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.
Agmon-LevinNMoscaMPetriMShoenfeldY. Systemic lupus erythematosus one disease or many?Autoimmun2012; 11: 593–595.
3.
PalaginiLMoscaMTaniCGemignaniAMauriMBombardieriS. Depression and systemic lupus erythematosus: A systematic review. Lupus2013; 22: 409–416.
4.
MoscaMGovoniMTomiettoP. The development of a simple questionnaire to screen patients with SLE for the presence of neuropsychiatric symptoms in routine clinical practice. Lupus2011; 20: 485–492.
5.
TurchettiGYazdanyJPallaIYelinEMoscaM. Systemic lupus erythematosus and the economic perspective: A systematic literature review and points to consider. Clin Exp Rheumatol2012; 30: 116–122.
6.
TragerJWardMM. Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol2007; 13: 345–351.
7.
Da CostaDDobkinPLPinardL. The role of stress in functional disability among women with systemic lupus erythematosus: A prospective study. Arthritis Care Res1999; 12: 112–119.
8.
PawlakCRWitteTHeikenH. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom2003; 72: 159–165.
9.
KozoraEEllisonMCWaxmonskyJAWamboldtFSPattersonTL. Major life stress, coping styles, and social support in relation to psychological distress in patients with systemic lupus erythematosus. Lupus2005; 14: 363–372.
10.
BirminghamDJNagarajaHNRovinBH. Fluctuation in self-perceived stress and increased risk of flare in patients with lupus nephritis carrying the serotonin receptor 1A –1019 G allele. Arthritis Rheum2006; 54: 3291–3299.
11.
BricouOTaiebOBaubetTGalBGuillevinLMoroMR. Stress and coping strategies in systemic lupus erythematosus: A review. Neuroimmunomodulation2006; 13: 283–293.
12.
VosTFlaxmanADNaghaviM. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet2012; 380: 2163–2219.
13.
KnutsonKL. Does inadequate sleep play a role in vulnerability to obesity?Am J Hum Biol2012; 24: 361–371.
14.
RiemannDBaglioniCSpiegelhalderK. Lack of sleep and insomnia. Impact on somatic and mental health [article in German]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz2011; 54: 1296–1302.
15.
AbadVCSarinasPSGuilleminaultC. Sleep and rheumatologic disorders. Sleep Med Rev2008; 12: 211–228.
16.
Fernandez-MendozaJVgontzasAN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep2013; 15: 418–418.
17.
PalaginiLBrunoRMGemignaniABaglioniCGhiadoniLRiemannD. Sleep loss and hypertension: A systematic review. Curr Pharm Des2013; 19: 2409–2419.
18.
PalaginiLTaniCMauriM. Sleep disorders and systemic lupus erythematosus. Lupus2014; 23: 115–123.
19.
RiemannDNissenCPalaginiLOtteAPerlisMLSpiegelhalderK. The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol2015; 14: 547–558.
20.
PalaginiLTaniCBrunoRM. Poor sleep quality in systemic lupus erythematosus: Does it depend on depressive symptoms?Lupus2014; 23: 1350–1357.
21.
CostaDDBernatskySDritsaM. Determinants of sleep quality in women with systemic lupus erythematosus. Arthritis Rheum2005; 53: 272–278.
22.
VinaERGreenSLTrivediTKwohCKUtsetTO. Correlates of sleep abnormalities in systemic lupus: A cross-sectional survey in an urban, academic center. J Clin Rheumatol2013; 19: 7–13.
23.
WekkingEMVingerhoetsAJvan DamAPNossentJCSwaakAJ. Daily stressors and systemic lupus erythematosus: A longitudinal analysis—first findings. Psychother Psychosom1991; 55: 108–113.
24.
Peralta-RamírezMJiménez-AlonsoJGodoy-GarcíaJFPerez-GarcíaM. Group Lupus Virgen de las Nieves. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom Med2004; 66: 788–794.
25.
BonnetMHArandDL. Hyperarousal and insomnia: State of the science. Sleep Med Rev2010; 14: 9–15.
26.
RiemannDSpiegelhalderKFeigeB. The hyperarousal model of insomnia: A review of the concept and its evidence. Sleep Med Rev2010; 14: 19–31.
27.
RoehrsTGumenyukVDrakeCRothT. Physiological correlates of insomnia. Curr Top Behav Neurosci2014; 21: 277–290.
28.
MeerloPSgoifoASucheckiD. Restricted and disrupted sleep: Effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev2008; 12: 197–210.
29.
McKinleyPSOuelletteSCWinkelGH. The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. Arthritis Rheum1995; 38: 826–834.
30.
LazarusRS. Toward better research on stress and coping. Am Psychol2000; 55: 665–673.
31.
Cummings EM, Greene AL, Karraker KH. (eds). Life-span developmental psychology: Perspectives on stress and coping. Hillsdale, NJ. Lawrence Erlbaum Associates, 1991.
