Mediating Role of Quality of Life between Perceived Stress and Sleep Quality among Patients with Rheumatoid Arthritis

Main Article Content

Mahpara Munir
Zartashia Kynat Javaid
Khalid Mahmood
Mazhar Fareed
Amna Mubeen
Amara Liaqat Ali

Abstract

Background: Arthritis is a chronic illness that affects millions of people worldwide. This study aimed to investigate the effects of perceived stress, life satisfaction, and sleep quality on people with arthritis. Its specific goal was to ascertain how this population's quality of life influences the relationship between perceived stress and sleep quality.


Objective: To examine the mediating role of quality of life in the relationship between perceived stress and sleep quality among patients with rheumatoid arthritis (RA).


Methods: A cross-sectional study design was employed, involving 200 RA patients aged 20 to 90 years from various hospitals in Faisalabad. Participants were recruited through support groups and outpatient programs. Data were collected using the Sleep Quality Scale (SQS), Perceived Stress Scale (PSS), and the WHO Quality of Life (WHOQOL) Questionnaire. The study adhered to ethical guidelines set forth in the Declaration of Helsinki. Statistical analyses, including descriptive statistics, Pearson correlation, independent samples t-tests, and mediation analysis using Sobel, Aroian, and Goodman tests, were conducted using SPSS version 25.


Results: The mean sleep quality score was 40.52 (SD = 5.34), the mean perceived stress score was 22.36 (SD = 3.22), and the mean quality of life score was 85.45 (SD = 14.13). Significant gender differences were found in perceived stress (p = 0.026), with males reporting higher stress levels. Sleep quality negatively correlated with perceived stress (r = -0.38, p < 0.05) and positively correlated with quality of life (r = 0.82, p < 0.01). Perceived stress and quality of life were negatively correlated (r = -0.62, p < 0.05). Mediation analysis showed that quality of life significantly mediated the relationship between perceived stress and sleep quality (Sobel test statistic = 2.32, p = 0.021).


Conclusion: Perceived stress and sleep quality were significantly associated among RA patients, with quality of life serving as a mediating factor. Higher perceived stress correlated with poorer sleep quality and lower quality of life. Addressing stress and improving quality of life could enhance sleep quality and overall well-being in RA patients. Further research, particularly longitudinal studies, is recommended to deepen understanding and develop targeted interventions.

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How to Cite
Munir, M., Javaid, Z. K., Mahmood, K., Fareed, M., Mubeen, A., & Amara Liaqat Ali. (2024). Mediating Role of Quality of Life between Perceived Stress and Sleep Quality among Patients with Rheumatoid Arthritis. Journal of Health and Rehabilitation Research, 4(2), 1570–1575. https://doi.org/10.61919/jhrr.v4i2.1176
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Articles
Author Biographies

Mahpara Munir, Madina Teaching Hospital/University Medical & Dental College Faisalabad Pakistan.

Assistant Professor (Medicine), Madina Teaching Hospital/University Medical & Dental College Faisalabad, Pakistan.

Zartashia Kynat Javaid, Government College University Faisalabad Pakistan.

Lecturer, Department of Applied Psychology, Government College University Faisalabad, Pakistan.

Khalid Mahmood, Government College University Faisalabad Pakistan.

Associate Professor, Department of Applied Psychology, Government College University Faisalabad, Pakistan.

Mazhar Fareed, University of Health Sciences Lahore Pakistan.

MPhil Scholar Biochemistry, BZU Multan/ Post Graduate Trainee Medicinal Disease, University of Health Sciences Lahore, Pakistan.

Amna Mubeen, Government College University Faisalabad Pakistan.

BS Applied Psychology, Government College University Faisalabad, Pakistan.

Amara Liaqat Ali, University Utara Malaysia.

PhD Scholar, School of Applied Psychology, University Utara Malaysia.

References

Kopp S, Carlsson GE, Haraldson T, Wenneberg B. Long-Term Effect of Intra-Articular Injections of Sodium Hyaluronate and Corticosteroid on Temporomandibular Joint Arthritis. J Oral Maxillofac Surg. 1987;45(11):929-935.

