When life's a pain: perceived stress and psychosocial factors in women with arthritis transitioning from midlife to older age

Research Doctorate - Doctor of Philosophy (PhD)Arthritis represents an ongoing public health challenge. This disease contributes substantially to global healthcare expenditure and is a major cause of disability, limited mobility and chronic pain. The overarching aim of this thesis was to examine the contribution of perceived stress and associated psychosocial factors to the burden of arthritis and disease onset in a cohort of women transitioning from midlife to older age. In order to achieve these aims, a multi-method approach was applied. Women from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) provided the sampling frame for all analyses contained within this thesis. Specifically, the first study aimed to determine the relative importance of psychosocial factors in arthritis diagnosis. This study focused on 10,509 women who responded to questions on arthritis in the fifth survey of the ALSWH conducted in 2007. Findings from this analysis indicated that arthritis was characterised by widespread psychosocial concerns, particularly relating to chronic stress and poor mental health. Following the adjustment for behavioural, demographic and health-related characteristics, anxiety was the only psychosocial factor associated with arthritis (OR=1.4, 95% CI=1.2, 1.7; p<0.001). The second quantitative analysis aimed to examine the role of perceived stress as a risk factor for arthritis development. This analysis focused on 12,202 women from the 1946-1951 cohort who completed at least one ALSWH survey in either 2001, 2004 or 2007. Longitudinal analyses were modelled using Generalised Estimating Equations, with and without a time lag. Findings from these analyses indicate that perceived stress is a strong risk factor for arthritis, with both minimal (OR=1.7, 95%CI=1.5, 2.0; p<0.001) and moderate/high (OR=2.4, 95%CI=2.0, 2.9; p