Sarah R. Ormseth

The Contribution of Pain and Depression to Self-Reported Sleep Disturbance in Patients with Rheumatoid Arthritis

Summary Pain and depression were related to sleep disturbance in rheumatoid arthritis. Depression partly mediated the relationship between pain and sleep. ABSTRACT The objective of this article 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 who 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, the SF‐36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. 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.

Confirmatory Factor Analysis of the Pittsburgh Sleep Quality Index in Rheumatoid Arthritis Patients

The purpose of this research was to evaluate the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in rheumatoid arthritis (RA). The sample included 107 patients with RA, 88 females and seven males, with an average age of 56.09 years, recruited from the greater Southern California area. Confirmatory factor analysis evaluated single, two- and three-factor models. The single factor solution yielded a poor fit to the data. While the three-factor solution had the best fit, the two-factor solution, comprised of sleep efficiency and perceived sleep quality factors, was optimal because it had very good fit, and acceptable reliability for its individual factors. Clinical indices were consistently correlated with the sleep quality factor, but not with the sleep efficiency factor.

Culture, emotion, and cancer screening: an integrative framework for investigating health behavior.

BackgroundAlthough health disparity research has investigated social structural, cultural, or psychological factors, the interrelations among these factors deserve greater attention.PurposeThis study aims to examine cancer screening emotions and their relations to screening fatalism as determinants of breast cancer screening among women from diverse socioeconomic and ethnic backgrounds.MethodsAn integrative conceptual framework was used to test the multivariate relations among socioeconomic status, age, screening fatalism, screening emotions, and clinical breast exam compliance among 281 Latino and Anglo women, using multi-group structural equation causal modeling.ResultsScreening emotions and screening fatalism had a negative, direct influence on clinical breast exam compliance for both ethnic groups. Still, ethnicity moderated the indirect effect of screening fatalism on clinical breast exam compliance through screening emotions.ConclusionsIntegrative conceptual frameworks and multivariate methods may shed light on the complex relations among factors influencing health behaviors relevant to disparities. Future research and intervention must recognize this complexity when working with diverse populations.

A multidimensional model of fatigue in patients with rheumatoid arthritis.

Objective. To evaluate a multidimensional model testing disease activity, mood disturbance, and poor sleep quality as determinants of fatigue in patients with rheumatoid arthritis (RA). Method. The data of 106 participants were drawn from baseline of a randomized comparative efficacy trial of psychosocial interventions for RA. Sets of reliable and valid measures were used to represent model constructs. Structural equation modeling was used to test the direct effects of disease activity, mood disturbance, and poor sleep quality on fatigue, as well as the indirect effects of disease activity as mediated by mood disturbance and poor sleep quality. Results. The final model fit the data well, and the specified predictors explained 62% of the variance in fatigue. Higher levels of disease activity, mood disturbance, and poor sleep quality had direct effects on fatigue. Disease activity was indirectly related to fatigue through its effects on mood disturbance, which in turn was related to poor sleep quality. Mood disturbance also indirectly influenced fatigue through poor sleep quality. Conclusion. Our findings confirmed the importance of a multidimensional framework in evaluating the contribution of disease activity, mood disturbance, and sleep quality to fatigue in RA using a structural equation approach. Mood disturbance and poor sleep quality played major roles in explaining fatigue along with patient-reported disease activity.

Healthcare Mistreatment and Continuity of Cancer Screening Among Latino and Anglo American Women in Southern California

The aim of this research was to examine the relation of perceptions of healthcare mistreatment and related emotions to continuity of cancer screening care among women who reported healthcare mistreatment. The structure of relations among cultural beliefs about healthcare professionals, perceptions of mistreatment, mistreatment-related emotions, and continuity of screening was investigated. Participants included 313 Anglo and Latino American women of varying demographic characteristics from southern California who were recruited using multi-stage stratified sampling. Structural equation modeling confirmed the relation of perceptions of mistreatment to continuity of care for both Anglo and Latino American women, with ethnicity moderating this association. For Anglo Americans, greater perceptions of mistreatment were negatively related to continuity of screening. However, for Latinas the relation was indirect, through mistreatment-related anger. While greater perceptions of mistreatment were associated with higher levels of anger for both ethnic groups, anger was negatively related to continuity of care for Latino but not for Anglo women. Furthermore, cultural beliefs about professionals were indirectly related to continuity of screening through perceptions of mistreatment and/or mistreatment-related anger. These findings highlight the importance of the role of cultural and psychological factors in research and interventions aimed at improving patient-professional relations with culturally diverse women.

Conceptualizing and examining the role of stress in arthritis: a comment on Harris et al.

