Depression and causal attributions in the early stages of a chronic painful disease: A longitudinal study of early synovitis

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Abstract
A prospective longitudinal study of the persistence of depression was conducted over a two year period using 69 newly admitted out-patients with the painful symptoms of early synovitis (Rheumatoid Arthritis). Depressive symptoms at admission best predicted depression both 10and 22 months after admission. Attributions about painful symptoms did not predict later depression (learned helplessness) but there was some evidence for an antecedent hypothesis which showed that particular types of self-esteem and certain beliefs about pain control at the time of admission affect the expression of depression in the two years after diagnosis, but do not significantly improve its prediction. There was no evidence to support a scar hypothesis. The strongest evidence was found for a consequence hypothesis where attributions about pain and pain per se were consequences of depression early and late in the disease. Some indirect evidence supports the prediction that personal helplessness precedes universal helplessness as the disease progresses.