The Role of Perceived Self-Efficacy, Perceived Control, and Causal Attributions in Adaptation to Rheumnatoid Arthritis: Distinguishing Mediator from Moderator Effects

To examine mediational versus moderational relationships among perceived control self-efficacy, and causal attributions in adjustment to chronic iUness, data were obtained at two times from 64 rheumatoid arthritis (RA) patients. Adaptational outcomes were operationalized as depression and disability. Greater evidence wasfoundfor moderational than mediational models. Only one of six mediational hypotheses was significant: Self-efficacy mediated the relationship between perceived control and disability. Four of six moderational hypotheses were significant in concurrent adaptation, and three of these remained significant when later adaptation was assessed. Moderational effects differed for depression and disability: When RA controllability or patient selfefficacy was low, internal, global, stable attributions for the cause of a symptom flare were linked to greater depression but less disability. These disparate findings are discussed in terms of the learned-helplessness model and the context of chronic illness.