Sex Differences in the Relations of Positive and Negative Daily Events and Fatigue in Adults With Rheumatoid Arthritis


      Fatigue is a common, disabling symptom for individuals with rheumatoid arthritis (RA). This study 1) examined sex differences in the relations between daily changes in positive and negative interpersonal events and same-day and next-day fatigue and 2) tested positive affect and negative affect as mediators of the associations between changes in interpersonal events and fatigue. Reports of fatigue, number of positive and negative interpersonal events, and positive and negative affect were assessed daily for 30 days via diaries in 228 men and women diagnosed with RA. Days of higher than average daily positive events were associated with both decreased same-day fatigue and increased next-day fatigue, but only among women. Sex differences in same-day relations between positive events and fatigue were mediated by increases in positive affect. For both sexes, days of higher than average daily negative events related to increased same-day and next-day fatigue, and the same-day relations between negative events and fatigue were mediated by increases in negative affect. A more nuanced understanding of similarities and differences between men and women in the associations between changes in interpersonal events and fatigue may inform future interventions for RA fatigue.


      This article presents an examination of sex differences in the links between changes in daily interpersonal events and fatigue in chronic pain patients. The findings can help clinicians target the psychosocial factors that potentially can ameliorate their patients' experience of fatigue.

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        • Aiken L.S.
        • West S.G.
        Multiple Regression: Testing and Interpreting Interactions.
        Sage, Newbury Park1991
        • Antonucci T.C.
        • Akiyama H.
        An examination of sex differences in social support among older men and women.
        Sex Roles. 1987; 17: 737-749
        • Baron R.M.
        • Kenny D.A.
        The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.
        J Person Soc Psychol. 1986; 51: 1173-1182
        • Belza B.L.
        • Henke C.J.
        • Yelin E.H.
        • Epstein W.V.
        • Gilliss C.L.
        Correlates of fatigue in older adults with rheumatoid arthritis.
        Nurs Res. 1993; 42: 93-99
        • Davis M.C.
        • Zautra A.J.
        • Younger J.
        • Motivala S.J.
        • Attrep J.
        • Irwin M.R.
        Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: Implications for fatigue.
        Brain Behav Immunl. 2008; 22: 24-32
        • Evers A.W.M.
        • Kraaimaat F.W.
        • van Riel P.L.C.M.
        • de Jong A.J.L.
        Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: A randomized controlled trial.
        Pain. 2002; 100: 141-153
        • Feldman-Barrett L.
        • Robin L.
        • Pietromonaco P.R.
        • Eyssell K.M.
        Are women the ‘'more emotional'’ sex?: Evidence from emotional experiences in social context.
        Cogn Emot. 1998; 12: 555-578
        • Gable S.L.
        • Reis H.T.
        • Impett E.A.
        • Asher E.R.
        What do you do when things go right? The intrapersonal and interpersonal benefits of sharing positive events.
        J Person Soc Psychol. 2004; 87: 228-245
        • Huyser B.A.
        • Parker J.C.
        • Thoreson R.
        • Smarr K.L.
        • Johnson J.C.
        • Hoffman R.
        Predictors of subjective fatigue among individuals with rheumatoid arthritis.
        Arthritis Rheum. 1998; 41: 2230-2237
        • Igarashi T.
        • Takai J.
        • Yoshida T.
        Gender differences in social network development via mobile phone text messages: A longitudinal study.
        J Soc Pers Relat. 2005; 22: 691-713
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity: A comparison of six methods.
        Pain. 1986; 27: 117-126
        • Littell R.C.
        • Milliken G.A.
        • Stroup W.W.
        • Wolfinger R.D.
        SAS System for Linear Mixed Models.
        SAS Institute, Cary, NC1996
        • MacKinnon D.P.
        Introduction to Statistical Mediation Analysis.
        Erlbaum, New York, NY2008
        • Mancuso C.
        • Rincon M.
        • Sayles W.
        • Paget S.A.
        Psychosocial variables and fatigue: A longitudinal study comparing individuals with rheumatoid arthritis and healthy controls.
        J Rheumatol. 2006; 33: 1496-1502
        • Matthews K.A.
        • Raikkonen K.
        • Everson S.A.
        • Flory J.D.
        • Marco C.A.
        • Owens J.F.
        • Lloyd C.E.
        Do the daily experiences of healthy men and women vary according to occupational prestige and work strain?.
        Psychosom Med. 2000; 62: 346-353
        • Neuberger G.B.
        • Press A.N.
