WHY ME - THE PERSISTENCE OF NEGATIVE APPRAISALS OVER THE COURSE OF ILLNESS

This paper examines the relationship of illness appraisals and causal attributions to later psychological adjustment among individuals copin g with a chronic illness. Data on threat and challenge appraisals, cau sal attributions, and depression were collected twice over an 18-month period from patients with recently diagnosed rheumatoid arthritis (RA ). Appraisals and attributions were differentially related to psycholo gical adjustment. Challenge appraisals were stable over time but were unrelated to depression. Internal, stable, global attributions about t he diagnosis were associated with greater depression at follow-up for subjects who were initially high on the depression measure but were re lated to lowered depression for individuals with initially low depress ion. An interaction between initial threat appraisals and depression w as also found for depression 18 months later. For individuals with low depression scores initially, threat appraisals were related to greate r depression later; when initial depression was high, threat appraisal s were unrelated to later depression. In addition, initial threat appr aisals mediated the relationship between initial level of depression a nd rumination (continuing to ask, ''Why me?'') 18 months later. These findings are discussed in terms of the failure to achieve some resolut ion about the place of the illness in one's life and of theories of dy sphoric rumination that suggest that negative self-focus contributes t o a continuing depressed mood.