Biopsychosocial factors associated with body image in Brazilian women with Systemic Lupus Erythematosus

Background Systemic Lupus Erythematosus (SLE), a chronic autoimmune disease that predominantly affects women, can alter both physical appearance and bodily functioning through its manifestations and treatment, posing challenges to body image. Although body image in SLE has been associated with clinical, psychological, and sociodemographic factors, few studies have examined these domains simultaneously in women with SLE within a biopsychosocial framework, which limits understanding of their joint contributions. Objective To examine biopsychosocial factors associated with body image in a Brazilian sample of women with SLE. Methods A nationwide cross-sectional survey was conducted with 597 women with SLE. Participants provided sociodemographic and clinical information and completed the Body Esteem Scale for Adults and Adolescents (BESAA), Satisfaction with Life Scale (SWLS), and Depression, Anxiety, and Stress Scale-21 (DASS-21). Bivariate associations were examined with nonparametric tests, and independent associations were examined with a hierarchical multiple linear regression including theoretically pre-specified sociodemographic, clinical, and psychological blocks. Results In bivariate analyses, poorer body image was associated with active disease, skin lesions, joint pain, serous membrane inflammation, fever without infection, lower life satisfaction, higher levels of depression, anxiety, and stress, lower educational attainment, and lower household income. The final model explained 35.4% of the variance in body image, with psychological variables accounting for 17.7% beyond sociodemographic and clinical characteristics. Greater life satisfaction and unintentional weight loss were independently associated with more positive body image, whereas higher levels of depression, skin lesions, and joint pain were independently associated with poorer body image. Conclusions Body image in women with SLE is associated with factors across different biopsychosocial domains, suggesting that it should not be examined solely from a clinical perspective. Rather, psychological and social factors should be considered alongside disease-related characteristics to support more comprehensive approaches to the assessment and care of body image concerns in this population.