Session Information
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease affecting multiple organs, leading to a significant impact on health-related quality of life. Theoretical models are critical to understanding the mechanisms behind the relationships between pain and psychosocial variables and can be used to help guide future research and treatment among patients with SLE. Thus, the present study examined whether helplessness is a mediator of the relationship between pain and three types of psychological distress among patients with SLE; specifically anxiety, depression, and perceived stress.
Methods: A convenience sample was obtained of patients aged 18 years and above diagnosed with SLE according to ACR 1982 guidelines at a large medical center in Southern California. Assessment included the Lupus Patient-Reported Outcome tool, Arthritis Helplessness Index, Perceived Stress Scale-10, and Hospital Anxiety and Depression Scale. Multiple mediation analysis was completing using an SPSS macro called “PROCESS.”
Results: The cohort of 136 patients had a mean age of 48.6 years (SD = 13.87), and was mostly female (92.6%) and Caucasian (44.9%). The direct effect of pain vitality on anxiety symptoms was -0.074, p < .001; the relationship between pain vitality and anxiety symptoms was significantly decreased when helplessness was included in our model, ab = -.041, BCa 95% CI [-0.073, -.015]. The direct effect of pain vitality on depressive symptoms was -0.069, p < .001; the relationship between pain vitality and depressive symptoms was significantly decreased when helplessness was included in our model, ab = -.035, BCa 95% CI [-0.502, -.212]. The direct effect of pain vitality on stress was -0.038, p < .01; the relationship between pain vitality and stress was significantly decreased when helplessness was included in our model, ab = -.041, BCa 95% CI [-0.063, -.027].
Conclusion: Consistent with studies conducted in other autoimmune populations, findings suggested that helplessness fully mediated the relationship between pain and measures of anxiety, depression, and perceived stress. These results provide a theoretical model to better understand mechanisms that may help explain the relationship between pain and psychological distress in this population. Despite the moderate to low reports of perceived stress, the high reports of perceived helplessness, anxiety and depressive symptoms suggest a need for intervention to improve self-efficacy and reduce psychological distress.
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Table 1. Demographic Characteristics of sample (n = 136) and results of multiple mediation analysis assessing relationship between LupusPRO-Pain Vitality |
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Demographics |
M (SD) |
N (%) |
Range |
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Age |
48.6 (13.8) |
|
18-81 |
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Education in years |
15.2 (2.8) |
|
8-24 |
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Annual Income ($) |
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|
|
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<15K |
|
11 (8.1) |
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15-25K |
|
16 (11.9) |
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25-39K |
|
12 (8.8) |
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40-60K |
|
13 (9.6) |
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60-75K |
|
13 (9.6) |
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75-100K |
|
21 (15.4) |
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>100K |
|
49 (36.3) |
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Female |
|
126 (92.6) |
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Race/Ethnicity |
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|
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White |
|
61 (44.9) |
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Hispanic |
|
25 (18.4) |
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African American |
|
19 (14.0) |
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Asian/Pacific Islander |
|
29 (15.7) |
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Other Mixed Race/Ethnicity |
|
11 (8.1) |
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Marital Status |
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Married/Lives with partner |
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76 (55.9) |
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Single/Never married |
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54 (25.7) |
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Divorced/Separated/Widowed |
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22 (16.2) |
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Disease Activity: Active |
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62 (45.9) |
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Disease Duration |
16.9 (11.9) |
|
0-55 |
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Anxiolytic Use |
|
35 (25.9) |
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Antidepressant Use |
|
34 (25.2) |
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Medication Use |
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Prednisone Use |
|
59 (43.7) |
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Immunosuppressant Use |
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87 (64.4) |
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Cytotoxic |
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24 (17.8) |
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Biologic |
|
62 (45.9) |
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HADS-Depression |
5.4 (4.0) |
43 (23.1%) |
0-21 |
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HADS-Anxiety |
7.7 (4.1) |
61 (41%) |
0-21 |
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PSS |
17.8(6.3) |
|
0-40 |
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LupusPRO-Pain Vitality |
56.6(27.3) |
|
0-100 |
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AHI-Helplessness |
14.5(5.4) |
|
5-30 |
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Mediational Analysis |
Direct Effect without mediator |
SE |
Indirect Effect with Helplessness Mediator |
Boot SE |
BCa 95% CI |
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Depression |
-.069 |
.011 |
-.035 |
.007 |
-.050, -.021 |
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Anxiety |
-.074 |
.021 |
-.041 |
.015 |
-.073, -.015 |
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PSS |
-.038 |
.013 |
-.043 |
.009 |
-.063, -.027 |
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Note. HADS N% pertains to participants reporting a score of 8 or above for depression and anxiety subscale. SE: Standard Error of the estimate BCa, bias corrected and accelerated. |
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To cite this abstract in AMA style:
Azizoddin DR, Mills SD, Nicassio PM, Racaza GZ, Weisman M. The Mediational Role of Helplessness in Psychological Outcomes in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-mediational-role-of-helplessness-in-psychological-outcomes-in-systemic-lupus-erythematosus/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-mediational-role-of-helplessness-in-psychological-outcomes-in-systemic-lupus-erythematosus/