Background/Purpose: Stress can influence immune and neuroendocrine processes, and may lead to poor outcomes in people with systemic lupus erythematosus (SLE). Social support can potentially reduce the negative influences of stress on disease outcomes. We examined the relationships between stress and disease outcomes and whether social support mitigates those relationships in SLE. 

Methods:   We examined cross-sectional data from GOAL, a large population-based cohort of patients with validated SLE from Atlanta, Georgia. Since 2011, participants respond annually to validate self-administered health outcome surveys. Social Support was assessed with the Patient-Reported Outcomes Measurement Information System Social Support Short Form 4a (Emotional, Informational and Instrumental). We used Cohen’s Perceived Stress Scale 4 (PSS-4), Systemic Lupus Activity Questionnaire (SLAQ) and the Patient Health Questionnaire-9 (PHQ) for depression severity. Analysis of covariance (ANCOVA) was used to examine the effect of social support (categorical) on the linear relation between perceived stress and disease outcomes.

Results:   Among 670 participants (93.9% women, 80.0% Black; mean age 48.4), mean(SD) scores were 7.20(2.55) for PSS-4, 15.18(8.66) for SLAQ, and 7.18(5.92) for PHQ-9. Mean(SD) social support scores were 52.03(9.28) for instrumental, 52.80(10.73) for informational, and 55.45(9.33) for emotional support.  Stress was significantly associated with disease activity and depression. Instrumental support was the only social support construct that modified the effect of stress on disease activity. Neither emotional, informational nor instrumental support influenced the association between stress and depression. However, at a given stress level, participants with low social support have significantly worse disease activity and depression.

Conclusion: In a population-based SLE cohort with large numbers of Blacks, there was an elevated level of perceived stress and moderate to severe disease activity, with 30% endorsing moderate to severe depression. Instrumental social support may buffer the association between disease activity and stress. Recognizing the importance of developing more instrumental resources, such as transportation and home care services may contribute significantly to improving SLE health outcomes.