Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue

Abstract

Objective Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. Methods Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF‐36) vitality scale along with a variety of self‐report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1‐to‐T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self‐report of fibromyalgia, pain, and SLE duration, activity, and damage. Results Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF‐36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1‐to‐T2 decrease in stress was associated with a clinically meaningful decline in fatigue (β = –11.8 [95% CI –15.6, –8.9]; P < 0.0001). Conclusion While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.

Peripheral neuropathy and health-related quality of life in patients with primary Sjögren’s syndrome: a preliminary report

“…Fatigue (expressed as reduced vitality in SF-36) and pain are the most common extraglandular symptoms reported by patients suffering from rheumatologic diseases [21][22][23]. In population-based studies, the prevalence of persistent fatigue reaches approximately 20% among healthy individuals and up to 70% in patients with autoimmune diseases [21,22]. The pathogenesis of persistent fatigue is still unknown.…”

Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

“…Depression affects both physical and mental dimensions of fatigue in SLE. Additionally, depression is frequent in SLE patients (between 17 and 75% of patients), and some authors have mentioned that SLE contributes to depression through its neurological involvement, an autoimmune effect, and the emotional consequences of pain and disability [30][31][32]. Stress, which is a subjective negative perception of life events, which may be influenced by sociological and psychological factors and SLE burden, seems to mediate the relationship between depression and fatigue over time in SLE patients.…”

“…Stress, which is a subjective negative perception of life events, which may be influenced by sociological and psychological factors and SLE burden, seems to mediate the relationship between depression and fatigue over time in SLE patients. Decline in stress has been associated with a meaningful improvement in fatigue in SLE [31]. Sleep disorders have also been shown to be common and significant predictors of fatigue, occurring in more than half of SLE patients [28,29,33,34].…”

Dual trajectories of fatigue and disease activity in an inception cohort of adults with systemic lupus erythematosus over 10 years

“…One study demonstrated that over a one-year period self-reported perceived stress mediated the relationship between fatigue and depression. 39 In another study of 515 patients, fatigue was reported by 90% sample population and associated with helplessness and abnormal illness-related behaviours over the course of approximately 4 years follow up. 9 In the univariable and multivariable analyses of baseline variables, using C3 with the best fatigue trajectory as the reference group, demonstrated that older age at diagnosis was associated with lower fatigue classes (C3 and C4).…”