Depression, stigma and social isolation: the psychosocial trifecta of primary chronic cutaneous lupus erythematosus, a cross-sectional and path analysis

Abstract

ObjectiveDepression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients’ psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations).MethodsCross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (ɑ=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association.ResultsAmong 121 participants (87.6% women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI −0.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model.ConclusionOur findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.

Stigma and Daily lives among Patients with Major Depressive Disorder in Gaza Governorates

“…Another study by Vrbova et al [10] indicated that the stigma associated with a significant deterioration in the quality of life. The findings of the current study agreed with those of a study by Drenkard et al [11]which found a significant relationship between depression and stigma.…”

Successful treatment of severe chronic cutaneous lupus with anifrolumab: A series of 6 cases

“…Due to the visibility of skin lesions, cutaneous disease has a significant impact on patients’ quality of life, comfort with socialization, and self-image. 6 Given the morbidity associated with the scarring and dyspigmentation wrought by CCLE, quick and efficacious treatment is highly desired. 5 Type I IFNs are key mediators and correlate with cutaneous disease in SLE, as well as specific CLE subtypes, subacute cutaneous, and DLE.…”

“… 3 , 4 Given its potential for permanent scarring and dyspigmentation, CLE carries a significant negative impact on quality of life. 5 , 6 Management of CLE subtypes has traditionally consisted of preventive measures alongside combinations of topical and systemic immunosuppressive therapies. First line treatments consist of topical or intralesional steroids and antimalarials.…”

Cutaneous lupus erythematosus is associated with an increased risk of cardiac and vascular diseases: a large-scale, propensity-matched global retrospective cohort study

“… 34 However, the concomitance of cardiovascular disease and CLE found here was independent of classical cardiovascular risk factors as those were included in the PSM-model. Other behavioural and psychosocial factors might play a role as CLE can lead to significant impairment of mental health with higher prevalence of depression 7 , 35 amongst other psychiatric diseases. Depression in particular imposes a higher risk for cardiovascular diseases.…”