Depression has been established as a common reaction to rheumatoid arthritis but has rarely been investigated among people with other forms of arthritis. The present study examined the prevalence and determinants of depressive symptoms in people with ankyylosing spondylitis, focusing on gender differences and set in the context of widely held medical views concerning the psychosocial nature of ankylosing spondylitis patients. Results showed that approximately one third of the ankylosing spondylitis patients reported a high level of depressive symptoms and that women reported more depression than men. No evidence was found to support the stereotype of the "typical" ankylosing spondylitis patient as being Jess dep.ressed than people with other forms of arthritis. Pain was found to be a major determinant of depression for women, but was of lesser importance for men. The implications of these findings are discussed.

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The purpose of this research was to investigate psychological factors associated with ankylosing spondylitis (AS), focusing on possible differences between members and nonmembers of self-help groups for people with this form of chronic disease. Analysis of health locus of control beliefs along 3 dimensions: internality, powerful others and chance, showed that members of National Ankylosing Spondylitis Society (NASS) self-help groups placed significantly less reliance on "powerful others" for control of health than did nonmembers. This pattern of beliefs may be related to the nature of AS, which is incurable, progressive, unpredictable and difficult to diagnose. It may therefore appear to the patient that health care professionals have little to offer them. People who join a self-help group may also feel less reliant on medical personnel to control their health. Group members also differed from nonmembers in terms of belief in the value of exercise for AS, frequency of exercise, tendency to seek information about the disorder and perceived social support. A combination of psychosocial and medical variables discriminated between members and nonmembers at a rate of 71.9% accuracy. Results indicate that NASS self-help group members appear to comply more with exercise treatment and also receive a valuable source of social support from fellow members. This investigation demonstrates the utility of including psychosocial variables in the study of chronic disease.

Traditionally, patient education is based on two myths : 1) increases in patients' knowledge lead to changes in behavior and 2) changes in behavior (exercise, pain management techniques) improve health status (pain, disability, depression). There it little evidence in the arthritis patient education literature that changes in knowledge or behavior improve patients' health status. In fact, little association has been found between these changes and improved health status. Explanation:The mechanism by which patient education improves arthritis may be more psychological (giving patients a sense of control) than behavioral. For example, strong associations have been shown between improved self-efficacy for controlling arthritis symptoms and health status. Therefore, arthritis patient education programs should be designed with an emphasis on giving patients a sense of control rather than on increasing knowledge or the practice of new behaviors. Patient eduction: Selection of'patient educational strategiesE. Seydel, E. Taal*, H. Rasker**. *University of Twente; **Medisch Spectrum Twente, Department of Psychology, P.O. Box 217, 7500 AE Enschede, The Netherlands.In the last few years patient education on rheumatology is a tremendous growing field of research. It is receiving more interest from behavioral scientists, physicians, nurses, policy makers, and other people who want their patients to become more informed about their conditions, to use self-management strategies, and to prevent disability. In shaping patient education health professionals are often guided by implicit criteria, vague assumptions or by trial and error. Some of them tend to equate patient education with such information dissemination techniques as teaching, and distribution of instructional pamphlets. However, instructional techniques to increase patients' knowledge is not sufficient to change behavior. There is a growing evidence, that if patient education succeeds in influencing behavior, this will not automatically result in better self-management or better health status. Self-management is defined as a process whereby a patient functions on his/her own behalf in health enhancing behavior, disease detection and treatment'. Self-efficacy seems to be an important moderator in enhancing self-management and refers to the expectation of a person that the can perform a given behavior successfully. We suggest the use of a more systematic and encompassing paradigm based on the self-efficacy concept. This concept has been successfully applied to a broad range of clinical problems, including a.o. chronic illness and health promotion. To facilitate the shaping of a patient education program based on the self-efficacy paradigm, we will present a model of patient education analysis and a set of criteria for developing and evaluating patient education programs. Some of the criteria are (1) a firm problem analysis (2) the encouragement of client responsibility, (3) full disclosure of information pertaining to the illness, (4) training of the patient in decisi...