Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand

Abstract

Background Depressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE. Methods This cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least three months, aged 18-59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9 (PHQ-9). We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index (SLEDAI), the Systemic Lupus International Collaborating Clinics Damage Index (SLICC Damage Index), Numeric Rating Scale (NRS), Fatigue Severity Scale (FSS), Body Image Scale (BIS), and the ENRICHD Social Support Instrument (ESSI). Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data. Result The proportion of the participants with depressive symptoms was 43.2%, while 8.1% of those patients faced moderate to severe depressive symptoms and could be diagnosed with depression. SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95%CI = 1.35-108.46), fatigue (aOR = 2.36, 95%CI = 1.08-5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI = 1.76-18.80), low satisfied of body image (aOR = 12.49, 95%CI = 2.23-69.80), and low social support (aOR = 17.96, 95% CI = 1.86-173.77). Disease flare, organ damage, and family income sufficiency could not predict the risk of depressive symptoms in patients with SLE (p ≤ .05). Conclusion The findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.