OJPM  Vol.4 No.1 , January 2014
An intervention to reduce psychosocial and biological indicators of stress in African American lupus patients: The balancing lupus experiences with stress strategies study
ABSTRACT

Objective: Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. Methods: The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated “Better Choices, Better Health” Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months’ post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress. Results: Participation in the workshops had large effects upon depression (d = 1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d = 1.13 and d = 0.78), fatigue (d = 1.03), pain (d = 0.96), and lupus self-efficacy (d = 0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls. Conclusion: The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP’s.


Cite this paper
Williams, E. , Penfield, M. , Kamen, D. and Oates, J. (2014) An intervention to reduce psychosocial and biological indicators of stress in African American lupus patients: The balancing lupus experiences with stress strategies study. Open Journal of Preventive Medicine, 4, 22-31. doi: 10.4236/ojpm.2014.41005.
References
[1]   Chida, Y. and Hamer, M. (2008) Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: A quantitative review of 30 years of investigations. Psychological Bulletin, 134, 829-885. http://dx.doi.org/10.1037/a0013342

[2]   Dunbar, P., Hill, J. and Neale, T. (1993) Urinary neopterin quantification indicates altered cell-mediated immunity in healthy subjects under psychological stress. Australian & New Zealand Journal of Psychiatry, 27, 495-501.
http://dx.doi.org/10.3109/00048679309075808

[3]   Hoglund, C., Axen, J. and Kemi, C. (2006) Changes in immune regulation in response to examination stress in atopic and healthy individuals. Clinical & Experimental Allergy, 36, 982-992.
http://dx.doi.org/10.1111/j.1365-2222.2006.02529.x

[4]   Bricou, O., Taïeb1, O., Baubet, T., Gal, B., Guillevin, L. and Moro1, M.-R. (2004) Stress and coping strategies in systemic lupus erythematosus. La Presse Medicale, 33, 1284-1292. http://dx.doi.org/10.1016/S0755-4982(04)98908-7

[5]   Peralta-Ramirez, M., Coin-Mejias, M. and Jimenez-Alonso, J. (2006) Stress as a predictor of cognitive functioning in lupus. Lupus, 15, 858-864.
http://dx.doi.org/10.1177/0961203306071404

[6]   Pawlak, C., Witte, T. and Heiken, H. (2003) Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychotherapy and Psychosomatics, 72, 159-165.
http://dx.doi.org/10.1159/000069735

[7]   Birmingham, D., Nagaraja, H. and Rovin, B. (2006) Fluctuation in self-perceived stress and increased risk of flare in patients with lupus nephritis carrying the serotonin receptor 1A-1019G allele. Arthritis & Rheumatism, 54, 3291-3299. http://dx.doi.org/10.1002/art.22135

[8]   Peralta-Ramirez, M., Jiménez-Alonso, J., Godoy-García, J. F., Pérez-García, M. and on behalf of the group Lupus Virgen de las Nieves. (2004) The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosomatic Medicine, 66, 788-794.
http://dx.doi.org/10.1097/01.psy.0000133327.41044.94

[9]   Oates, J., Levesque, M. and Hobbs, M. (2003) Nitric oxide synthase 2 promoter polymorphisms and systemic lupus erythematosus in african-americans. Journal of Rheumatology, 30, 60-67.

[10]   Alarcon, G., Beasley, T. and Roseman, J. (2005) Ethnic disparities in health and disease: The need to account for ancestral admixture when estimating the genetic contribution to both (LUMINA XXVI). Lupus, 14, 867-868.
http://dx.doi.org/10.1191/0961203305lu2184xx

[11]   Rus, V. and Hochberg, M. (2002) Chapter 4 the epidemiology of systemic lupus erythematosus. In: Wallace, D. and Hahn, B. Eds., Dubois’ Lupus Erythematosus, Lippincott Williams & Wilkins, Philadelphia, 65-83.

[12]   Wyatt, S., et al. (2003) Racism and cardiovascular disease in African Americans. American Journal of Medical Sciences, 325, 315-331.
http://dx.doi.org/10.1097/00000441-200306000-00003

[13]   Williams, D. (2003) The health of men: Structured inequalities and opportunities. American Journal of Public Health, 93, 724-731.
http://dx.doi.org/10.2105/AJPH.93.5.724

[14]   Hertzman, C. and Wiens, M. (1996) Child development and long-term outcomes: A population health perspective and summary of successful interventions. Social Science & Medicine, 43, 1083-1095.
http://dx.doi.org/10.1016/0277-9536(96)00028-7

[15]   Cattell, V. (2001) Poor people, poor places, and poor health: The mediating role of social networks and social capital. Social Science & Medicine, 52, 1501-1516.
http://dx.doi.org/10.1016/S0277-9536(00)00259-8

[16]   Williams, D. and Collins, C. (2001) Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416.

