Background Fatigue is a prevalent and debilitating problem in the systemic autoimmune disorder Sjögren’s syndrome. Psychosocial factors have been indicated to at least partly explain fatigue in this patient group. Insight into these factors and the relation of these factors with fatigue, will indicate the need for tailoring psychological interventions aimed at the reduction of fatigue to individual patients.
Objectives To identify psychosocial subgroups of patients with Sjögren’s syndrome and to examine differences in fatigue between these subgroups.
Methods 300 patients with primary Sjögren’s syndrome (mean age 56 years, 93% female) completed questionnaires on fatigue (MFI), physical activity cognitions (TAMPA-SK), illness cognitions (ICQ), cognitive emotion regulation (CERQ-short), coping strategies (Brief COPE), emotion processing and regulation (TAS-20, ERQ, BEQ), and social support (SSL, ABO). The psychosocial variables were summarized using principal axis factor analysis with oblimin rotation. Psychosocial subgroups were identified using hierarchical cluster analysis (Ward’s method) and K-means cluster analysis. Subgroup differences in fatigue were examined with univariate analysis of variance.
Results Factor analysis yielded eight psychosocial factors: kinesiophobia (KP, fear to exercise), negative thinking (NT), positive thinking (PT), positive disease outcome (PD), alexithymia (AT), emotional expressivity (EE), social support (SS), and spouse engagement (SE). Cluster analyses identified four psychosocial subgroups: 1) an adaptive profile (n=64) with positive scores on all dimensions; 2) a self-reliance profile (n=64), with neutral scores on all dimensions except adaptive scores on positive thinking and positive disease outcomes and maladaptive scores on spouse engagement; 3) a maladaptive profile (n=52), with negative scores on all dimensions except a neutral score on emotional expressivity; and 4) a cognitive reappraisal profile, with adaptive scores on cognitive factors and maladaptive scores on emotional factors. Subgroup 3 reported more fatigue than the other subgroups on four of five fatigue dimensions (p<0.05), except physical fatigue compared to subgroup 2. The other subgroups did not differ from each other, with the exception of subgroup 2 reporting more mental fatigue, i.e. concentration and thought problems, than subgroup 4 (p<0.05).
Conclusions Patients with Sjögren’s syndrome with a generalized maladaptive psychosocial profile experience more fatigue than patients with an adaptive, self-reliance or cognitive reappraisal profile. Thus, besides the identification of a single group with a generalized maladaptive profile, there is little support for tailoring fatigue interventions on the basis of psychosocial risk profiles.
Supported by the Dutch Arthritis Association.
Disclosure of Interest None Declared
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