title: The role of stress in functional disability among women with systemic lupus erythematosus: a prospective study.
abstract: OBJECTIVE
  In the last decade, the biopsychosocial approach has been applied 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 Assessment Questionnaire (HAQ) in women with SLE.
  
  
  METHODS
  Forty-two women with SLE were assessed at baseline and 8 months later. 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 demographic and disease damage variables (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were collected once at baseline.
  
  
  RESULTS
  Mean HAQ scores at baseline (0.52) and followup (0.46) indicated mild disability and remained fairly stable, although individual variation was observed (mean change -0.07; range -1.25-0.5). Demographic (age, education) 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 functional ability (r = 0.42) 8 months later. Individual changes in depressed mood over the 8-month period were correlated (r = 0.33) with changes in functional ability. Hierarchical multiple regression revealed that after controlling for baseline HAQ scores and changes in depressed mood, baseline negative life events remained a significant predictor of changes in functional ability.
  
  
  CONCLUSIONS
  We found that the major short-term determinants of functional disability were not demographic- or disease-related factors, but rather stress caused by negative life events. Comprehensive treatment of SLE requires management of life stress.
authors.affiliation: Division of Clinical Epidemiology, Montreal General Hospital, Quebec, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Da Costa
authors.forename: P L
authors.initials: PL
authors.lastname: Dobkin
authors.forename: L
authors.initials: L
authors.lastname: Pinard
authors.forename: P R
authors.initials: PR
authors.lastname: Fortin
authors.forename: D S
authors.initials: DS
authors.lastname: Danoff
authors.forename: J M
authors.initials: JM
authors.lastname: Esdaile
authors.forename: A E
authors.initials: AE
authors.lastname: Clarke
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D006233:Persons with Disabilities / Q000145:classification / Q000523:psychology*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology* / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires