Coping strategies, depression, anxiety and fatigue in rheumatic diseases: A moderated mediation analysis

Background: The present study aimed to explore, in patients with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, the direct effects of coping strategies on fatigue and the role of depression and anxiety as mediators. It also investigates how moderators, including diagnosis, disease activity, disease duration, and sex, affect the pathways. Methods: This observational cross-sectional study examined a sample of 807 patients receiving outpatient care, who were assessed with the following self-report validated questionnaires: the Coping Orientation to the Problems Experienced, the Chalder Fatigue Questionnaire, the Quick Inventory of Depressive Symptomatology, and the State-Trait Anxiety Inventory. Results: While the effect of problem-focused and emotion-focused coping did not seem to be related to fatigue, dysfunctional coping significantly was. Once depression and anxiety were considered as mediators, the direct effect of dysfunctional coping on fatigue lost its significance. When examining the diagnostic category as a moderator, dysfunctional coping has a more significant relationship with fatigue in axial spondyloarthritis compared to rheumatoid arthritis or psoriatic arthritis. When considering sex as a moderator, the association between dysfunctional coping and depression appeared stronger in females than in males. Disease activity and disease duration do not appear to moderate the paths. Conclusion: Maladaptive coping in rheumatic diseases appears to contribute to higher fatigue levels, a relationship mediated by anxiety and depression symptoms, while diagnosis and sex moderate specific paths.