World Health Organization. World Mental Health Report: Transforming Mental Health for All. 2022.

Chancay MG, Guendsechadze SN, Blanco I. Types of Pain and Their Psychosocial Impact in Women With Rheumatoid Arthritis. Women's Midlife Health. 2019;5:1-9.

Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Res. 1989;28(2):193-213.

Cohen S, Doyle WJ, Baum A. Socioeconomic Status Is Associated With Stress Hormones. Psychosom Med. 2006;68(3):414-420.

The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol Med. 1998;28(3):551-558.

Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021;2021.

Herbert C, Meixner F, Wiebking C, Gilg V. Regular Physical Activity, Short-Term Exercise, Mental Health, and Well-Being Among University Students: The Results of an Online and a Laboratory Study. Front Psychol. 2020;11:509.

Whale K, Dennis J, Wylde V, Beswick A, Gooberman-Hill R. The Effectiveness of Non-Pharmacological Sleep Interventions for People With Chronic Pain: A Systematic Review and Meta-Analysis. BMC Musculoskelet Disord. 2022;23(1):440.

Tahirova J, Roziklov N, Mamatkulova F, Shernazarov F. Insomnia Problem Causes of Sleep Disorder, Help Measures at Home. Sci Innov. 2022;1(D8):521-525.

Nikolayevich DR, Ermekovich AT. Artistic and Aesthetic Function of the Landscape in Shukshin's Prose. Gospodarka i Innowacje. 2022;27:108-113.

Grandner MA, Patel NP, Gehrman PR, et al. Problems Associated With Short Sleep: Bridging the Gap Between Laboratory and Epidemiological Studies. Sleep Med Rev. 2010;14(4):239-247.

Tsuno N, Jaussent I, Dauvilliers Y. Determinants of Excessive Daytime Sleepiness in a French Community-Dwelling Elderly Population. J Sleep Res. 2007;16(4):364-371.

Baglioni C, Battagliese G, Feige B, et al. Insomnia as a Predictor of Depression: A Meta-Analytic Evaluation of Longitudinal Epidemiological Studies. J Affect Disord. 2011;135(1-3):10-19.

Alvaro PK, Roberts RM, Harris JK. A Systematic Review Assessing Bidirectionality Between Sleep Disturbances, Anxiety, and Depression. Sleep. 2013;36(7):1059-1068.

Ibanez A, Zimmer ER. Time to Synergize Mental Health With Brain Health. Nat Ment Health. 2023;1(7):441-443.

Affini MI, Arora VM, Gulati J, Mason N, Klein A, Cho HJ, Clarke K, Lee V, McDaniel LM, Orlov NM. Defining Existing Practices to Support the Sleep of Hospitalized Patients: A Mixed‐Methods Study of Top‐Ranked Hospitals. J Hosp Med. 2022;17(8):633-638.

Erten Uyumaz B, Feijs L, Hu J. A Review of Digital Cognitive Behavioral Therapy for Insomnia (CBT-I Apps): Are They Designed for Engagement? Int J Environ Res Public Health. 2021;18(6):2929.

Kirsch Micheletti J, Bláfoss R, Sundstrup E, Bay H, Pastre CM, Andersen LL. Association Between Lifestyle and Musculoskeletal Pain: Cross-Sectional Study Among 10,000 Adults From the General Working Population. BMC Musculoskelet Disord. 2019;20(1):1-8.

Jiloha R. COVID-19 and Mental Health. Epidemiol Int. 2020;5(1):7-9.

Rottapel RE, Zhou ES, Spadola CE, Clark CR, Kontos EZ, Laver K, Chen JT, Redline S, Bertisch SM. Adapting Sleep Hygiene for Community Interventions: A Qualitative Investigation of Sleep Hygiene Behaviors Among Racially/Ethnically Diverse, Low-Income Adults. Sleep Health. 2020;6(2):205-213.

Caneiro J, Bunzli S, O'Sullivan P. Beliefs About the Body and Pain: The Critical Role in Musculoskeletal Pain Management. Braz J Phys Ther. 2021;25(1):17-29.

