ArticleThe contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritisNicassio, Perry M.a,*; Ormseth, Sarah R.b; Kay, Morganc; Custodio, Maraa; Irwin, Michael R.a; Olmstead, Richarda; Weisman, Michael H.dAuthor Information Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. aCousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA bDepartment of Psychology, Loma Linda University, Loma Linda, CA, USA cCalifornia School of Professional Psychology of Alliant International University, Alhambra, CA, USA dDivision of Rheumatology, Cedars Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA *Corresponding author. Address: Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Los Angeles, CA 90095-7076, USA. Tel.: +1 310 825 3141; fax: +1 310 794 9247. E-mail address:[email protected] Article history: Received 31 March 2011; Received in revised form 8 September 2011; Accepted 28 September 2011. Pain: January 2012 - Volume 153 - Issue 1 - p 107-112 doi: 10.1016/j.pain.2011.09.024 Buy Metrics Abstract Summary Pain and depression were related to sleep disturbance in rheumatoid arthritis. Depression partly mediated the relationship between pain and sleep. The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition. © 2012 Lippincott Williams & Wilkins, Inc.