        • Lindsley H.B.
        • Hinton R.
        • Cagle P.E.
        • Carlson K.
        • Scott S.
        • Dahl J.
        • Kramer B.
        Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis.
        Res Nurs Health. 1997; 20: 195-204
        • Nikolaus S.
        • Bode C.
        • Taal E.
        • van de Laar M.A.F.J.
        New insights into the experience of fatigue among patients with rheumatoid arthritis: A qualitative study.
        Ann Rheum Dis. 2009 Oct 22; ([Epub ahead of print])
        • Papanicolaou D.A.
        • Wilder R.L.
        • Manolagas S.C.
        • Chrousos G.P.
        The pathophysiologic roles of interleukin-6 in human disease.
        Ann Intern Med. 1998; 128: 127-137
        • Parrish B.
        • Zautra A.J.
        • Davis M.C.
        The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis.
        Health Psychol. 2008; 27: 694-702
        • Pennebaker J.W.
        • Roberts T.
        Toward a his and hers theory of emotion: Gender differences in visceral perception.
        J Soc Clin Psychol. 1992; 11: 192-212
        • Pollard L.C.
        • Choy E.H.
        • Gonzalez J.
        • Khoshaba B.
        • Scott D.L.
        Fatigue in rheumatoid arthritis reflects pain, not disease activity.
        Rheumatology. 2006; 45: 885-889
        • Rohleder N.
        • Schommer N.C.
        • Hellhammer D.H.
        • Engel R.
        • Kirschbaum C.
        Sex differences in glucocorticoid sensitivity of proinflammatory cytokine production after psychosocial stress.
        Psychosom Med. 2001; 63: 966-972
        • Rupp I.
        • Boshuizen H.C.
        • Jacobi C.E.
        • Dinant H.J.
        • van den Bos G.A.M.
        Impact of fatigue on health-related quality of life in rheumatoid arthritis.
        Arthritis Care Res. 2004; 51: 578-585
        • Schanberg L.E.
        • Sandstrom M.J.
        • Starr K.
        • Gil K.M.
        • Lefebvre J.C.
        • Keefe F.J.
        • Affleck G.
        • Tennen H.
        The relationship of daily mood and stressful events to symptoms in juvenile rheumatic disease.
        Arthritis Care Res. 2000; 13: 33-41
        • Smets E.M.A.
        • Garssen B.
        • Bonke B.
        • De Haes J.C.J.M.
        The multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue.
        J Psychosom Res. 1995; 39: 315-325
        • Stone A.A.
        • Broderick J.E.
        • Porter L.S.
        • Kaell A.T.
        The experience of rheumatoid arthritis pain and fatigue: Examining momentary reports and correlates over one week.
        Arthritis Care Res. 1997; 10: 185-193
        • Tack B.B.
        Fatigue in rheumatoid arthritis: Conditions, strategies, and consequences.
        Arthritis Care Res. 1990; 3: 65-70
        • Todd B.K.
        • Anjali M.
        • William E.B.
        • Jeffrey J.F.
        Gender differences in gratitude: Examining appraisals, narratives, the willingness to express emotions, and changes in psychological needs.
        J Person. 2009; 77: 691-730
        • Treharne G.J.
        • Kitas G.D.
        • Lyons A.C.
        • Booth D.A.
        Well-being in rheumatoid arthritis: The effects of disease duration and psychosocial factors.
        J Health Psychol. 2005; 10: 457-474
        • Unruh A.M.
        Gender variations in clinical pain experience.
        Pain. 1996; 65: 123-167
        • Ware J.E.
        • Sherbournce C.D.
        The MOS 36-Item Short Form Health Survey (SF-36).
        Med Care. 1992; 30: 473-483
        • Watson D.
        • Clark L.A.
        • Tellegen A.
        Development and validation of brief measures of positive and negative affect: the PANAS scales.
        J Person Soc Psychol. 1988; 54: 1063-1070
        • Wolfe F.
        The relation between tender points and fibromyalgia symptom variables: Evidence that fibromyalgia is not a discrete disorder in the clinic.
        Ann Rheum Dis. 1997; 56: 268-271
        • Wolfe F.
        • Hawley D.J.
        • Wilson K.
        The prevalence and meaning of fatigue in rheumatic disease.
        J Rheumatol. 1996; 23: 1407-1417
        • Yunus M.B.
        • Arslan S.
        • Aldag J.C.
        Relationship between body mass index and fibromyalgia features.
        Scand J Rheumatol. 2002; 31: 27-31
        • Zautra A.J.
        • Affleck G.G.
        • Tennen H.
        • Reich J.W.
        • Davis M.C.
        Dynamic approaches to emotions and stress in everyday life: Bolger and Zuckerman reloaded with positive as well as negative affects.
        J Person. 2005; 73: 1511-1538
        • Zautra A.J.
        • Fasman R.
        • Parish B.P.
        • Davis M.C.
        Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia.
        Pain. 2007; 128: 128-135
        • Zautra A.J.
        • Guarnaccia C.A.
        • Dohrenwend B.P.
        Measuring small life events.
        Am J Community Psychol. 1986; 14: 629-655