It has long been known that having arthritis is associated with significant psychiatric comorbidity [1]. For example, approximately 20 to 30 % of patients with arthritis suffer from depressive disorders [2]. It has also been confirmed that having arthritis is a stressful experience for many patients, and that stress may contribute to greater pain, disease activity, and mood disturbance in diagnosed patients [3]. However, while research has documented the negative psychological impact of having arthritis on patients in community samples over time [4], it has never been substantiated that psychological factors, including stress, increase the risk of developing arthritis. This vitally important knowledge would broaden our understanding of the etiology of arthritis and its management. Furthermore, based on evidence that stress may contribute to disease onset, novel treatment strategies could be developed and implemented that could prevent the onset of arthritis, potentially reducing its worldwide prevalence and impact. While longitudinal studies that are executed on the population level are difficult to design and execute, they provide unique opportunities for examining prospective relationships that can alter our perspective of an entire field. The study by Harris et al. [5] is noteworthy for its magnitude and the significance of its findings. The authors reported results suggesting that perceived stress may have an independent role in the development of arthritis. Using data from a sample of over 12,000 participants from the Australian Longitudinal Study of Women’s Health assessed at 3-year intervals, the authors found that perceived stress significantly increased the odds of having arthritis over time. Their multivariate modeling approach, which included a time lag, confirmed the effect of stress on the onset of arthritis 3 years later, while controlling for the contribution of other psychological factors, behavioral variables, disease comorbidities, and health care use. Interestingly, social support, a potentially mitigating factor as a stress buffer, did not protect patients from the onset of arthritis. Nevertheless, greater social support is associated with better mental health functioning in patients who have been diagnosed with arthritis and face the challenges of coping with their illness [6]. Their data also demonstrated that stressful life events were not predictive of arthritis onset. The results illustrate the importance of distinguishing between objective stressors from the feeling of being stressed, showing that the latter is more prognostic of the onset of arthritis. While the objective and subjective components of the stress process have been long debated and studied in the behavioral medicine literature [7], this finding may have particular relevance to autoimmune disease. Subjective stress is correlated with depression and anxiety that drive the sympathetic, neuroendocrine, and immune systems that, in turn, can exacerbate the inflammatory response. Hypothetically, chronic stress might increase the propensity for developing arthritis in persons with genetic vulnerability for autoimmune disorders. Whether this is true or not warrants empirical scrutiny. On a more practical note, it is important to identify patients who are stressed in clinical practice who may be at risk for arthritic conditions. Clinicians can easily assess perceived stress in medical settings by querying patients about their perceived burdens and/or by administering brief self-report instruments [8]. In addition, the Harris et al. study raises important questions about the distinction between osteoarthritis (OA) and rheumatoid arthritis (RA), and whether their data are applicable to either or both conditions. Although their survey P. M. Nicassio (*) Department of Psychiatry, School of Medicine, University of California, Los Angeles, CA, USA e-mail: pnicassio@mednet.ucla.edu

Evolution of Emotional Symptoms Over Time Among Daughters of Patients With Breast Cancer

OBJECTIVE This study longitudinally profiled anxiety and depressive symptoms of daughters of patients with breast cancer and examined the mother׳s survival status, the daughter׳s age at the time of mother׳s diagnosis, and the style of family communication about breast cancer as moderators of change in symptomatology across participants׳ first 3 appointments at the University of California, Los Angeles Revlon Breast Center High Risk Clinic. METHODS We evaluated the effects of hypothesized predictors on change in anxiety and depressive symptoms, 3 (symptomatology at first, second, and third clinic visits) × 2 (mother survived or died) × 2 (<20 or ≥20y old at diagnosis) × 2 (open or closed family communication) repeated-measures analyses of variance were employed. RESULTS There was a main effect for time of diagnosis on state anxiety, demonstrating a significant reduction in anxiety across clinic visits overall (p < 0.001). There were also significant 3-way interactions. For state anxiety, mother׳s survival status moderated the time of diagnosis × age at diagnosis and time of diagnosis × family communication interaction effects. For daughters whose mothers died, decreased anxiety was observed in those who were younger at the time of diagnosis (p = 0.001). For daughters whose mothers survived, anxiety was decreased for those with closed family communication styles (p = 0.001). The time of diagnosis × mother׳s survival × age at diagnosis interaction was also significant for depressive symptoms (p = 0.001). Among daughters whose mothers died, those who were younger showed decreases in symptoms (p = 0.004). CONCLUSION These daughters appeared to benefit from the high-risk program as demonstrated by decreased symptomatology, particularly daughters whose mothers died who were younger at the time of diagnosis.

Psychological Factors that Link Socioeconomic Status to Depression/Anxiety in Patients with Systemic Lupus Erythematosus

Our analyses examined whether reserve capacity factors would explain the relationship between socioeconomic status (SES) and symptoms of depression/anxiety in patients with systemic lupus erythematosus (SLE). We assessed disease activity, depression/anxiety symptoms, and intrapersonal and interpersonal reserve capacity measures in 128 patients with SLE. Multiple meditational analyses revealed that intrapersonal and interpersonal psychosocial aspects of reserve capacity fully mediated the relationship between SES and depression/anxiety. Lower SES was indirectly associated with higher symptoms of depression and anxiety through the effects of psychosocial resilience. Interventions aimed at improving modifiable reserve capacity variables, such as self-esteem and optimism, may improve anxious/depressive symptomatology in patients with SLE.

Role of psychosocial reserve capacity in anxiety and depression in patients with systemic lupus erythematosus.

To examine the relationship between reserve capacity measures and anxiety/depression among patients with systemic lupus erythematosus (SLE) from Southern California (SoCal), United States and Manila, Philippines.

A Multidimensional model of disability and role functioning in rheumatoid arthritis

To examine a model addressing the roles of rheumatoid arthritis (RA) disease burden, mood disturbance, and disability as determinants of impairments in role functioning.