{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:09:56Z","timestamp":1790201396866,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T00:00:00Z","timestamp":1607040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Little is known about potential mechanisms of action linking protective positive psychological variables and functional disability in patients with rheumatic and musculoskeletal disease. The present study was undertaken to examine symptoms of psychopathology, including stress, depression, anxiety, and sleep quality, as serial mediators of the association between gratitude, self\u2010compassion, self\u2010forgiveness, and functional impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed risk and protective factors for functional disability in patients with fibromyalgia (FM), osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) who were recruited from an Austrian health care facility. Respondents completed online surveys, including the Gratitude Questionnaire 6\u2010item form, the Self\u2010Compassion Scale short form, the Self\u2010Forgiveness and Forgiveness of Others Index, the Perceived Stress Scale 4, the Patient Health Questionnaire 2, the 2\u2010item Generalized Anxiety Disorder Scale, the Sleep Condition Indicator, and the Health Assessment Questionnaire. Bivariate and serial mediation analyses were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For our sample of 1,218 patients (52% female, n = 632; AS [37%], OA [34%], RA [14%], and FM [24%]), stress, depression, and anxiety, in parallel as first\u2010order mediators, and sleep quality as a second\u2010order mediator, explained the association between positive psychological variables and functional disability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Positive psychological factors exert a beneficial downstream effect on mental well\u2010being, sleep health, and health\u2010related functional impairment. Therapeutic promotion of gratitude, self\u2010compassion, and self\u2010forgiveness may improve mental and physical health in patients with rheumatic and musculoskeletal disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24440","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T18:43:40Z","timestamp":1600281820000},"page":"55-64","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Positive Psychological Factors and Impairment in Rheumatic and Musculoskeletal Disease: Do Psychopathology and Sleep Quality Explain the Linkage?"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-0452","authenticated-orcid":false,"given":"Jameson K.","family":"Hirsch","sequence":"first","affiliation":[{"name":"East Tennessee State University  Johnson City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather 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