[17]   O’Donnell, M. (2004) Health-promotion behaviors that promote self-healing. The Journal of Alternative and Complementary Medicine, 10, S49-S60.
http://dx.doi.org/10.1089/1075553042245809

[18]   Gaab, J., Sonderegger, L., Scherrer, S. and Ehlert., U. (2006) Psychoneuroendocrine effects of cognitive-behavioral stress management in a naturalistic setting-a randomized controlled trial. Psychoneuroendocrinology, 31, 428-438.
http://dx.doi.org/10.1016/j.psyneuen.2005.10.005

[19]   Greco, C., Rudy, T. and Manzi, S. (2004) Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: A randomized controlled trial. Arthritis & Rheumatism, 51, 625-634.
http://dx.doi.org/10.1002/art.20533

[20]   Bijlani, R., Vempati, R. and Yadav, R. (2005) A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. The Journal of Alternative and Complementary Medicine, 11, 267-274.
http://dx.doi.org/10.1002/art.20533

[21]   Dobkin, P., Da Costa, D. and Joseph, L. (2002) Counterbalancing patient demands with evidence: Results from a Pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus. Annals of Behavioral Medicine, 24, 88-99.
http://dx.doi.org/10.1207/S15324796ABM2402_05

[22]   Lorig, K., Ritter, P. and Plant, K. (2005) A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis & Rheumatism, 53, 950-957.
http://dx.doi.org/10.1002/art.21604

[23]   Hochberg, M. (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis & Rheumatism, 40, 1725.
http://dx.doi.org/10.1002/art.1780400928

[24]   Lorig, K. and Holman, H. (1993) Arthritis self-management studies: A twelve-year review. Health Education Quarterly, 20, 17-28.
http://dx.doi.org/10.1177/109019819302000104

[25]   Lorig, K., Sobel, D. and Stewart, A. (1999) Evidence that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care, 37, 5-14.
http://dx.doi.org/10.1097/00005650-199901000-00003

[26]   Lorig, K., Mazonson, P. and Holman, H. (1993) Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis & Rheumatism, 36, 437-446.
http://dx.doi.org/10.1002/art.1780360403

[27]   Lorig, K., et al. (2008) Living a healthy life with chronic conditions: Self management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema and others. Bull Publishing Company, Boulder.

[28]   Spielberger, C. and Gorsuch, R. (1983) Manual for the state-trait anxiety inventory (form y) (“self evaluation questionnaire”). Consulting Psychologists Press, Palo Alto.

[29]   Lorig, K., Chastain, R.L. Ung, E., Shoor, S. and Holman, H.R. (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis & Rheumatism, 32, 37-44.
http://dx.doi.org/10.1002/anr.1780320107

[30]   Green, N. (1995) Development of the perceptions of racism scale. Image: the Journal of Nursing Scholarship, 27, 141-146. http://dx.doi.org/10.1111/j.1547-5069.1995.tb00838.x

[31]   Stewart, A., Hays, R. and Ware, J. (1992) Health perceptions, energy/fatigue, and health distress measures. In: Stewart, A. and Ware, J. Eds, Measuring Functioning and Well-Being: The Medical Outcomes Study Approach, Duke University Press, Durham, 143-172.

[32]   Beck, A. (2006) Depression: Causes and treatment. Philadelphia, University of Pennsylvania Press, Philadelphia.

[33]   Webster, K., Cella, D. and Yost, K. (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: Properties, application, and interpretation. Health and Quality of Life Outcomes, 1, 79.
http://dx.doi.org/10.1186/1477-7525-1-79

[34]   Yu, E., et al. (2006) Validation of LUP-QOL: A lupus-specific measure of health-related quality of life. Eular.

[35]   Lorig, K., Ritter, P., Stewart, A.L., Sobel, D.S., William Brown, Jr. B., Bandura, A., Gonzalez, V.M., Laurent, D.D. and Holman, H.R. (2001) Chronic disease self-management program: 2 year health status and health Care utilization outcomes. Medical Care, 39, 1217-1223.
http://dx.doi.org/10.1097/00005650-200111000-00008

[36]   Gallagher, P. and Young, A. (2002) Cortisol/DHEA ratios in depression. Neuropsychopharmacology, 26, 410.

