Abstract
Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated "Better Choices, Better Health" Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress. Participation in the workshops had large effects upon depression (d=1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d =1.13 and d = 0.78), fatigue (d =1.03), pain (d =0.96), and lupus self-efficacy (d =0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls. The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP's.
Highlights
A number of studies have investigated chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations [1]
Mean scores on the Lupus Self-Efficacy survey and BDI-II were improved compared to baseline, both were reduced compared to post-intervention
At four months post-intervention, large effects were again found on depression (d = 1.68) and health and well-being (d = 0.78). This pilot demonstrated that a validated chronic disease self-management program to support and assist participants in finding practical ways to deal with pain, fatigue, and stress, as well as introduce better nutrition and exercise choices, new treatment options, and better ways to talk with doctors and family about health matters could reduce perceived stress and improve quality of life in African American lupus patients
Summary
A number of studies have investigated chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations [1]. It is believed that stress worsens the clinical symptomatology of patients with lupus. Recommendations to lupus patients to avoid stress are based on numerous studies that have demonstrated associations between daily stress and disease exacerbations [4,5,6,7,8]. Williams et al / Open Journal of Preventive Medicine 4 (2014) 22-31 daily stress with social relationships and social duties may be factors related to the course of disease activity [6]. Stress is related impairments in visual memory, fluency and attention in patients with SLE [5]
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