Predictors of stress in patients with Lupus

Abstract

BackgroundStress is common in patients with Systemic Lupus Erythematosus (SLE), and is associated with depression, fatigue, and disease flares. Stress may be modifiable and identifying those at high risk allows clinicians and allied health care professionals to develop a multidisciplinary management plan to direct appropriate resources. This study is aimed at identifying predictors of high stress over time among patients with SLE.MethodsLongitudinal data from two interviews of the Lupus Outcomes Study 2 years apart from 726 patients with SLE were analyzed for stress, measured using the Perceived Stress Scale (PSS; high-stress PSS ≥6). T-test and Chi-square analyses compared patient characteristics by high-stress status. Logistic regressions were conducted with high stress as the dependent variable. Covariates included demographics, disease features, quality of life (QOL), health care utilization (HCU), and comorbidities. QoL was measured using the SF-36 form (Physical Component Score, PCS; Mental Component Score, MCS) and MOS Cognitive Functioning Scale (CFS). HCU indicated having established care with a rheumatologist, use of an emergency room or hospitalization, and quality of care. P ≤ 0.05 were considered significant.ResultsThe mean age of the cohort was 50.6 (12.5) years, 92% were women and 68% were Caucasian. The mean (SD) PSS was 5.3 (3.6), and high stress (PSS >6) was noted in 253 participants. Those with high stress were more frequently below the poverty line and less commonly employed. They had a greater prevalence of comorbidities and HCU; and worse disease severity (activity, flare, damage) and QOL. In regression analyses, high stress (baseline) was associated with younger age, married status, worse QOL, and presence of diabetes. Better QOL (PCS, MCS) independently predicted decreased odds of high stress, while high stress (baseline) predicted high stress (OR 3.16, 95% CI 1.85, 5.37, p < 0.0001) at follow-up, after adjusting for demographics, disease features, HCU, and comorbidities.ConclusionPatients with SLE should be routinely screened for QOL and stress during their clinical care, to identify those at risk for poor health outcomes. This information can facilitate multidisciplinary management for those at risk for worse health outcomes.

Anxiety and Depression and Associated Risk Factors among Outpatients with Systemic Lupus Erythematosus: Eastern Province, Saudi Arabia

“…There is inconsistent information regarding the prevalence of these manifestations among males. The discrepancy between our result and previously reported negative associations could be attributed to the variation in the screening tools used [ 24 ]. Despite SLE’s impact on neuropsychiatric health, there is still a lack of data regarding the prevalence of depression in males compared to females, mainly due to a lower prevalence of the disease in male patients [ 42 ].…”

“…Being unemployed is a predictor for anxiety and depression among the general population [23], and the correlation between unemployment and anxiety/depression was confirmed in the current study, especially with the high reported percentage of unemployment among participants. Along the same lines, recent studies found a higher anxiety and depression rate in patients with lower incomes [22,24]. Unemployment has shown a direct relationship with abnormal immune function through increased production of cytokines [25] and other biomarkers [26].…”

Quality of Life in Systemic Lupus Erythematosus and Other Chronic Diseases: Highlighting the Amplified Impact of Depressive Episodes

“…H-QoL appears to be linked with unfavorable outcomes in SLE [43] alongside depressive symptoms and stress [14]. Therefore, the prevention, early identification, and treatment of mood disorders are crucial for individuals with SLE and should consider their multifactorial pathogenesis involving both direct (e.g., antineuronal antibodies, pain) and indirect (e.g., glucocorticoids, relationship issues, comorbidities) factors [44,45].…”

“…Lastly, the effect of the stress of living with a chronic illness must be considered. It is only recently that emerging evidence has begun to suggest that the presence of depressive syndromes may serve as a determinant for a significant impairment of H-QoL among SLE patients [13,14].…”

Optimalisasi Dukungan Sosial Bagi Pasien Lupus dan Keluarga Pasca Pandemi Covid-19 di Yayasan Kupu Parahita Indonesia

“…Lupus merupakan penyakit autoimun kronis yang memerlukan perawatan jangka panjang (E. Handono et al, 2017;Leung et al, 2021). Pasien lupus dan keluarga dihadapkan dengan berbagai stresor dan tantangan meliputi kondisi penyakit yang naik turun, kondisi pasien yang sering mengalami mood swing, keharusan kontrol ke layanan kesehatan setiap bulan, minum obat setiap hari, menghadapi efek samping obat yang bermacam-macam dan tidak menyenangkan, biaya obat dan perawatan yang tidak murah, menghadapi respons sekitar yang beraneka ragam, hingga komplikasi IJCSL P-ISSN: 2579-7166 E-ISSN: 2549-6417 penyakit pada panca indera, jantung, paru, kandungan, dan saraf (Berger & Font, 2015;Cojocaru et al, 2022;Harnadia et al, 2021;Jolly & Katz, 2022;Sari Dewi et al, 2016). Diperlukan dukungan yang kuat baik bagi pasien maupun keluarga agar mampu menghadapi sakitnya dengan tenang (E. S. Jannah et al, 2022;Lombard, 2017).…”