Does enhancing social support and self-efficacy improve physical function and mental health in SLE?

Researchers at Brigham & Women's Hospital and Beth Israel Deaconess Medical Center, both of Boston, had previously shown self-efficacy and social support to be potentially modifiable risk factors for adverse outcomes in SLE. In this study, they sought to improve both through a program of partner support, based on the theory that better social support is associated with improved coping in lupus and better health, and that partners could be collaborative toward this goal[1].

A total of 122 SLE patients plus their partners (spouses or family members) were enrolled and randomized. They were largely Caucasian and college educated. Those in the experimental group participated in a psychoeducational intervention "designed to enhance self-efficacy, social support and problem solving in a one-hour session with a nurse educator followed by monthly telephone counseling for six months." They were taught to identify their problems, evaluate alternative solutions, plan more effectively, and discern discordant partner/patient beliefs. Those randomized to the control group received attention placebo.

By six months, significant improvement was seen in couples' communication and problem-focused coping. At 12 months (6 months after the intervention had ended):

• self efficacy remained at baseline for the control group but had risen from 6.3 to 7.2 for the experimental group;
  
  
• global mental health status (on the SF-36) declined from 61 to 58 points in the control group and rose from 51 to 69 in the experimental group;
  
  
• global physical function improved by 7 points in the experimental vs. control group, adjusting for baseline covariates.

Further, there was a significant decrease in fatigue, a notable proxy of illness, in the experimental group.

This research suggests that outcomes are not as good as they could be - with the same medications - if physicians were able to provide patients with the means to develop more effective coping strategies and improved social support systems.

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posted 11/3/2003

[1] Karlson EW, Liang MH, Eaton H, Huang J, Fitzgerald L, Rogers MP, Daltroy LH. A Randomized Clinical Trial of a Psychoeducational Intervention to Improve Outcomes in SLE. Arthritis Rheum. 2003 Sep;48(9):S645.