Long H, Howells K, Peters S, Blakemore A. Does Health Coaching Improve Health‐Related Quality of Life and Reduce Hospital Admissions in People With Chronic Obstructive Pulmonary Disease? A Systematic Review and Meta‐Analysis. Br J Health Psychol. 2019;24(3):515-546.

Spadola CE, Rottapel RE, Zhou ES, Chen JT, Guo N, Khalsa SBS, Redline S, Bertisch SM. A Sleep Hygiene and Yoga Intervention Conducted in Affordable Housing Communities: Pilot Study Results and Lessons for a Future Trial. Complement Ther Clin Pract. 2020;39:101121.

Mamurov B, Mamanazarov A, Abdullaev K, Davronov I, Davronov N, Kobiljonov K. Acmeological Approach to the Formation of Healthy Lifestyle Among University Students. In: III International Scientific Congress Society of Ambient Intelligence 2020 (ISC-SAI 2020).

Finan PH, Goodin BR, Smith MT. The Association of Sleep and Pain: An Update and a Path Forward. J Pain. 2013;14(12):1539-1552.

Johnson JA, Rash JA, Campbell TS, Savard J, Gehrman PR, Perlis M, et al. A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Cognitive Behavior Therapy for Insomnia (CBT-I) in Cancer Survivors. Sleep Med Rev. 2020;52:101311.

Selye H. Stress and Physical Activity. McGill J Educ. 1976;11(001).

Adeeb M, Saleem M, Kynat Z, Tufail MW, Zaffar M. Quality of Life, Perceived Social Support and Death Anxiety Among Cardiovascular Patients. Pakistan Heart J. 2017;50(2).

Riaz M, Mazhar R, Mahmood DK, Javaid ZK, Saleem MA. Body Esteem and Psychological Distress Among Cancer Patients: The Mediating Role of Resilience. Pakistan J Soc Educ Lang. 2021;7(2).

Folkman S. The Case for Positive Emotions in the Stress Process. Anxiety Stress Coping. 2008;21(1):3-14.

Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of Insomnia: Prevalence, Self-Help Treatments, Consultations, and Determinants of Help Seeking Behaviors. Sleep Med. 2006;7(2):123-130.

Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation's Sleep Time Duration Recommendations: Methodology and Results Summary. Sleep Health. 2015;1(1):40-43.

Diener ED, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess. 1985;49(1):71-75.

Zhang P, Gao J, Wang Y, Sun Q, Sun X. Effect of Chronic Disease Self‐Management Program on the Quality of Life of HIV‐Infected Men Who Have Sex With Men: An Empirical Study in Shanghai, China. Int J Health Plann Manage. 2019;34(3):1055-64.

Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617-627.

Choruses GP, Gold PW. The Concepts of Stress and Stress System Disorders. JAMA. 1992;267(9):1244-1252.

Rosengren A, Hawken S, Ounpuu S, et al. Association of Psychosocial Risk Factors With Risk of Acute Myocardial Infarction in 11119 Cases and 13648 Controls From 52 Countries (the INTERHEART Study): Case-Control Study. Lancet. 2004;364(9438):953-962.

Wolfe F, Walitt BT, Katz RS, Hauser W. Social Security Work Disability and Its Predictors in Patients With Fibromyalgia and Other Rheumatic Disorders. Rheumatology (Oxford). 2010;49(4):761-768.

Nicassio PM, Moxham EG, Schuman CE, Gevirtz RN. The Contribution of Pain, Reported Sleep Quality, and Depressive Symptoms to Fatigue in Fibromyalgia. Pain. 2002;100(3):271-279.

Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, Campanholo CB, Chau J, Eder L, Fernández-Ávila DG, FitzGerald O. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Updated Treatment Recommendations for Psoriatic Arthritis 2021. Nat Rev Rheumatol. 2022;18(8):465-479.

Wróbel A, Barańska I, Szklarczyk J, Majda A, Jaworek J. Relationship Between Perceived Stress, Stress Coping Strategies, and Clinical Status in Patients With Rheumatoid Arthritis. Rheumatology Int. 2023;43(9):1665-74.