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Purpose: Psychological and sociodemographic factors contribute to disability in systemic lupus erythematosus. Yet the pathways by which these factors influence disability remain unclear. The objective of this study was to evaluate a model examining socioeconomic status (SES), perceived stress, and depressive symptoms as determinants of lupus-related disability.Methods: The sample included 134 patients receiving treatment at an academic hospital. Structural equation modeling examined the direct and indirect effects of SES (income, education, and subjective social status), perceived stress (Perceived Stress Scale), and depressive symptoms (Hospital Depression Anxiety Scale depression subscale) on disability (Lupus Patient-Reported Outcome measure Physical Health and Pain-Vitality subscales).Results: Structural equation modeling confirmed that the model fit the data well. The SES exerted a direct negative effect on perceived stress (ß = -0.40, p < 0.001). In turn, perceived stress predicted higher levels of depression (ß = 0.72, p < 0.001), which ultimately contributed to greater disability (ß = 0.53, p < 0.001). The influence of SES on disability was indirect (mediated by perceived stress and depression).Conclusions: Findings support the socioeconomic gradient in disability as mediated by perceived stress and depression, such that lower SES contributed to lupus-related disability via perceived stress and depressive symptoms.Implications for RehabilitationLow socioeconomic status, perceived stress, and depression are prognostic factors for the disability in systemic lupus erythematosus.Study findings indicate that perceived stress and depression fully mediate (account for) the negative impact of low socioeconomic status on lupus-related disability.Screening for and addressing psychological distress may enhance management of disability in lupus patients.This research demonstrates the value of a conceptual framework for identifying potentially modifiable risk factors for disability in lupus and other chronic disabling diseases.

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OBJECTIVE: This study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit. METHODS: We studied 536 Hispanics with established RA from a single centre. PtGA and MDGA were measured annually on 10 cm visual analogue scales and discordance was defined as absolute difference between them ≥3 cm. Associations between predictors and outcomes of interest were evaluated using multivariable regression and analysis of covariance for cross-sectional and longitudinal data, respectively. RESULTS: Independent predictors of baseline PtGA were pain, fatigue, depression, general health perceptions and tender joint count. MDGA was predicted by swollen joint count, tender joint count, erythrocyte sedimentation rate, fatigue and depression. Both PtGA and MDGA improved over time (all p<0.001). Discordance was observed in 43% at baseline, with fair stability over 2 years. Higher (worse) patient ratings were most prevalent; their presence at any time and increasing persistence predicted lower physical and mental HRQOL, decreased work productivity and more activity impairment at 2-year follow-up (all p<0.001). CONCLUSIONS: Determinants of PtGA, MDGA and changes over 2 years were disparate in Hispanics with RA yielding significant discordance. Higher patient ratings at any time contributed to worse HRQOL, work productivity and activity impairment on final visit.

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OBJECTIVE: To examine a model addressing the roles of rheumatoid arthritis (RA) disease burden, mood disturbance, and disability as determinants of impairments in role functioning. METHODS: In a cross-sectional design, 103 RA patients recruited from the community to participate in a clinical trial completed assessments of self-assessed disease burden (total joint pain and disease activity), mood disturbance (Center for Epidemiological Studies Depression Scale depressed mood, somatic symptoms, lack of positive affect, and interpersonal problems), disability (Health Assessment Questionnaire disability index gross and fine motor), and role functioning (Short Form 36 health survey physical and social). Structural equation modeling (SEM) was used to examine direct and indirect mechanisms linking disease burden to role functioning. RESULTS: SEM results indicated that the model had excellent fit: S-Bχ(2)(30) = 38.59, P = 0.135; comparative fit index = 0.977, standardized root mean residual = 0.062, and root mean square error of approximation = 0.053. Mediational analyses demonstrated that, while disease burden was associated with poor role functioning, its effects were jointly mediated by mood disturbance and disability. After the effects of mood disturbance and disability were taken into account, the effect of disease burden on role functioning was not significant. CONCLUSION: The results indicate that mood disturbance and disability may serve as important pathways through which RA disease burden affects role functioning. Future longitudinal research is suggested to replicate these findings and further explore the mediational mechanisms examined in this study.

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OBJECTIVE: The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic. METHOD: Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES-D score ≥ 16), current level of anxiety (State-Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer). RESULTS: A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted "U" relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels. SIGNIFICANCE OF RESULTS: Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

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