title: Insomnia symptoms, perceived stress and coping strategies in patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  The aim of this study is to evaluate perceived stress and coping strategies in individuals with systemic lupus erythematosus (SLE) according to the presence of insomnia symptoms, using a set of variables that include anxiety and depressive symptoms evaluation.
  
  
  METHODS
  Ninety SLE women were evaluated in a cross-sectional study using the Perceived Stress Scale (PSS), Brief COPE, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI) and Self-rating Anxiety Scale (SAS).
  
  
  RESULTS
  Individuals with insomnia symptoms (n = 57, 66%) presented higher PSS (p < 0.001), PSQI (p < 0.0001), BDI, (p < 0.0001) scores and showed less-effective coping strategies such as the use of behavioral disengagement (p = 0.04), self-blame (p = 0.02) and emotional-focused coping (p = 0.001). In a multi-regression model ISI was the independent determinant of high PSS and of behavioral disengagement; PSQI was the only determinant of self-blame (p = 0.02) and emotional-focused coping.
  
  
  CONCLUSIONS
  SLE individuals with insomnia symptoms show high levels of perceived stress and more frequent use of disengaging and emotional-focused coping strategies. This body of evidence suggests that individuals with SLE and comorbid insomnia symptoms may therefore require additional interventions for insomnia.
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy lpalagini@tiscali.it l.palagini@ao-pisa.toscana.it.
authors.forename: L
authors.initials: L
authors.lastname: Palagini
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mauri
authors.affiliation: Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Faraguna
authors.affiliation: Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Carli
authors.affiliation: Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tani
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Dell'Osso
authors.affiliation: Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mosca
authors.affiliation: Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Freiburg University Medical Center, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Riemann
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Neuropsychiatric lupus; nephritis; systemic lupus erythematosus