The purpose of this cross sectional descriptive study, guided by Lazarus. Stress Appraisal theory (1999), was to: (1) explore the relationships between the cognitive appraisals of patient defined pain and Other chronic stressors, negative mood, and quality of life satisfaction of adults living with SCD, (2) test the mediating effect of pain and non-pain threat appraisals on negative mood and quality of life perceptions,(3) examine the potential moderating effect of health care provider threat appraisal on the relationship between patient defined pain and non-pain stress and quality of life and, (4) collect narrative data that will be used in future research in adults with SCD.

According to Lazarus (1999), cognitive appraisals represent an individual's personal beliefs about the relevance and meaning of a stressor within transactions in the environment and the significance of its outcome to his/her personal wellbeing. Over a two year period, ninety-seven adults (18 years and older) completed in-person or telephone interviews completing questionnaires that measured pain and non pain SCD stressors, cognitive appraisals of SCD illness, SCD pain, negative mood, and quality of life.

Patient defined pain and non pain (Other) stressors were significant predictors of increased negative mood and lower quality of life satisfaction. The most frequently encountered stressor was related to health care provider relationships, and socioeconomic status related to SCD disability was appraised as the most stressful. Hierarchical regression analyses demonstrated that the ability to control SCD pain mediated the relationship between pain severity and negative mood. The pervasiveness of SCD pain on all aspects of life was the single most important underlying stressor that contributed to both the frequency and severity of patient defined non pain stressors.

Gaining a more in depth awareness and understanding of the cognitive appraisal of pain and non pain stressors would help health care providers to focus more intently on the person living with SCD. Moreover, it also would provide the first steps in identifying significant predictors and designing health care provider driven interventions to improve the quality of life of adults living with SCD.