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

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

Desiree R Azizoddin et al. Arthritis Care Res (Hoboken).

Abstract

Objectives: Fatigue is common among individuals with systemic lupus erythematosus (SLE) but causes are not well understood. We examined perceived stress and depressive symptoms as predictors of fatigue in SLE.

Methods: Data from two years of the Lupus Outcomes Study (n=650), obtained through annual structured interviews, were used. Fatigue was measured with the 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-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% were women, 68% were Caucasian. 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% CI [1.1, 2.2], p <0.0001) significantly predicted T2 fatigue but depression was no longer significance. The addition of T1-T2 decrease in stress was associated with 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.

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