Background/Purpose: Patients with juvenile lupus and dermatomyositis (JSLE/JDM) often experience persistent emotional distress and early loss of cardiovascular health (CVH)—the sum of protective factors that reduce cardiovascular disease risk. We previously found that elevated emotional distress trajectories were associated with worse CVH trajectories, especially for diet and physical activity. To inform future intervention targets, we examined parent-reported resiliency factors hypothesized to associate with lower emotional distress and better diet/physical activity.

Methods: The LEADS-CV cohort has been described previously (https://duke.is/y/cx66). We included 58 participants with complete data. Emotional distress was assessed using parent-proxy PROMIS Pediatric Psychological Stress Experiences, Depressive Symptoms, and Anxiety measures (PROMIS-Stress/-Depr/-Anx). Resiliency factors were evaluated for both patients (parent-proxy PROMIS Positive Affect; Emotion Dysregulation Inventory Reactivity & Dysphoria subscales [EDI-R/-D]) and parents (self-reported PROMIS Self Efficacy & Emotional Support). Parent-proxy measures of diet quality (FLASHE screener) and physical activity (PROMIS Physical Activity) were administered. Growth mixture models (GMM) were used to identify latent resiliency trajectories, and linear mixed-effects models (LMM) examined associations among resiliency factors, emotional distress, and diet/physical activity.

Results: GMMs identified good, fair, and poor latent trajectories for parent-proxy PROMIS Positive Affect and EDI-R/EDI-D, and good and poor trajectories for parent self-report PROMIS Self Efficacy & Emotional Support (Figure 1). Poor resiliency trajectories were common (17-53%) and associated with higher baseline emotional distress. LMMs showed consistent associations of PROMIS Positive Affect, EDI-R, and EDI-D with all emotional distress measures (β range |0.34–0.74| in expected directions, Table 1). Parent-reported PROMIS Emotional Support was inversely associated with parent-proxy PROMIS-Stress and PROMIS-Depr (β = -0.21 & -0.22 respectively), and parent-reported PROMIS Self Efficacy was inversely associated with PROMIS-Depr and PROMIS-Anx (both β = -0.18) (Table 1). Higher PROMIS-Depr scores were uniquely linked to worse diet quality (β range -0.56 to -0.77, Table 2), while no other consistent relationships emerged among emotional distress, resiliency factors, diet quality, or physical activity (not shown).

Conclusion: Enhancing positive affect and emotion regulation in patients and strengthening emotional support and self-efficacy among caregivers may mitigate emotional distress in patients with JSLE/JDM. Depressive symptoms may uniquely predispose JSLE/JDM patients to worse diet quality and warrant attention in CVH behavior change interventions. Further research incorporating novel assessment tools (e.g., wearable devices) and intensive study designs (e.g., ecological momentary assessment) is needed to further elucidate the dynamic associations between emotional distress and CVH behaviors.

Figure 1: Resiliency Factor Latent Trajectories

Table 1: Linear Mixed-Effects Models (LMM): Associations of Resiliency Factors & Emotional Distress Measures

Table 2: Linear Mixed-Effects Models Reveal Unique Association of Higher Depressive Symptoms with Worse Diet Quality

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/positive-affect-and-emotion-regulation-protect-juvenile-onset-lupus-and-dermatomyositis-patients-from-emotional-distress-longitudinal-analysis-of-lupus-erythematosus-and-dermatomyositis-stress-and-ca/