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We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12\u2010week online peer\u2010led symptom management intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a secondary data analysis from a randomized control trial comparing a peer health\u2010coached intervention to a waitlist control. Participants completed the Connor\u2010Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy\u2010Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and seventy\u2010three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (<jats:italic>P<\/jats:italic> &lt; 0.001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of \u22121.41 (95% confidence interval [CI] \u22122.41 to \u22120.41), pain interference of \u22120.86 (95% CI \u22121.65 to \u22120.08), and depressive symptoms of \u22121.99 (95% CI \u22123.16 to \u22120.81).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.25352","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T22:48:56Z","timestamp":1713221336000},"page":"1278-1286","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Peer\u2010Led Symptom Management Intervention to Enhance Resilience in People With Systemic Sclerosis: Mediation Analysis From a Randomized Clinical Trial"],"prefix":"10.1002","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7723-6431","authenticated-orcid":false,"given":"Yen T.","family":"Chen","sequence":"first","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2982-484X","authenticated-orcid":false,"given":"Afton 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