32.
CarverCS. You want to measure coping but your protocol’s too long: Consider the Brief COPE. Int J Behav Med1997; 4: 92–100.
33.
PenleyJATomakaJWiebeJS. The association of coping to physical and psychological health outcomes: A meta-analytic review. J Behav Med2002; 25: 551–603.
34.
HolahanCJMoosRH. Risk, resistance, and psychological distress: A longitudinal analysis with adults and children. J Abnorm Psychol1987; 96: 3–13.
35.
AdamsSGDammersPMSaiaTLBrantleyPGaydosGR. Stress, depression, and anxiety predict average symptom severity and daily symptom fluctuation in systemic lupus erythematosus. J Behav Med1994; 17: 459–477.
36.
McCrackenLMSemenchukEMGoetschVL. Cross-sectional and longitudinal analyses of coping responses and health status in persons with systemic lupus erythematosus. Behav Med1995; 20: 179–187.
37.
DobkinPLFortinPRJosephLEsdaileJMDanoffDSClarkeAE. Psychosocial contributors to mental and physical health in patients with systemic lupus erythematosus. Arthritis Care Res1998; 11: 23–31.
38.
HerrmannMSchölmerichJStraubRH. Stress and rheumatic diseases. Rheum Dis Clin North Am2000; 26: 737–763.
39.
BaglioniCBattaglieseGFeigeB. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord2011; 135: 10–19.
40.
HochbergMC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725–1725.
41.
American Academy of Sleep Medicine. International classification of sleep disorders—third edition. (ICSD-3), Chicago: American Academy of Sleep Medicine, 2014.
42.
BuysseDJReynoldsCF3rdMonkTHBermanSRKupferDJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res1989; 28: 193–213.
43.
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42: 599–608.
44.
MoscaMBencivelliWVitaliCCarraiPNeriRBombardieriS. The validity of the ECLAM index for the retrospective evaluation of disease activity in systemic lupus erythematosus. Lupus2000; 9: 445–450.
45.
GladmanDDUrowitzMBGoldsmithCH. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum1997; 40: 809–813.
46.
MorinCM. Insomnia: Psychological assessment and management, New York: Guilford Press, 1993.
47.
CohenSKamarckTMermelsteinR. A global measure of perceived stress. J Health Soc Behav1983; 24: 385–396.
48.
TuncayTMusabakIGokDEKutluM. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health Qual Life Outcomes2008; 6: 79–79.
49.
BeckATWardCHMendelsonMMockJErbaughJ. An inventory for measuring depression. Arch Gen Psychiatry1961; 4: 561–571.
50.
ZungWW. A rating instrument for anxiety disorders. Psychosomatics1971; 12: 371–379.
51.
NCSS Statistical Software. Kaysville, Utah, USA, 2008.
52.
Gusbeth-TatomirPBoisteanuDSeicaABugaCCovicA. Sleep disorders: A systematic review of an emerging major clinical issue in renal patients. Int Urol Nephrol2007; 39: 1217–1226.
53.
PierratosAHanlyPJ. Sleep disorders over the full range of chronic kidney disease. Blood Purif2011; 31: 146–150.
54.
MoscaMGovoniMTomiettoP. The development of a simple questionnaire to screen patients with SLE for the presence of neuropsychiatric symptoms in routine clinical practice. Lupus2011; 20: 485–492.
55.
MeerloPHavekesRSteigerA. Chronically restricted or disrupted sleep as a causal factor in the development of depression. Curr Top Behav Neurosci2015; 25: 459–481.
56.
HarveyAG. Insomnia, psychiatric disorders, and the transdiagnostic perspective. Curr Dir Psychol Sci2008; 17: 299–303.
57.
SivertsenBSaloPMykletunA. The bidirectional association between depression and insomnia: The HUNT study. Psychosom Med2012; 74: 758–765.
58.
FriedmanLBrooksJO3rdBliwiseDLYesavageJAWicksDS. Perceptions of life stress and chronic insomnia in older adults. Psychol Aging1995; 10: 352–357.
59.
MorinCMRodrigueSIversH. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med2003; 65: 259–267.
60.
PillaiVRothTMullinsHMDrakeCL. Moderators and mediators of the relationship between stress and insomnia: Stressor chronicity, cognitive intrusion, and coping behavior. Sleep2014; 37: 1199–1208.
61.
FeltonBJRevensonTAHinrichesenGA. Stress and coping in the explanation of psychological adjustment among chronically ill adults. Soc Sci Med1984; 18: 889–898.
62.
BombardierCHD’AmicoCJordanJS. The relationship of appraisal and coping to chronic illness adjustment. Behav Res Ther1990; 28: 297–304.
63.
ManneSLZautraAJ. Couples coping with chronic illness: Women with rheumatoid arthritis and their healthy husbands. J Behav Med1990; 13: 327–342.
