Ormseth Sarah R, Draper Taylor L, Irwin Michael R, Weisman Michael H, Aréchiga Adam E, Hartoonian Narineh, Bui Thuy, Nicassio Perry M
Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, University of California, Los Angeles.
Loma Linda University, Loma Linda, California.
Arthritis Care Res (Hoboken). 2015 Dec;67(12):1686-92. doi: 10.1002/acr.22658.
To examine a model addressing the roles of rheumatoid arthritis (RA) disease burden, mood disturbance, and disability as determinants of impairments in role functioning.
In a cross-sectional design, 103 RA patients recruited from the community to participate in a clinical trial completed assessments of self-assessed disease burden (total joint pain and disease activity), mood disturbance (Center for Epidemiological Studies Depression Scale depressed mood, somatic symptoms, lack of positive affect, and interpersonal problems), disability (Health Assessment Questionnaire disability index gross and fine motor), and role functioning (Short Form 36 health survey physical and social). Structural equation modeling (SEM) was used to examine direct and indirect mechanisms linking disease burden to role functioning.
SEM results indicated that the model had excellent fit: S-Bχ(2)(30) = 38.59, P = 0.135; comparative fit index = 0.977, standardized root mean residual = 0.062, and root mean square error of approximation = 0.053. Mediational analyses demonstrated that, while disease burden was associated with poor role functioning, its effects were jointly mediated by mood disturbance and disability. After the effects of mood disturbance and disability were taken into account, the effect of disease burden on role functioning was not significant.
The results indicate that mood disturbance and disability may serve as important pathways through which RA disease burden affects role functioning. Future longitudinal research is suggested to replicate these findings and further explore the mediational mechanisms examined in this study.
检验一个模型，该模型探讨类风湿关节炎（RA）疾病负担、情绪障碍和残疾作为角色功能受损决定因素的作用。
采用横断面设计，从社区招募103名参与临床试验的RA患者，完成自我评估的疾病负担（关节总疼痛和疾病活动度）、情绪障碍（流行病学研究中心抑郁量表中的抑郁情绪、躯体症状、缺乏积极情绪和人际问题）、残疾（健康评估问卷残疾指数的粗大和精细运动）以及角色功能（简短健康调查问卷的身体和社会功能）评估。采用结构方程模型（SEM）检验将疾病负担与角色功能联系起来的直接和间接机制。
SEM结果表明该模型拟合良好：S-Bχ(2)(30) = 38.59，P = 0.135；比较拟合指数 = 0.977，标准化根均残差 = 0.062，近似误差均方根 = 0.053。中介分析表明，虽然疾病负担与角色功能差有关，但其影响由情绪障碍和残疾共同介导。在考虑情绪障碍和残疾的影响后，疾病负担对角色功能的影响不显著。
结果表明，情绪障碍和残疾可能是RA疾病负担影响角色功能的重要途径。建议未来进行纵向研究以重复这些发现，并进一步探索本研究中检验的中介机制。
