This article is the first to review published research on psychosocial factors and behavioral interventions related to systemic lupus erythematosus (SLE). The first section presents descriptive studies, followed by studies that investigate psychosocial factors as predictor and outcome variables. These studies demonstrate that the consideration of psychosocial factors is critical to understanding the disease experience of persons with SLE. Next, studies of behavioral interventions are presented, leading to the conclusion that randomized controlled trials are essential yet rare. The final section highlights limitations of the extant literature and suggests directions for future research and recommendations for clinicians.

The present longitudinal study examined the role of general and tailored social support in mitigating the deleterious impact of racial discrimination on depressive symptoms and optimism in a large sample of African American women. Participants were 590 African American women who completed measures assessing racial discrimination, general social support, tailored social support for racial discrimination, depressive symptoms, and optimism at two time points (2001–2002 and 2003–2004). Our results indicated that higher levels of general and tailored social support predicted optimism one year later; changes in both types of support also predicted changes in optimism over time. Although initial levels of neither measure of social support predicted depressive symptoms over time, changes in tailored support predicted changes in depressive symptoms. We also sought to determine whether general and tailored social support “buffer” or diminish the negative effects of racial discrimination on depressive symptoms and optimism. Our results revealed a classic buffering effect of tailored social support, but not general support on depressive symptoms for women experiencing high levels of discrimination.

The purpose of the present study was to investigate relationships among sexual dissatisfaction, body image, and physical and psychological functioning in 54 women with systemic lupus erythematosus (SLE) and a demographically similar comparison sample of 29 healthy women. For women with SLE, sexual dissatisfaction was positively correlated with fatigue, depressive symptoms, and feelings of physical attractiveness. No significant differences existed between women with SLE and healthy women with respect to sexual dissatisfaction or body image. Our results suggest that the impact of disease on body image and sexual dissatisfaction are greatest when levels of fatigue and depressive symptoms are high.

These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.

The purpose of this study is to obtain feedback from 20 men on developing effective programming to reduce the impact of diabetes (t2dm) among Black men. Three focus groups were convened in Des Moines, Iowa. Men were recruited, all either diagnosed with t2dm (n = 10), pre-diabetic (n = 1), or experienced t2dm through family and friends (n = 9). The results highlighted themes related to t2dm knowledge, masculinity, and behavioral health; gender-centered diabetes management education; and family support and functioning. Men provided recommendations for program format and content, desirable facilitator characteristics, and whether to include spouses/partners, relatives, and friends. These results provide guidance and ideas to nurses wishing to enhance t2dm education and patient outcomes for Black men.

This study used focus-group methodology to seek understanding about the unique influence of stress, gender, and culture on type 2 diabetes mellitus (t2dm) prevention and management among Black men. Twenty men from Iowa were recruited from a larger longitudinal study on Black families; each of these men participated in one of three focus groups. Ninety-five percent of the men in the sample were Black and all were either diagnosed with t2dm ( n = 10), were prediabetic ( n = 1), or had experience with t2dm through family and friends ( n = 9). Our results revealed the existence of significant stress and some pessimism with respect to perceived ability to prevent and manage t2dm. The participants made it clear that, while their families are primary sources of support for managing stress, including t2dm, they can also be a source of stress, particularly with respect to parenting. Black men had mixed opinions on their relationships with respect to their health care providers; some had positive, long-standing relationships while others reported little or no relationship with their providers. In response to life stress, Black men reported experiencing inadequate and disrupted sleep as well as consuming too much alcohol at times. Some of the participants reported engaging in physical activity to manage their stress. The study concluded that, as researchers develop t2dm prevention and management programs, they should continue to consider the unique role that stress in its various forms, plays in the lives of Black men.

Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.

We examined whether instructing participants to write in a narrative fashion about stressful life events would produce superior physical and psychological health benefits relative to standard expressive writing instructions that do not specify the essay's structure. Undergraduates (N = 101) were randomly assigned to engage in two, 20-minute narrative writing, standard expressive writing, or control writing tasks. Follow-up data were obtained one month later. The essays of the narrative writing group evidenced higher levels of narrative structure than did those of the expressive writing group. Greater narrative structure was associated with mental health gains, and self-rated emotionality of the essays was associated with less perceived stress at follow-up. In addition, the narrative and expressive writing groups reported lower levels of perceived stress and depressive symptoms relative to controls but did not differ from each other with regard to these outcomes. Health care utilization at follow-up did not vary by group assignment. Findings suggest that both emotional expression and narrative structure may be key factors underlying expressive writing's mental health benefits. Results also suggest that, among college students, instruction in narrative formation does not increase the positive effects of expressive writing relative to standard expressive writing instructions.Keywords expressive writing; emotional disclosure; narrative; health; stress; psychological adjustment Does Narrative Writing Instruction Enhance the Benefits of Expressive Writing?Extensive research has documented links between expressive writing and improvement in physical and mental health, when participants writing about personal stressors or traumatic experiences have been compared to control participants assigned to write about more perfunctory topics (see Frattaroli, 2006, for a meta-analytic review). These studies have been conducted with college student samples (see Smyth, 1998, for a meta-analytic review), community-residing adults (Francis & Pennebaker, 1992;Spera, Buhrfeind, & Pennebaker, 1994), survivors of child sexual abuse (Batten, Follette, Hall, & Palm, 2002) and rape (Brown & Heimberg, 2001), and medical patients (e.g., Danoff-Burg, Agee, Romanoff, Kremer, & Strosberg, 2006;Norman, Lumley, Dooley, & Diamond, 2004;O'Cleirigh, Ironson, Fletcher, & Schneiderman, 2008;Petrie, Fontanilla, Thomas, Booth, & Pennebaker, 2004;Smyth, Stone, Hurewitz, & Kaell, 1999;Stanton et al., 2002). Despite the proliferation of expressive writing research, the mechanisms underlying its therapeutic effect are not yet clear (Low, Stanton, & Danoff-Burg, 2006). In attempting to explain mechanisms by which expressive writing produces benefits, researchers have emphasized the importance of creating a narrative (Pennebaker & Seagal, 1999;Ramírez-Esparza & Pennebaker, 2006;Smyth & Pennebaker, 1999). Although numerous theories exist regarding what constitutes a narrative (e.g., Gergen & Gergen, 1997;McAdams, 1996), definitions often emphasize story...