spouses are depressed, they may be less likely to provide the necessary quality support needed by the partner with rheumatoid arthritis. It has been found that spousal support given to the partner with rheumatoid arthritis enhances coping mechanisms, and therefore reduces pain; support also reduces catastrophizing---which can become an irritant to those sharing the environment with chronic pain patients. Spousal depression, and the criticism and hostility depression often engenders, can result in a rheumatoid arthritis patient having maladaptive coping behaviors, and therefore poor psychological adjustment, not to mention more pain.
Perhaps we rheumatologists should have long ago stopped treating only the patient with rheumatoid arthritis. Instead, we should be treating the couples. It is not enough to feel we are enlightened enough to care about the psychological well-being of our patients: We must consider also the psyche of the spouse.
