The role of stress in functional disability among women with systemic lupus erythematosus: A prospective study

Objective. In the last decade, the biopsychosocial approach has been applie d to systemic lupus erythematosus (SLE) to understand the multiple factors involved in the disease course. This study examined the link between stress and changes in functional disability as assessed by the Stanford Health As sessment Questionnaire (HAQ) in women with SLE, Methods, Forty-two women with SLE were assessed at baseline and 8 months la ter Major stress (Life Events), minor stressors (Hassles), depression (Beck Depression Inventory) disease activity (Systemic Lupus Activity Measure), and functional disability were collected at both time points, while demogra phic and disease damage variables (Systemic Lupus International Collaborati ng Clinics/American College of Rheumatology Damage Index) were collected on ce at baseline. Results, Mean HAQ scores at-baseline (0.52) and followup (0.46) indicated m ild disability and remained fairly stable, although individual variation wa s observed (mean change -0.07; range -1.25-0.5). Demographic (age, educatio n) and disease (duration, activity damage) variables were not related to 8- month changes on the HAQ. Of the baseline stress measures, greater negative life events in the preceding 6 months was correlated with reduced function al ability (r = 0.42) 8 months later Individual changes in depressed mood o ver the 8-month period rr ere correlated (r = 0.33) with changes in functio nal ability. Hierarchical multiple regression revealed that after controlli ng for baseline HAQ scores and changes in depressed mood, baseline negative life events remained a significant predictor of changes in functional abil ity. Conclusion, We found that the major short-term determinants of functional d isability were not demographic- or disease-related factors, but rather stre ss caused bf negative life events, Comprehensive treatment of-SLE requires management of life stress.