Tangkittiwet Navaporn, Charuvanij Sirirat, Manaboriboon Boonying, Chantaratin Sasitorn, Pattaragarn Anirut, Piyaphanee Nuntawan
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Lupus. 2025 Apr;34(4):395-404. doi: 10.1177/09612033251325313. Epub 2025 Mar 2.
BackgroundThe illness perception and mental health in Systemic Lupus Erythematosus (SLE) is acknowledged. However, the link between illness perceptions and psychological issues in adolescents with SLE remains unclear. This study aims to assess the relationships between illness perception and depressive symptoms, anxiety, fatigue, pain, and sleep quality, as well as to identify factors associated with negative illness perception.MethodsA cross-sectional study was conducted with adolescents aged 12-18 years diagnosed with SLE during a clinic visit. Personal information was collected through a self-report questionnaire. Illness perception was assessed using Brief Illness Perception Questionnaire (B-IPQ), while psychological impact was evaluated using Patient Health Questionnaire for Adolescents (PHQ-A) and Generalized Anxiety Disorders Scale (GAD-7). PedsQL Multidimensional Fatigue Scale, Visual Analogue Scale of Pain (VAS-P), and Pittsburgh Sleep Quality Index (PSQI) were used to assess fatigue, pain, and sleep quality, respectively. Disease activity was measured by the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) and Physician Global Assessment (PGA), while organ damage was assessed using the SLICC/ACR Damage Index (SDI). The correlations between these measures were analyzed, and multivariable regression analysis was conducted to identify associated factors.ResultsThe study included 102 patients, with a mean age of 15.2 ± 1.7 years, of whom 94.1% were female. Depressive symptoms (PHQ-A ≥5), anxiety (GAD-7 ≥7), pain (VAS-P > 3), and poor sleep quality (PSQI>5) were observed in 31.4%, 14.7%, 14.7%, and 29.4% of the patients, respectively. Within B-IPQ items, the timeline was perceived most negatively, while treatment control was perceived most positively. Negative illness perception moderately correlated with depressive symptoms (r = 0.487), anxiety (r = 0.459), and fatigue (r = 0.493), weakly correlated with pain (r = 0.334), sleep quality (r = 0.355) and PGA (r = 0.255), and no correlation with SELENA-SLEDAI and SDI. A self-reported poor relationship with friends (B coefficient 9.12, 95%CI: 3.22-15.01, = .003) and a PGA score of 0.5 or higher (8.61, 3.52-13.69, = .001) were associated with negative illness perception.ConclusionsPsychological distress including depressive symptoms, anxiety, fatigue, pain, and sleep quality significantly correlated to illness perception in adolescent SLE. Further research is required to investigate the effects of illness perception on patient adherence and outcomes.
背景
系统性红斑狼疮（SLE）患者的疾病认知与心理健康状况已得到认可。然而，SLE青少年患者的疾病认知与心理问题之间的联系仍不明确。本研究旨在评估疾病认知与抑郁症状、焦虑、疲劳、疼痛及睡眠质量之间的关系，并确定与消极疾病认知相关的因素。
方法
对12至18岁在门诊就诊时被诊断为SLE的青少年进行了一项横断面研究。通过自我报告问卷收集个人信息。使用简短疾病认知问卷（B-IPQ）评估疾病认知，同时使用青少年患者健康问卷（PHQ-A）和广泛性焦虑障碍量表（GAD-7）评估心理影响。分别使用儿童生活质量多维疲劳量表、疼痛视觉模拟量表（VAS-P）和匹兹堡睡眠质量指数（PSQI）评估疲劳、疼痛和睡眠质量。通过狼疮性红斑中雌激素安全性全国评估-SLE疾病活动指数（SELENA-SLEDAI）和医生整体评估（PGA）测量疾病活动度，使用SLICC/ACR损伤指数（SDI）评估器官损伤。分析这些指标之间的相关性，并进行多变量回归分析以确定相关因素。
结果
该研究纳入了102例患者，平均年龄为15.2±1.7岁，其中94.1%为女性。分别有31.4%、14.7%、14.7%和29.4%的患者出现抑郁症状（PHQ-A≥5）、焦虑（GAD-7≥7）、疼痛（VAS-P>3）和睡眠质量差（PSQI>5）。在B-IPQ项目中，对时间线的认知最为消极，而对治疗控制的认知最为积极。消极疾病认知与抑郁症状（r = 0.487）、焦虑（r = 0.459）和疲劳（r = 0.493）中度相关，与疼痛（r = 0.334）、睡眠质量（r = 0.355）和PGA（r = 0.255）弱相关，与SELENA-SLEDAI和SDI无相关性。自我报告的与朋友关系不佳（B系数9.12，95%CI：3.22-15.01，P = .003）和PGA评分0.5或更高（8.61，3.52-13.69，P = .001）与消极疾病认知相关。
结论
包括抑郁症状、焦虑、疲劳、疼痛和睡眠质量在内的心理困扰与青少年SLE患者的疾病认知显著相关。需要进一步研究以调查疾病认知对患者依从性和预后的影响。
