The Relationship of Daily Mood and Stressful Events to Symptoms in Juvenile Rheumatic Disease Laura E. Schanberg, Marlene J. Sandstrom, Kathleen Starr, Karen M. Gil, John C. Lefebvre, Francis J. Keefe, Glenn Affleck, and Howard Tennen Objectives. The purpose of this study was 3-fold: 1) to assess the feasibility of a daily diary for use with children with juvenile rheumatic disease (JRD), 2) to describe daily variation in mood, stressful events, and symptoms in children with JRD, and 3) to examine the extent to which daily mood and daily stressful events predict daily symptoms in children with JRD. Methods. Twelve children with JRD completed a daily booklet for 7 days. The daily booklet included measures of daily mood, daily stressful events, daily symptoms, and daily function. The children also completed a visual analog scale for pain and the Children’s Depression Inventory. Results. Subjects showed good compliance with scheduled completion and return of the daily dia- ries. Results indicated that children with JRD showed variability in daily mood, frequency of daily stressful events, and daily symptoms across days. Multilevel fixed effects models showed that more negative daily mood and more daily stressful events significantly predicted increased reports of fatigue, stiffness, and cutting back on daily activities. Nega- tive daily mood also correlated with increases in daily reported pain. Conclusions. These results indicate that daily di- ary research is both feasible and potentially infor- mative in children with JRD. Our data emphasize the need for further investigation into the role of daily mood and daily stressful events on disease course in JRD. Key words. Daily measures; Juvenile rheumatic disease; Mood; Pain; Stressful events; Juvenile ar- thritis. INTRODUCTION Juvenile rheumatic disease (JRD), of which juve- nile rheumatoid arthritis is the most common, affects an estimated 250,000 American children (1–3). The course of disease is often unpredictable, but most often follows a fluctuating course with periods of flare and quiescence. Periods of flare are character- ized by increased disease activity and worsening symptoms, such as pain, fatigue, morning stiffness, and increased functional difficulties. During periods of flare, children may abruptly experience more trou- ble completing routine activities, both at home and school. Supported by grants from the Arthritis Foundation, the Fetzer Institute, and the NIH. Laura E. Schanberg, MD, Department of Pediatrics, and Marlene J. Sandstrom, PhD (current address: Williams College, Williams- town, Massachusetts), Kathleen Starr, PhD, John C. Lefebvre, PhD (current address: Wofford College, Spartanburg, South Carolina), and Francis J. Keefe, PhD, Pain Management Program of the De- partment of Psychiatry, Duke University Medical Center, Durham, North Carolina; Karen M. Gil, PhD, Department of Psychology, University of North Carolina, Chapel Hill; and Glenn Affleck, PhD, and Howard Tennen, PhD, Department of Community Med- icine, University of Connecticut Health Center, Farmington. Address correspondence to Laura E. Schanberg, MD, Division of Pediatric Rheumatology, Department of Pediatrics, Box 3212, Duke University Medical Center, Durham, NC 27710. Submitted for publication December 31, 1997; accepted in re- vised form November 5, 1999. © 2000 by the American College of Rheumatology. 0893-7524/00/$5.00 33