The impact of fatigue on quality of life in patients with systemic lupus erythematosus: the mediating roles of resilience and self-efficacy

Fatigue is a debilitating symptom in systemic lupus erythematosus (SLE), but its effect on health-related quality of life (HRQoL) and the mediating roles of resilience and self-efficacy are not fully understood. This study aimed to investigate the mediating roles of resilience and self-efficacy in the relationship between fatigue and HRQoL in patients with SLE, using a chain mediation model to identify psychosocial pathways for clinical intervention. In this cross-sectional study, 374 SLE patients from a tertiary care center in Egypt were assessed using validated instruments: the FACIT-Fatigue scale (fatigue), SF-12 (HRQoL), CD-RISC-10 (resilience), and ASES-SF (self-efficacy). Chain mediation analysis was conducted via PROCESS macro (Model 6) with 5,000 bootstrap samples to evaluate direct and indirect effects. Fatigue significantly and negatively associated with impairment in both physical(β = -0.38, p < 0.001) and mental HRQoL (β = -0.77, p < 0.001). Resilience and self-efficacy sequentially mediated fatigue’s impact on mental HRQoL, accounting for 3.45–11.63% of the total effect. While fatigue directly reduced mental HRQoL (75.33% of total effect), resilience independently buffered 9.59% of the impact, and self-efficacy mediated 8.99%. While psychological morbidity and disease activity aggravated fatigue, resilience helped to mitigate these effects by improving adaptive coping. In SLE patients, fatigue has a negative effect on HRQoL directly as well as indirectly through lowered resilience and self-efficacy. To reduce the burden of fatigue, it is important to include techniques to improve self-efficacy and therapies to increase resilience in the care for SLE.