title: The contribution of disease activity on functional limitations over time through psychological mediators: a 12-month longitudinal study in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  To explore whether helplessness, internality and depression would mediate the relationship between disease activity and functional limitations in patients with AS in a 12-month longitudinal study.
  
  
  METHODS
  A total of 294 participants with AS meeting modified New York criteria completed clinical and psychological assessments at 6-month intervals. Psychological measures evaluated helplessness, depression and internality. Path analysis evaluated the direct and indirect effects of baseline disease activity on 12-month functional limitations via the psychological measures of helplessness, internality and depression at 6 months.
  
  
  RESULTS
  Baseline disease activity demonstrated direct and indirect effects on 12-month functional limitations. Helplessness and depression, but not internality, served as mediators of the relationship between disease activity and functional limitations.
  
  
  CONCLUSIONS
  Higher baseline disease activity predicted greater functional limitations at 12 months through helplessness and depression. Our findings suggest that helplessness and depression may constitute future treatment targets in reducing functional limitations in patients with AS.
authors.affiliation: Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Becker B-131, Los Angeles, CA 90048, USA.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Jang
authors.forename: Charles E
authors.initials: CE
authors.lastname: Green
authors.forename: Shervin
authors.initials: S
authors.lastname: Assassi
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ward
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weisman
authors.forename: Perry M
authors.initials: PM
authors.lastname: Nicassio
mesh_terms: D000223:Adaptation, Psychological; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006380:Helplessness, Learned; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013167:Spondylitis, Ankylosing / Q000503:physiopathology* / Q000523:psychology*; D011795:Surveys and Questionnaires