Influence of Depressive Symptoms on Disease Activity in Patients with Rheumatoid Arthritis: the Mediating Effect of Self-Efficacy

Authors

• Wen-Wei Lin, National Taiwan Sport University
• Chieh-Tsung Yen, Buddhist Tzu Chi Medical Foundation
• Hua-Lung Huang, Buddhist Tzu Chi Medical Foundation
• Hanoch Livneh, Portland State UniversityFollow
• Ming-Chi Lu, Tzu Chi University, Hualien
• Wei-Jen Chen, National Taiwan Sport University
• Tzung-Yi Tsai, Buddhist Tzu Chi Medical Foundation

Author ORCID Identifier(s)

Hanoch Livneh (0000-0001-5149-1717)

Ming-Chi Lu (0000-0001-9051-0351)

Tzung-Yi Tsai (0000-0002-9865-7101)

Sponsor

This study was supported by a grant from Tzu Chi Hospital (DTCRD112-I-21) and NSTC-113-2314-B-303-008.

Publication Title

Medicina

Document Type

Article

Publication Date

3-27-2026

Subjects

Rheumatoid Arthritis -- Treatments

Abstract

Background and Objectives:

Rheumatoid arthritis (RA) is a lifelong autoimmune disease in which joint inflammation is caused by a dysfunctional immune system. Synchronous depressive symptoms have been identified as determinants of disease progression, especially disease activity as measured using the 28-joint Disease Activity Score (DAS28). Although growing evidence suggests the interplay between depression and DAS28 in RA, related findings remain inconsistent, implying that a pivotal underlying mechanism is overlooked. Hence, we aimed to examine whether self-efficacy, the belief in one’s ability to manage health, could mediate the association between depressive symptoms and DAS28.

Materials and Methods:

Between January and October 2023, we carried out a cross-sectional survey to recruit patients with RA from a target hospital in Taiwan. Participants completed demographic and disease-related questionnaires, the Chinese version of the Arthritis Self-Efficacy Scale, and the Taiwanese Depression Questionnaire. Mediation analysis was performed using the Hayes PROCESS macro function on SPSS.

Results:

In 259 recruited persons with RA, depressive symptoms were found to negatively associate with self-efficacy, and self-efficacy negatively related to DAS28. Mediation analysis demonstrated that depressive symptoms affected DAS28 indirectly through self-efficacy (B = 0.022; 95% confidence interval: 0.015–0.031), accounting for 32.8% of the total impacts.

Conclusions: Our findings suggest that the association between depressive symptoms and DAS28 may be mediated by individual self-efficacy. Interventions beyond the relief of depressive symptoms and that enhance the concept of self-efficacy should be emphasized while managing patients with RA.

Rights

Copyright (c) 2026 The Authors

This work is licensed under a Creative Commons Attribution 4.0 International License.

Locate the Document

https://doi.org/10.3390/medicina62030449

DOI

10.3390/medicina62030449

Persistent Identifier

https://archives.pdx.edu/ds/psu/44590

Publisher

MDPI AG

Citation Details

Lin, W.-W., Yen, C.-T., Huang, H.-L., Livneh, H., Lu, M.-C., Chen, W.-J., & Tsai, T.-Y. (2026). Influence of Depressive Symptoms on Disease Activity in Patients with Rheumatoid Arthritis: The Mediating Effect of Self-Efficacy. Medicina, 62(3), 449.