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

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: H(1)—disease activity and perceived impact of disease are negatively associated with overall QoL and happiness in patients with RA; H(2)—‘positive’ personality traits are related to happiness both directly and indirectly through perceived disease impact; H(3)—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.