Abstract
Background Pain is a pervasive and distressful symptom in patients with SLE, particularly among high-risk individuals. Self-efficacy can mitigate the negative impact of pain on daily activities. However, depressed patients face challenges to control pain. We examined whether self-efficacy affects pain interference in Black women with SLE and whether depression alter those relationships.
Methods Baseline PROMIS measures of Pain interference, Self-efficacy to manage symptoms (SEMS), Self-efficacy to manage medications and treatments (SEMMT), and Depression were transversally collected among Black women with SLE who participated in the Women Empowered to Live with Lupus (WELL) Study. We examined the relationship between Pain interference and self-efficacy (SEMS and SEMMT), and the interaction of depression with self-efficacy, after adjusting for confounders.
Results Of 699 participants, 143 (21%) were 18-34, 329 (47%) 35-54, and 227 (33%) ≥55 years old; 262 (38%) attained ≤high school, 226 (32%) some college, and 211 (30%) ≥bachelor’s degree. Pain interference declined by 2.8 points per 5-point increase in SEMS (slope=−0.556, p-value<0.001) and by 1.4 points per 5-point increase in SEMMT (slope=−0.282, p-value<0.001). The table depicts the adjusted slopes and adjusted means of Pain interference on SEMS and SEMMT by depression severity. Depression showed a statistically significant interaction with SEMS (R2=0.41, p-value for the interaction=0.05). Pain interference was inversely and significantly associated with SEMS in patients without depression (adjusted slope=−0.196, p-value<0.001); however, the association was not statistically significant in those with mild depression (adjusted slope=0.035, p-value=0.7), nor those with moderate/severe depression (adjusted slope=−0.080, p-value=0.3). No significant mean difference (p-value=0.11) was observed among patients without depression (adjusted mean=56.9), mild depression (adjusted mean=58.2), and moderate/severe depression (adjusted mean=58.9). Although depression did not show an overall statistically significant interaction effect with SEMMT (R2=0.40, p-value for interaction=0.06), we did observe a statistically significant mean difference (p-value=0.003) among patients without depression (adjusted mean=56.2), mild depression (adjusted mean=58.0), and moderate/severe depression (adjusted mean=59.2).
Conclusion Self-efficacy (to manage symptoms and to manage medications and treatments) was inversely related to pain interference in Black women with SLE. However, depression altered those relationships, particularly decreasing the potential benefits of self-efficacy to manage symptoms of pain interference. Depression is a highly prevalent and often underdiagnosed comorbidity in patients with SLE; consequently, untreated depression may limit the potential benefits of self-management interventions that rely on self-efficacy to achieve better pain control in this population. Programs designed to build self-efficacy should consider these findings to determine how to maximize intervention effectiveness.
Trial Registration Number NCT02988661
