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Positive Psychological Factors and Impairment in Rheumatic and Musculoskeletal Disease: Do Psychopathology and Sleep Quality Explain the Linkage?


Arthritis Care Res (Hoboken). 2020 Sep 16. doi: 10.1002/acr.24440. Online ahead of print.

Jameson K Hirsch 1, Heather R Altier 1, Martin Offenbächer 2, Loren Toussaint 3, Niko Kohls 4, Fuschia M Sirois 5

Author Information

1 Department of Psychology, East Tennessee State University, Johnson City, USA.

2 Gastein Healing Gallery, Bad Gastein-Böckstein, Austria.

3 Department of Psychology, Luther College, Decorah, USA.

4 Department of Integrative Health Promotion, University of Applied Science, Coburg, Germany.

5 Department of Psychology, University of Sheffield, Sheffield, UK.


Objective: Little is known about potential mechanisms of action linking protective positive psychological variables and functional disability in patients with rheumatic and musculoskeletal disease. We examined symptoms of psychopathology, including stress, depression and anxiety, and sleep quality, as serial mediators of the association between gratitude, self-compassion and self-forgiveness, and functional impairment.

Method: We assessed risk and protective factors for functional disability in patients with fibromyalgia (FMS), osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS), who were recruited from an Austrian healthcare facility. Respondents completed online surveys, including the Gratitude Questionnaire - 6, Self-Compassion Scale - Short Form, Self-Forgiveness and Forgiveness of Others Index, Perceived Stress Scale - 4, Patient Health Questionnaire - 2, Generalized Anxiety Disorder - 2, Sleep Condition Indicator, and the Health Assessment Questionnaire. Bivariate and serial mediation analyses were conducted.

Results: For our sample of 1,218 patients (N = 632 female, 52%), AS (37%), OA (34%), RA (14%) and FMS (24%), stress, depression, and anxiety, in parallel as first-order mediators, and sleep quality as a second-order mediator, explained the association between positive psychological variables and functional disability.

Conclusion: Positive psychological factors exert a beneficial downstream effect on mental wellbeing, sleep health and health-related functional impairment. Therapeutic promotion of gratitude, self-compassion and self-forgiveness may improve mental and physical health in patients with rheumatic and musculoskeletal disease.