Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Abstract

Objectives. A significant number of patients with systemic lupus erythematosus (SLE) have depression, and many are untreated. We aim to assess the frequency of moderate to severe depression (MSD) in a multiethnic group of SLE patients with different sociodemographic backgrounds, identify modifiable factors associated with depression, and determine the impact of depression, disease activity, damage, cognitive function, and pain severity on health-related quality of life (HRQoL). Methods. Ninety-nine patients with SLE were evaluated in a cross-sectional study. Sociodemographic data, Beck Depression Inventory (BDI II), SLE disease activity index (SLEDAI-2K), SLICC Damage Index (SLICC-DI), pain severity (10 cm visual analogue scale), cognitive function (Automated Neuropsychologic Assessment Metrics (ANAM)), and the physical (PCS) and mental (MCS) component scores of the Short Form Health Survey (SF-36) were recorded. Bivariate analysis identified potential associations of relevant variables with BDI II and SF-36. Regression analysis determined independent correlates with MSD, PCS, and MCS. Results. Over 50% of subjects (50.5%) were African-American, 37.1% had a family income of ≤$20,000, and 31.3% had MSD. In the bivariate analysis, family income, SLEDAI-2K, cognitive function, and pain severity were associated with MSD. Using binary logistic regression, SLEDAI-2K and pain severity remained independently correlated with MSD ( p = 0.004 ). In the multiple linear regression analysis, pain severity was the only independent correlate of PCS ( p < 0.0001 ), while cognitive function and BDI II were the main factors associated with MCS ( p = 0.020 and p < 0.0001 , respectively). Conclusion. Pain severity and disease activity are associated with MSD in our unique population, are potentially modifiable, and deserve further attention in the clinic. Depression and pain significantly affect HRQoL and should be aggressively managed.

Psychological Implications to the Therapy of Systemic Lupus Erythematosus

“…Fifty-nine of these articles were sought for retrieval whilst only 35 articles that complied with the inclusion criteria were included. Twenty-six studies focusing on the psychological outcomes of lupus involved 7302 subjects with lupus [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] while nine interventional studies involved 431 subjects with SLE [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Because of a diverse nature of retrieved investigations and the heterogeneity of data in terms of the type of intervention technique, research procedures, and outcome evaluation measures, a meta-analysis could not be performed.…”

“…The prevalence of anxiety and depression and sleep quality in SLE was assessed in thirteen investigations in eight countries in Europe, Asia, and North America [ 18 , 19 , 21 , 22 , 26 , 27 , 30 , 34 , 35 , 38 , 40 , 42 , 43 ]. Most studies applied a cross-sectional design and used sample sizes ranging from 29 to 405 participants with an overwhelming majority (80–100%) of female participants.…”

“…Most studies applied a cross-sectional design and used sample sizes ranging from 29 to 405 participants with an overwhelming majority (80–100%) of female participants. Studies applied a number of commonly used standardized questionnaires and tools including the Beck Depression Inventory (BDI) [ 19 , 38 ], the Hospital Anxiety and Depression Scale (HADS) [ 27 , 34 , 36 , 37 , 39 , 40 ], the Patient Health Questionnaire-9 [ 21 ], and the Hamilton Depression Rating Scale (HAMD) [ 18 ] to assess symptoms of depression and anxiety while the Pittsburgh Sleep Quality Index (K-PSQI) was used to assess sleep quality indicators [ 26 , 34 , 35 , 38 ]. Studies reported mixed findings as mild to severe depression was present in 15-68.7% of subjects [ 18 , 21 , 30 ].…”

“…Depression was associated with anxiety, fatigue, pain intensity, symptoms of ill physical health, or medication side effects (e.g., an uptake of steroids, kidney function, or dizziness) [ 18 , 35 ], marital status, or ethnic background [ 19 , 21 ]. There were discordant findings on the relationship between depression, socioeconomic status, cognitive function, and disease activity in terms of SLEDAI scores [ 18 , 19 , 37 , 43 ]. A higher disease activity in terms of SLEDAI scores predicted depression [ 18 , 19 , 27 ].…”

“…There were discordant findings on the relationship between depression, socioeconomic status, cognitive function, and disease activity in terms of SLEDAI scores [ 18 , 19 , 37 , 43 ]. A higher disease activity in terms of SLEDAI scores predicted depression [ 18 , 19 , 27 ].…”