Azizoddin Desiree R, Olmstead Richard, Anderson Kris-Ann, Hirz Alanna E, Irwin Michael R, Gholizadeh Shadi, Weisman Michael, Ishimori Mariko, Wallace Daniel, Nicassio Perry
Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 4000, Oklahoma City, OK, 73104, USA.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
BMC Rheumatol. 2024 Sep 20;8(1):46. doi: 10.1186/s41927-024-00416-4.
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).
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: χ 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).
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.
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.
clinicaltrials.gov NCT00072657 01/02/2004 20/03/2009.
在储备能力模型的指导下，我们评估了社会经济地位（SES）、储备能力（无助感、自我效能感、社会支持）与类风湿性关节炎（RA）患者疼痛时负面情绪之间的独特关系。
二次分析使用了一项比较RA行为治疗的临床试验中106名成年人的基线横断面数据。符合条件的患者年龄≥18岁，符合美国风湿病学会（ACR）的RA标准（由研究风湿病学家确定），疾病和药物治疗方案稳定3个月，且无重大合并症。结构方程模型评估了SES、储备能力（无助感-关节炎无助感指数、自我效能感-个人掌控量表、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量表）对疼痛（风湿病疾病活动快速评估-RADAR和视觉模拟量表-VAS）的直接影响，以及SES通过储备能力和负面情绪介导的间接影响。使用多种拟合标准评估结构方程模型：卡方拟合优度统计量、比较拟合指数（CFI）、标准化均方根残差（SRMR）和近似均方根误差（RMSEA）。
参与者大多为女性（85%），平均年龄55.45岁，自我认定为白人（61%）、西班牙裔（16%）、黑人（13%）和其他（10%），患RA平均10.63年。结果表明，低SES通过较低的储备能力和较高的负面情绪导致更严重的疼痛。中介分析表明，储备能力和负面情绪部分介导了SES对疼痛的影响。最终模型解释了疼痛变异的39%。
研究结果表明，较低的SES与更差的临床疼痛结局相关，负面情绪和储备能力（无助感、社会支持和自我效能感）介导了SES对疼痛的影响。一个主要局限性是样本量小；未来的研究应以更大规模的纵向研究方法进一步评估该模型。针对低SES患者负面情绪的干预措施可能有助于更好地控制RA患者的疼痛。
clinicaltrials.gov NCT00072657 2004年2月1日 2009年3月20日。
