{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:19:04Z","timestamp":1791317944224,"version":"4.3.1"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T00:00:00Z","timestamp":1601337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["P60 AR053308"],"award-info":[{"award-number":["P60 AR053308"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF\u201036) vitality scale along with a variety of self\u2010report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1\u2010to\u2010T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self\u2010report of fibromyalgia, pain, and SLE duration, activity, and damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean \u00b1 SD age was 51 \u00b1 12 years, 92% of participants were women, and 68% were white. The mean \u00b1 SD SF\u201036 fatigue score was 55 \u00b1 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (\u03b2 = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; <jats:italic>P<\/jats:italic> &lt; 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1\u2010to\u2010T2 decrease in stress was associated with a clinically meaningful decline in fatigue (\u03b2 = \u201311.8 [95% CI \u201315.6, \u20138.9]; <jats:italic>P<\/jats:italic> &lt; 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24052","type":"journal-article","created":{"date-parts":[[2019,8,17]],"date-time":"2019-08-17T10:50:07Z","timestamp":1566039007000},"page":"1440-1448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6993-1776","authenticated-orcid":false,"given":"Desiree R.","family":"Azizoddin","sequence":"first","affiliation":[{"name":"Dana Farber Cancer Institute and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8460-2751","authenticated-orcid":false,"given":"Meenakshi","family":"Jolly","sequence":"additional","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilpa","family":"Arora","sequence":"additional","affiliation":[{"name":"John H. Stroger Hospital  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Yelin","sequence":"additional","affiliation":[{"name":"University of San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-2519","authenticated-orcid":false,"given":"Patricia","family":"Katz","sequence":"additional","affiliation":[{"name":"University of San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2011.11.002"},{"key":"e_1_2_6_3_1","first-page":"1706","article-title":"How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses?","volume":"32","author":"Jolly M","year":"2005","journal-title":"J Rheumatol"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1191\/096120300678828424"},{"key":"e_1_2_6_5_1","first-page":"482","article-title":"Fatigue in patients with systemic lupus erythematosus: lack of associations to serum cytokines, antiphospholipid antibodies, or other disease characteristics","volume":"29","author":"Omdal R","year":"2002","journal-title":"J Rheumatol"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2011.12.005"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203312436863"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/096120300678828046"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2004.03.015"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.091277"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.094763"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10615806.2015.1134785"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21686"},{"key":"e_1_2_6_14_1","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1002\/art.23832","article-title":"Additional components to measuring fatigue in patients with systemic lupus erythematosus: comment on the article by the Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria for Fatigue [letter]","volume":"59","author":"Wallace DJ","year":"2008","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24649"},{"key":"e_1_2_6_16_1","first-page":"1699","article-title":"Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression, and perceived social support","volume":"32","author":"Jump RL","year":"2005","journal-title":"J Rheumatol"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/39.11.1249"},{"key":"e_1_2_6_18_1","first-page":"1282","article-title":"Dimensions of fatigue in systemic lupus erythematosus: relationship to disease status and behavioral and psychosocial factors","volume":"33","author":"Da Costa D","year":"2006","journal-title":"J\u00a0Rheumatol"},{"key":"e_1_2_6_19_1","first-page":"1999","article-title":"Disease status predicts fatigue in systemic lupus erythematosus","volume":"28","author":"Tayer W","year":"2001","journal-title":"J Rheumatol"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203318817826"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203313486948"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317751046"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djs256"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2005.06.074"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23599"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780251101"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22481"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012150-00008"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105313508346"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000062554.74615.4C"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/014662167700100306"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1191\/0961203303lu332oa"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22231"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400506"},{"key":"e_1_2_6_36_1","first-page":"665","article-title":"Subscale analysis of quality of life in patients with systemic lupus erythematosus: association with depression, fatigue, disease activity and damage","volume":"30","author":"Choi ST","year":"2012","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_37_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-016-1580-6","article-title":"Intervention to Improve Quality of life for African\u2010American lupus patients (IQAN): Study protocol for a randomized controlled trial of a unique a la carte intervention approach to self\u2010management of lupus in African Americans","volume":"16","author":"Williams EM","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310378413"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203313491849"},{"key":"e_1_2_6_40_1","first-page":"790724","article-title":"Silent burdens in disease: fatigue and depression in SLE","volume":"2014","author":"Fonseca R","year":"2014","journal-title":"Autoimmune Dis"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00393-016-0185-0"},{"key":"e_1_2_6_42_1","first-page":"283","article-title":"Fatigue in patients with systemic lupus erythematosus: the psychosocial aspects","volume":"30","author":"Omdal R","year":"2003","journal-title":"J Rheumatol"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-017-9505-z"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12035-015-9090-9"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2015.00028"},{"key":"e_1_2_6_46_1","doi-asserted-by":"crossref","first-page":"4530104","DOI":"10.1155\/2017\/4530104","article-title":"Fatigue and activity management education for individuals with systemic lupus erythematosus","volume":"2017","author":"O\u2019Riordan R","year":"2017","journal-title":"Occup Ther Int"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.4236\/health.2014.61011"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2017.07.005"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2016.11.011"},{"key":"e_1_2_6_50_1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/art.20533","article-title":"Effects of a stress\u2010reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial","volume":"51","author":"Greco CM","year":"2004","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20279"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.24052","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24052","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.24052","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24052","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T16:24:55Z","timestamp":1759422295000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.24052"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,29]]},"references-count":50,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1002\/acr.24052"],"URL":"https:\/\/doi.org\/10.1002\/acr.24052","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,29]]},"assertion":[{"value":"2019-03-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}