{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:16:50Z","timestamp":1793218610599,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012542","name":"Dalin Tzu Chi Hospital","doi-asserted-by":"publisher","award":["DTCRD 112-I-21"],"award-info":[{"award-number":["DTCRD 112-I-21"]}],"id":[{"id":"10.13039\/501100012542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012542","name":"Dalin Tzu Chi Hospital","doi-asserted-by":"publisher","award":["NSTC-113-2314-B-303-008"],"award-info":[{"award-number":["NSTC-113-2314-B-303-008"]}],"id":[{"id":"10.13039\/501100012542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Rheumatoid arthritis (RA) is a lifelong autoimmune disease in which joint inflammation is caused by a dysfunctional immune system. Synchronous depressive symptoms have been identified as determinants of disease progression, especially disease activity as measured using the 28-joint Disease Activity Score (DAS28). Although growing evidence suggests the interplay between depression and DAS28 in RA, related findings remain inconsistent, implying that a pivotal underlying mechanism is overlooked. Hence, we aimed to examine whether self-efficacy, the belief in one\u2019s ability to manage health, could mediate the association between depressive symptoms and DAS28. Materials and Methods: Between January and October 2023, we carried out a cross-sectional survey to recruit patients with RA from a target hospital in Taiwan. Participants completed demographic and disease-related questionnaires, the Chinese version of the Arthritis Self-Efficacy Scale, and the Taiwanese Depression Questionnaire. Mediation analysis was performed using the Hayes PROCESS macro function on SPSS. Results: In 259 recruited persons with RA, depressive symptoms were found to negatively associate with self-efficacy, and self-efficacy negatively related to DAS28. Mediation analysis demonstrated that depressive symptoms affected DAS28 indirectly through self-efficacy (B = 0.022; 95% confidence interval: 0.015\u20130.031), accounting for 32.8% of the total impacts. Conclusions: Our findings suggest that the association between depressive symptoms and DAS28 may be mediated by individual self-efficacy. Interventions beyond the relief of depressive symptoms and that enhance the concept of self-efficacy should be emphasized while managing patients with RA.<\/jats:p>","DOI":"10.3390\/medicina62030449","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:41:02Z","timestamp":1772188862000},"page":"449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influence of Depressive Symptoms on Disease Activity in Patients with Rheumatoid Arthritis: The Mediating Effect of Self-Efficacy"],"prefix":"10.3390","volume":"62","author":[{"given":"Wen-Wei","family":"Lin","sequence":"first","affiliation":[{"name":"Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 333325, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieh-Tsung","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua-Lung","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-1717","authenticated-orcid":false,"given":"Hanoch","family":"Livneh","sequence":"additional","affiliation":[{"name":"Rehabilitation Counseling Program, Portland State University, Portland, OR 97207-0751, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9051-0351","authenticated-orcid":false,"given":"Ming-Chi","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 97004, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 333325, Taiwan"},{"name":"School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan"},{"name":"Center of Sports Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9865-7101","authenticated-orcid":false,"given":"Tzung-Yi","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"},{"name":"Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40364-025-00760-8","article-title":"Global, regional and national burden of rheumatoid arthritis from 1990 to 2021, with projections of incidence to 2050: A systematic and comprehensive analysis of the Global Burden of Disease study 2021","volume":"13","author":"Ma","year":"2025","journal-title":"Biomark. 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