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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Psychological Stress and Anxiety in Autoimmune Diseases: A Cross-Sectional Case–Control Study

by
Lucia Bubulac
1,†,
Eliza Seche
2,†,
Mirela Zivari
3,4,
Constantin Erena
5,
Dana-Maria Popescu-Spineni
6,7,
Claudia Florina Bogdan-Andreescu
8,
Cristina-Crenguța Albu
9,*,
Tudor Georgescu
10,*,
Dan Alexandru Slăvescu
2 and
Adrian Bobu
11
1
Department of Family Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
2
Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
3
Department of Psychology and Educational Sciences, Faculty of Psychology, Ecological University of Bucharest, 061341 Bucharest, Romania
4
Department of Psychology, Emergency University Hospital, 050098 Bucharest, Romania
5
Internal Medicine Department, Bucharest Emergency Clinical Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
6
Department of Social Medicine, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
7
Department of Biomedical Anthropology, “Francisc Reiner” Institute of Anthropology of the Romanian Academy, 050711 Bucharest, Romania
8
Department of Specialty Disciplines, “Titu Maiorescu” University, 031593 Bucharest, Romania
9
Department of Genetics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
10
Doctoral School, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
11
Faculty of Automatic Control and Computers, National University of Science and Technology POLITEHNICA, 060042 Bucharest, Romania
 
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*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Healthcare 2026, 14(16), 2584; https://doi.org/10.3390/healthcare14162584
Submission received: 8 July 2026 / Revised: 7 August 2026 / Accepted: 14 August 2026 / Published: 17 August 2026
Versions Notes

Abstract

Background: Psychological distress has been frequently reported in individual autoimmune diseases, but evidence regarding shared psychological characteristics across heterogeneous autoimmune conditions remains limited. Objective: This study compared stress vulnerability, exposure to major life events, state and trait anxiety, and Type A behavioral characteristics between adults with autoimmune diseases and controls. Methods: This cross-sectional case–control study included 389 adults: 204 patients with autoimmune diseases and 185 controls. Participants completed the Stress Vulnerability Scale, Holmes–Rahe Life Stress Inventory, State–Trait Anxiety Inventory, and Jenkins Activity Survey. Between-group differences, effect sizes, and correlations among psychometric variables were examined. Results: Patients with autoimmune diseases had significantly higher stress vulnerability scores (Cohen’s d = 0.39) and Holmes–Rahe life-event burden (d = 0.54) than controls. State anxiety (d = 0.52) and trait anxiety (d = 0.68) were also higher (all p < 0.001). Type A behavioral characteristics did not differ significantly between groups. State and trait anxiety showed the strongest correlation (r = 0.755, p < 0.001). Disease duration was positively associated with Holmes–Rahe scores but not with stress vulnerability or anxiety. Conclusions: Adults with autoimmune diseases showed a higher psychological burden across several complementary psychometric dimensions. These findings support consideration of psychological screening within multidisciplinary autoimmune disease care. Longitudinal and disease-specific studies integrating biological, psychological, and social factors are required to clarify temporal and potentially bidirectional relationships.
Keywords: autoimmune diseases; psychological stress; state anxiety; trait anxiety; psychoneuroimmunology; biopsychosocial model; psychological screening autoimmune diseases; psychological stress; state anxiety; trait anxiety; psychoneuroimmunology; biopsychosocial model; psychological screening

Share and Cite

MDPI and ACS Style

Bubulac, L.; Seche, E.; Zivari, M.; Erena, C.; Popescu-Spineni, D.-M.; Bogdan-Andreescu, C.F.; Albu, C.-C.; Georgescu, T.; Slăvescu, D.A.; Bobu, A. Psychological Stress and Anxiety in Autoimmune Diseases: A Cross-Sectional Case–Control Study. Healthcare 2026, 14, 2584. https://doi.org/10.3390/healthcare14162584

AMA Style

Bubulac L, Seche E, Zivari M, Erena C, Popescu-Spineni D-M, Bogdan-Andreescu CF, Albu C-C, Georgescu T, Slăvescu DA, Bobu A. Psychological Stress and Anxiety in Autoimmune Diseases: A Cross-Sectional Case–Control Study. Healthcare. 2026; 14(16):2584. https://doi.org/10.3390/healthcare14162584

Chicago/Turabian Style

Bubulac, Lucia, Eliza Seche, Mirela Zivari, Constantin Erena, Dana-Maria Popescu-Spineni, Claudia Florina Bogdan-Andreescu, Cristina-Crenguța Albu, Tudor Georgescu, Dan Alexandru Slăvescu, and Adrian Bobu. 2026. "Psychological Stress and Anxiety in Autoimmune Diseases: A Cross-Sectional Case–Control Study" Healthcare 14, no. 16: 2584. https://doi.org/10.3390/healthcare14162584

APA Style

Bubulac, L., Seche, E., Zivari, M., Erena, C., Popescu-Spineni, D.-M., Bogdan-Andreescu, C. F., Albu, C.-C., Georgescu, T., Slăvescu, D. A., & Bobu, A. (2026). Psychological Stress and Anxiety in Autoimmune Diseases: A Cross-Sectional Case–Control Study. Healthcare, 14(16), 2584. https://doi.org/10.3390/healthcare14162584

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