FRI0030 FEELINGS OF GUILT AND SHAME IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: BOUSSAA HIBA, Alia Fazaa, Saoussen Miladi, Kmar Ouenniche, Leila Souabni, Selma Kassab, Selma Chekili, Leith Zakraoui, Kawther Ben Abdelghani, Ahmed Laatar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic inflammatory disease which causes functional disability, pain, and joint destruction. The disease has a major impact on patient's independence, social activities and self-image. <h3>Objectives:</h3> The aims of this study were to assess whether RA is associated with increased feelings of shame and guilt, and to examine possible correlates with socio demographic characteristics and disease activity. <h3>Methods:</h3> To measure feelings of shame and guilt, in patients with RA (ACR/EULAR 2010), we used the Experience of Shame Scale (ESS) [1] and the Test of Self Conscious Affect- Version 3 (TOSCA-3S) [2]. The ESS is a 25-item questionnaire that assesses the frequency of characterological, behavioral and bodily shame experiences over the past year. Respondents rate each item on a scale ranging from 1 (not at all) to 4 (very much), with higher scores indicating greater shame. The TOSCA-3S is presented with 11 brief hypothetical scenarios followed by 3 common reactions, which reflect shame, guilt and externalization of blame. Each possible response is rated on a five-point scale from 1(not likely) to 5 (very likely). For the purpose of this study, only the shame and guilt response items were analyzed. Total scores for Shame Self-Talk and Guilt Self-Talk were calculated and compared to the scoring interpretation. A p&lt;0.05 was considered significant. <h3>Results:</h3> A total of 40 patients with RA were included, 36 women and 4 men, with a mean age of 54.2 years old [25-75]. Nine patients (22%) were illiterate, 42.5% were professionally active and 82.5% were married. The mean disease duration was 12.8 years [3-33], 80% of patients were on prednisone at a daily posology of 7 mg [2.5-12.5], 82.5% were on csDMARDs and 27.5% on bDMARDs. The mean DAS 28 ESR and CRP were respectively 4.3 [1.6-6.9] and 3.6 [1-6.2]. The mean total score of the ESS was 45.3 [27-81] with subscale means of: 19 [12-37] for characterological shame, 19 [10-30] for behavioral shame and 7.4 [4-16] for bodily shame. For the TOSCA-3S, the mean "shame self-talk Total" score was 33.8 [17-44], and the mean "guilt self-talk Total" score was 48 [37-55], which corresponds to "you often use" for men and "you use an average amount" for women, a shame and guilt self-talk. A significant correlation was found between disease activity (DAS 28 ESR) and total score of ESS, shame self-talk total score and guilt shame self-talk score (p=0.000). A significant correlation was also found between these scores and gender, age, level of education, professional activity and marital status. <h3>Conclusion:</h3> Our RA patients experienced general feelings of shame and guilt, which correlate with demographic items and disease activity. However, a case-control study with a larger population is necessary to determine whether patients with RA express more shame and guilt than their peers without RA. <h3>References:</h3> [1] Andrews B, Qian M, Valentine JD. Predicting depressive symptoms with a new measure of shame: the Experience of Shame Scale. Br J Clin Psychol 2002;41:29-42. [2] Tangney JP, Dearing RL, Wagner PE, Gramzow R (2000) The Test of Self-Conscious Affect-3 (TOSCA-3). George Mason University, Fairfax. <h3>Disclosure of Interests:</h3> None declared