Commentary: Juvenile Rheumatic Disease as a Psychosocial Stressor

Certain Hindu scriptures advise us not to be too attached to the fruits of our actions (Smith, 1965). Thus, in terms of scientific strategies, we should do our research care- fully, using the highest methodological standards, and ac- cept the results, whatever they are, with equanimity. Man- uscript reviewers should ask themselves primarily whether a study is sufficiently rigorous in its design and, in mak- ing their recommendations to the editor, disregard whether it had significant or meaningful results. Let the chips fall where they may, in other words. According to this view, those who survey the literature should accept into their database only well-designed studies that have passed sci- entific peer review, as required for publication in reputable journals. Another view of science, attributed to Paul Feyer- abend (1993) among others, is that there is no such thing as a "scientific" method. Science means using whatever ingenious ways we can devise to find the truth, with an emphasis on the success of the enterprise. Donald Hebb once said that the literature of psychology is full of stud- ies that were very well done and will not be heard from again. The eminent clinical psychologist David Shakow famously had to discontinue his graduate studies at Har- vard for several years because his first attempt at a dis- sertation, under the supervision of E. G. Boring, had equiv- ocal results (Shakow, 1976). Here, at the beginning of new Editor Ronald Brown's watch, the Journal of Pediatric Psychology has in its queue for publication three manuscripts concerning juvenile rheumatic disease as a psychosocial stressor on children and their families. Each of these studies had been duly accepted by his predecessor. Each is, in its way, rigorously designed but with modest results. Brown decided to print these articles in a special section and asked me to comment on them. The first of these manuscripts, by Cynthia A. Ger- hardt and her colleagues, was so well designed that it mer- ited funding by the National Arthritis Foundation, and the financial resources of the researchers were sufficient to pay the families $100 each for taking part. This investi- gation had a respectable sample size of 64 children with Ju- venile Rheumatoid Arthritis (JRA) and their parents (for the most part including fathers as well as mothers), with a relatively high participation rate among the families con- tacted. It also had a control group of 64 families of the children's classmates, matched for gender, age, and race, rather than relying on the normative samples of the mea- sures used for comparison purposes. The control children were screened to ensure that they did not have any chronic disease. The measures were well-accepted ones. The sta- tistical analyses were sophisticated, with suitable correc- tions to reduce Type I errors. Power calculations were also included so that at least medium effects could be detected. Nevertheless, the results reported were modest, with the main conclusion being how resilient the families were to the challenge of JRA in the children. It is true that signif- icantly more of the mothers of children with JRA exceeded the clinical cutoff on the SCL-90-R (Derogatis, 1983), and the "caseness" of a family was associated with family sup- portiveness and conflict. But most of the families of chil- dren with JRA were within the average range on the mea- sures used. It would seem that JRA is not necessarily a very severe psychosocial stressor. The second article, by Jennifer Reiter-Purtill and her colleagues, reports on a controlled longitudinal study of children with juvenile rheumatoid arthritis. Many of the co-authors were the same as in the previous article, all from the Children's Hospital Medical Center and the Uni- versity of Cincinnati. Once more, the National Arthritis Foundation funded the study. The demands of its design were even more rigorous than those of the previous study in that it involved longitudinal data collection over a 2-year period. As before, a nonchronically ill comparison con- trol group was used. Sample sizes were adequate, includ- ing 57 children with JRA and 63 comparison controls, and attrition over time was not too severe. In a multi- method procedure, reports by peers, teachers, and the children themselves were obtained. Collecting data from