Determinants of happiness and quality of life in patients with rheumatoid arthritis: a structural equation modelling approach

Abstract

Objectives: Besides increasing longevity, the ultimate goal of medical care is to improve patients' enjoyment of life, a concept akin to happiness. This study examined the determinants of happiness and quality of life (QoL) in patients with rheumatoid arthritis (RA).

Methods: In this observational, cross-sectional study, patients were assessed on disease activity, disease impact, personality, QoL and happiness. Structural equation modelling estimation was used to analyse the associations between these dimensions, pursuing three hypotheses: H₁-disease activity and perceived impact of disease are negatively associated with overall QoL and happiness in patients with RA; H₂-'positive' personality traits are related to happiness both directly and indirectly through perceived disease impact; H₃-happiness has a mediating effect in the relation between impact of disease and QoL.

Results: Data from 213 patients were analysed. Results supported all driving hypotheses. Happiness was positively related to 'positive' personality and, to a lesser extent, negatively related to impact of disease. Impact of disease, in turn, was positively related to disease activity and mitigated by 'positive' personality traits. Impact of disease had a much stronger relation with QoL than with happiness. Happiness mitigated the negative effect of disease impact on QoL.

Conclusion: Optimisation of QoL and happiness of people with RA requires effective control of the disease process and also improvement of the disease impact domains. Personality seems to play a pivotal mediating role in these relations.

Keywords: outcomes research; patient perspective; rheumatoid arthritis.

Figure 1

Estimated standardised direct effects for the proposed model. Circles represent latent factors. Squares represent measured variables (the scale scores). Arrows connecting circles and rectangles in one direction show a hypothesized direct relationship between the two variables. Curved lines with an arrow in both directions demonstrate a bi-directional relationship (covariance). Circles with the letter “e” written in it represent the associated error. DAS28CRP3v, Disease Activity Score using 28 joints and C-reactive protein and three variables; SHS, Subjective Happiness Scale.