The objective of this paper is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology (RADAR), the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index (AHI), the Active and Passive Pain Coping Scales of the Pain Management Inventory (PMI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI). Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.

Objective To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA). Methods A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS 28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI. Results Lower self-reported disease activity and higher active coping were significantly related to SF-36 physical functioning scores, whereas lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning. Higher self-reported disease activity and lower helplessness were associated with greater disability as indexed by the HAQ-DI. The DAS 28 was unrelated to these outcomes. Conclusions The findings highlight the importance of targeting psychological factors to enhance HRQOL in the clinical management of RA patients.

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Introduction A quarter of women Veterans (WVs) receiving VA healthcare meet diagnostic criteria for both insomnia disorder and posttraumatic stress disorder (PTSD). Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective at improving sleep among individuals with comorbid psychiatric conditions; however, no studies have examined the impact of CBT-I in women with insomnia plus PTSD. The current analyses examined changes in sleep symptoms, quality of life (QoL), and mental health symptoms from pre- to post-CBT-I in WVs with and without PTSD. Methods This was a secondary analysis of 75 WVs with insomnia (32 with probable PTSD), who received CBT-I within a behavioral sleep intervention study (NCT02076165). Measures completed at baseline, posttreatment, and 3-month follow-up included: insomnia severity (Insomnia Severity Index, ISI), sleep quality (Pittsburgh Sleep Quality Index, PSQI), PTSD symptoms (PTSD Checklist-5, PCL-5; probable PTSD=total score ≥33), depressive symptoms (Patient Health Qestionnaire-9, PHQ-9), and mental and physical quality of life (Short Form Health Survey, SF-12). One sample T-tests examined changes in ISI, PSQI, PHQ-9, PCL-5, and SF-12 from baseline to posttreatment and baseline to follow-up. Two samples T-tests compared change scores in ISI, PSQI, PHQ-9, and SF-12 between participants with and without PTSD. Results There were significant improvements in ISI (p≤.001), PSQI (p≤.001), PHQ-9 (p≤.001), PCL-5 (p=.001), and SF-12 mental (p≤.001) and physical (p=.03) from baseline to posttreatment and 3-month follow-up (p≤.001-.01). There were no significant change score differences between WVs with and without PTSD from baseline to posttreatment (p=.06-.98) or 3-month follow-up (p=.09-.93). Conclusion CBT-I appears to be an effective treatment to improve insomnia symptoms among WVs with and without PTSD, and may reduce psychiatric symptoms as well. These findings suggest WVs with comorbid insomnia and PTSD benefit from CBT-I. The appropriate sequencing of CBT-I and PTSD treatments remains potentially important, but unstudied. Support VA/HSR&D IIR-HX002300; NIH/NHLBI K24HL14305; VA Office of Academic Affiliations through the Advanced Fellowship Programs in HSR&D and Women’s Health

Introduction Women Veterans disproportionately suffer from insomnia, which negatively impacts health and overall quality of life. Insomnia can result in fewer value-based choices and less engagement in meaningful life activities. This study sought to identify common life values expressed by women Veterans engaged in an acceptance-and commitment-based behavioral therapy for primary insomnia. Methods 74 female-identifying Veterans (mean age=48.3 years; 47.3% non-Hispanic White, 28.4% Black/African American, 23.0% Hispanic/Latina, 12.2% American Indian/Alaska Native, 5.4% Asian American and 9.5% Other) who met DSM-5 diagnostic criteria for Insomnia disorder were randomly assigned to an acceptance-based behavioral treatment for insomnia called Acceptance of the Behavioral Changes to treat insomnia (ABC-I; compared to a similarly structured group receiving CBT-I). Women in the ABC-I group received 5 weekly, 60-minute sessions containing key components of sleep restriction, stimulus control, and sleep hygiene. In place of traditional cognitive therapy exercises, we incorporated essential components of Acceptance and Commitment Therapy (ACT), such as the identification of values. Outcome measures included qualitative responses of values identified by participants. Qualitative responses were coded by three separate raters who coded participant stated values into five categories: Work/Education, Relationships, Personal Care/Health, Leisure, and Pets. Results The three independent coders reached 100% agreement after independent coding and adjudication. The five categories are listed in order of frequency of response: 1) Relationships (n =68); 2) Personal Care/Health (n =51); 3) Work/Education (n =46); 4) Pets (n =12) and; 5) Leisure (n =5). Conclusion The current study showed that personal and social relationships are of high importance to women Veterans undergoing behavioral treatment for insomnia, followed by personal care and health, which includes spirituality/religion, and physical and mental health. Findings indicate that incorporating outcomes of insomnia treatment trials that assess relationship quality may prove important in future studies of women Veterans with sleep disorders. Further, identifying common shared values among women Veterans is an important first step in developing and adapting treatments for insomnia that help to improve quality of life. Support (If Any) VA HSR&D IIR 13-058-2 and RCS-20-191, NIH K24 HL143055; VA GLAHS GRECC