Socioeconomic status, reserve capacity, and depressive symptoms predict pain in Rheumatoid Arthritis: an examination of the reserve capacity model.

IF 2.1 Q3 RHEUMATOLOGY BMC Rheumatology Pub Date : 2024-09-20 DOI:10.1186/s41927-024-00416-4
Desiree R Azizoddin, Richard Olmstead, Kris-Ann Anderson, Alanna E Hirz, Michael R Irwin, Shadi Gholizadeh, Michael Weisman, Mariko Ishimori, Daniel Wallace, Perry Nicassio
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Abstract

Background: Guided by the reserve capacity model, we evaluated the unique relationships between socioeconomic status (SES), reserve capacity (helplessness, self-efficacy, social support), and negative emotions on pain in patients with Rheumatoid Arthritis (RA).

Methods: The secondary analysis used baseline, cross-sectional data from 106 adults in a clinical trial comparing behavioral treatments for RA. Patients were eligible if they were ≥ 18 years old, met the ACR criteria for RA (determined by study rheumatologist), had stable disease and drug regimens for 3 months, and did not have a significant comorbid condition. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness- Arthritis Helplessness Index, self-efficacy -Personal Mastery Scale, social support- Social Provisions Scale) and negative emotions (stress and depressive symptoms- Perceived Stress Scale and Hamilton Depression Rating Scale) on pain (Rapid Assessment of Disease Activity in Rheumatology-RADAR & visual analog scale-VAS), and the indirect effects of SES as mediated by reserve capacity and negative emotions. The SEM model was evaluated using multiple fit criteria: χ2 goodness-of-fit statistic, the comparative fit index (CFI), the standardized root mean square residual (SRMR), and the root mean square error of approximation (RMSEA).

Results: Participants were mostly female (85%), 55.45 years old on average, self-identified as white (61%), Hispanic (16%), black (13%), and other (10%), and had RA for an average of 10.63 years. Results showed that low SES contributed to worse pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. The final model explained 39% of the variance in pain.

Conclusions: The findings indicate that lower SES was related to worse clinical pain outcomes and negative emotions and reserve capacity (helplessness, social support, and self-efficacy) mediated the effect of SES on pain. A primary limitation is the small sample size; future studies should evaluate this model further in larger, longitudinal approaches. Interventions that target negative emotions in patients with low SES may facilitate better pain control with RA.

Trial registration: clinicaltrials.gov NCT00072657 01/02/2004 20/03/2009.

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社会经济地位、储备能力和抑郁症状可预测类风湿关节炎患者的疼痛:对储备能力模型的研究。
背景:在储备能力模型的指导下,我们评估了类风湿关节炎(RA)患者的社会经济地位(SES)、储备能力(无助感、自我效能感、社会支持)和负面情绪对疼痛的独特影响:二次分析使用了一项比较类风湿性关节炎行为疗法的临床试验中 106 名成人的基线横截面数据。患者年龄≥18岁,符合ACR的RA标准(由研究中的风湿病学家确定),病情和用药方案稳定3个月,且无严重并发症,即符合条件。结构方程模型评估了社会经济地位、储备能力(无助感-关节炎无助感指数、自我效能-个人掌握量表、社会支持-社会供给量表)和负面情绪(压力和抑郁症状-感知压力量表和汉密尔顿抑郁评分量表)对疼痛(风湿病学疾病活动性快速评估-RADAR和视觉模拟量表-VAS)的直接影响,以及社会经济地位在储备能力和负面情绪中介下的间接影响。采用多种拟合标准对 SEM 模型进行了评估:χ2 拟合度统计量、比较拟合指数(CFI)、标准化均方根残差(SRMR)和均方根近似误差(RMSEA):参与者大多为女性(85%),平均年龄 55.45 岁,自我认同为白人(61%)、西班牙裔(16%)、黑人(13%)和其他(10%),平均患有 RA 10.63 年。研究结果表明,低社会经济地位通过较低的储备能力和较高的负面情绪导致疼痛加剧。中介分析表明,储备能力和消极情绪部分中介了社会经济地位对疼痛的影响。最终模型解释了39%的疼痛变异:研究结果表明,较低的社会经济地位与较差的临床疼痛结果有关,而消极情绪和储备能力(无助感、社会支持和自我效能感)是社会经济地位对疼痛影响的中介。该研究的主要局限性在于样本量较小;未来的研究应采用更大规模的纵向方法来进一步评估该模型。针对低社会经济地位患者负面情绪的干预措施可能有助于更好地控制RA疼痛。试验注册:clinicaltrials.gov NCT00072657 01/02/2004 20/03/2009。
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来源期刊
BMC Rheumatology
BMC Rheumatology Medicine-Rheumatology
CiteScore
3.80
自引率
0.00%
发文量
73
审稿时长
15 weeks
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