The effects of disease activity, sleep and depressive symptoms on fatigue in systemic lupus erythematosus.
Item
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Title
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The effects of disease activity, sleep and depressive symptoms on fatigue in systemic lupus erythematosus.
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Identifier
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AAI9820563
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identifier
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9820563
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Creator
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McKinley, Paula S.
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Contributor
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Adviser: Arthur J. Spielman
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Date
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1998
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Physiological | Health Sciences, Mental Health | Health Sciences, Medicine and Surgery | Health Sciences, Pathology
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Abstract
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A majority of people with systemic lupus erythematosus consider fatigue their most debilitating symptom, yet its etiology is unknown. The purpose of this dissertation is to redefine the subjective fatigue concept into more meaningful components. Two approaches are used. Results from a cross-sectional study and a two-week daily diary study are presented. Participants were women with lupus. A comparison group of women without lupus was recruited through acquaintance referrals.;First, the lived experience of fatigue phenomenology and time course is explored. Fatigue dimensions, including sensations, perceptions, chronicity, affective attributions and functional consequences of fatigue, are described. For women with lupus, negative affective appraisals of fatigue and its perceived functional impact are higher than for women without lupus. Physical and cognitive fatigue phenomenology, conversely, are not distinctive. In terms of daily time course, fatigue fluctuates within days and across days in a cyclical, ebb and flow pattern. Women with lupus consistently report higher fatigue during the day, but not at bedtime, than their peers. In retrospective estimates and a daily sleep log, women with lupus report poorer quality, more disrupted sleep despite longer nightly time in bed. Depressive mood was not different between the groups in either cross-sectional or daily ratings.;The second approach to defining lupus fatigue is to test a multifactoral, mediational explanatory model of fatigue. The model posits that lupus disease activity, decreased sleep quality, and depresssive symptoms and mood all affect lupus fatigue. Further, poor sleep and depressive mood can help perpetuate each other through a reciprocal causal process. The model was generally supported with both cross-sectional and daily data. This model redefines fatigue as the end product of several underlying factors that affect fatigue through their ongoing relationships to each other. This model is not purported to be a comprehensive etiological model. Instead, its value is in identifying viable intervention strategies for fatigue. The results suggest that existing, nonpharmacological interventions for sleep and mood disturbance may help alleviate lupus fatigue.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
