What does this research mean for the field?

Depressive symptoms negatively impact disease activity in rheumatoid arthritis patients by reducing self-efficacy, which mediates this relationship. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The study aims to investigate how self-efficacy mediates the relationship between depressive symptoms and disease activity in rheumatoid arthritis.

February 28, 2026Open Access

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

Key Result

Self-efficacy mediates 32.8% of the effect of depressive symptoms on disease activity (DAS28) in rheumatoid arthritis patients.

Key Points

The study aims to investigate how self-efficacy mediates the relationship between depressive symptoms and disease activity in rheumatoid arthritis.
Conducted a cross-sectional survey involving patients with rheumatoid arthritis in Taiwan.
Participants completed questionnaires on demographics, disease status, self-efficacy, and depression.
Mediation analysis was performed using the Hayes PROCESS macro function on SPSS.
Depressive symptoms negatively impact self-efficacy among patients with rheumatoid arthritis.
Self-efficacy is negatively associated with disease activity as measured by DAS28.
Mediation analysis shows 32.8% of the impact of depression on DAS28 is mediated by self-efficacy.

Structured PICO

Population

259 patients with rheumatoid arthritis recruited from a target hospital in Taiwan.

Outcome

Association between depressive symptoms and disease activity (measured using the 28-joint Disease Activity Score [DAS28]), and the mediating effect of self-efficacy.surrogate

In patients with rheumatoid arthritis, self-efficacy significantly mediates the adverse impact of depressive symptoms on disease activity.

Main Result

Absolute Event Rate: 0% vs 0%

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.