[37]   Oderbeck, R., Benschop, R.J., Jacobs, R., Hosch, W., Jetschmann, J.U., Schürmeyer, T.H., Schmidt, R.E. and Schedlowski, M. (1998) Endocrine mechanisms of stressinduced DHEA secretion. Journal of Endocrinological Investigation, 21, 148-153.

[38]   Hechter, O., Grossman, A. and Chatterton, R.J. (1887) Relationship of dehydroepiandrosterone and cortisol in disease. Medical Hypotheses, 49, 85-91.
http://dx.doi.org/10.1016/S0306-9877(97)90258-9

[39]   Karlson, E., Liang, M.H., Eaton, H., Huang, J., Fitzgerald, L., Rogers, M.P. and Daltroy, L.H. (2004) A randomized clinical trial of psychoeducational intervention to improve outcomes in systemic lupus erythematosus. Arthritis & Rheumatism, 50, 1832-1841.
http://dx.doi.org/10.1002/art.20279

[40]   Kosinski, M., Zhao, S.Z., Dedhiya, S., Osterhaus, J.T. and Ware Jr., J.E. (2000) Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. Arthritis & Rheumatism, 43, 1478-1487.
http://dx.doi.org/10.1002/1529-0131(200007)43:7<1478::AID-ANR10>3.0.CO;2-M

[41]   Austin, J., Maisiak, R.S., Macrina, D.M. and Heck, L.W. (1996) Health outcome improvements in patients with systemic lupus erythematosus using two telephone counseling interventions. Arthritis & Rheumatism, 9, 391-399. http://dx.doi.org/10.1002/1529-0131(199610)9:5<391::AID-ANR1790090508>3.0.CO;2-V

[42]   Petri, M., Naqibuddin, M., Carson, K.A., Wallace, D.J., Weisman, M.H., Holliday, S.L., Sampedro, M., Padilla P.A. and Brey, R.L. (2010) Depression and cognitive impairment in newly diagnosed systemic lupus erythematosus. Journal of Rheumatology, 37, 2032-2038.
http://dx.doi.org/10.3899/jrheum.091366

[43]   Kozora, E., Ellison, M.C., Waxmonsky, J.A., Wamboldt, F.S. and Patterson, T.L. (2005) Major life stress, coping styles, and social support in relation to psychological distress in patients with systemic lupus erthematosus. Lupus, 14, 363-372.
http://dx.doi.org/10.1191/0961203305lu2094oa

[44]   Iverson, G.L., Sawyer, D.C., McCracken, L.M. and Kozora, E. (2001) Assessing depression in systemic lupus erythematosus: Determining reliable change. Lupus, 10, 266-271.
http://dx.doi.org/10.1191/096120301680416959

[45]   Ward, M., Marx, A. and Barry, N. (2002) Psychological distress and changes in the activity of systemic lupus erythematosus. Rheumatology, 41, 184-188.

[46]   Cleanthous, S., Tyagi, M., Isenberg, D.A. and Newman, S.P. (2012) what do we know about self-reported fatigue in systemic lupus erythematosus? Lupus, 21, 465-476.

[47]   Tench, C., McCurdie, I., White, P.D. and D’Cruz, D.P. (2000) The prevalence and associations of fatigue in systemic lupus erythematosus. Rheumatology, 39, 1249-1254.
http://dx.doi.org/10.1093/rheumatology/39.11.1249

[48]   Danoff-Burg, S. and Friedberg, F. (2009) Unmet needs of patients with systemic lupus erythematosus. Behavioral Medicine, 35, 5-13.
http://dx.doi.org/10.3200/BMED.35.1.5-13

[49]   Izawa, S., Saito, K., Shirotsuki, K., Sugaya, N. and Nomura, S. (2012) Effects of prolonged stress on cortisol and dehydroapiandrosterone: A study of a two-week teaching practice. Psychoneuroendocrinology, 37, 852-858.
http://dx.doi.org/10.1016/j.psyneuen.2011.10.001

[50]   Blackman, M., Muniyappa, R., Wilson, M., Moquin, B.E., Baldwin, H.L., Wong, K.A., Snyder, C., Magalnick, M., Alli, S., Reynolds, J., Steinberg, S.M. and Goldbach-Mansky, R. (2007) Diurnal secretion of growth hormone, cortisol and dihydroepiandorsterone in pre- and postmenopausal women with active rheumatoid arthritis: A pilot case-control study. Arthritis Research & Therapy, 9, 73-82. http://dx.doi.org/10.1186/ar2271

 
 
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