Description
In systemic sclerosis (SSc), a multisystem autoimmune disease characterized by an accumulation of collagen in the skin and internal organs, patients experience physical ailments such as pain and skin disfigurement, as well as psychological ailments, such as depression, distress, and fatigue. In addition to threats on life, these chronic and disabling symptoms negatively impact patients' quality of life and ability to manage their disease. These effects cannot be fully explained by medical parameters, therefore indicating a need to evaluate the impact of psychological characteristics such as optimism and pessimism. Optimism and pessimism focus on expectancies for the future. Optimism involves the expectation of positive outcomes and an engaged approach to life, whereas pessimism involves the expectation of negative outcomes and a tendency to withdraw from challenging situations. Research shows that optimism has been consistently associated with better health outcomes, including higher levels of health perception and psychological well-being. In contrast, pessimism has been associated with worse health outcomes, such as higher degrees of depression and lower degrees of subjective well-being. These findings have been shown among patients with cancer, cardiovascular disease, and rheumatoid arthritis, but have not been investigated in patients with SSc, a disease with poorly understood etiology and limited treatment options. The present study investigated whether optimism and pessimism moderate or mediate the relationship between disease severity and depression and disability in patients with SSc by testing two opposing models. Participants were 169 patients with SSc recruited through the University of California at Los Angeles (UCLA) Scleroderma Quality of Life Study. Participants were administered clinical examinations by the physician investigators, and completed pen-and-paper surveys. These surveys included demographic questions and self-report measures of optimism, pessimism, depression, and disability. Optimism and pessimism were evaluated using the Life Orientation Test-Revised, for which confirmatory factor analysis revealed a two-factor structure. Congruent to the literature, optimism was found to be negatively associated with depression and disability, and pessimism was positively associated with depression and disability. Results revealed that neither optimism nor pessimism was a mediator or moderator of the relationship between disease severity and quality of life outcomes. This study was the first to examine optimism and pessimism in patients with SSc. Although these characteristics did not serve as moderators or mediators of the hypothesized relationships, further research is warranted to examine their effect on other disease outcomes in SSc.
