51
|
Hung HM, Chen MF, Chen CH. The clinically crucial predictors of depression in women with systemic autoimmune diseases. Health Care Women Int 2019; 41:293-307. [PMID: 31246540 DOI: 10.1080/07399332.2019.1623796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The researchers' aim of this study was to identify and quantify the useful, clinically crucial predictors of depression in Taiwanese women with systemic autoimmune diseases (SADs). We used a cross-sectional method. A total of 241 Taiwanese women with SADs between 21 and 85 years of age participated in the study. Analysis revealed that the strongest predictors of depression in participants were: perceived stress, fatigue, mental health, physical health, chronic-disease-related comorbidities, self-perceived SAD severity, and social support. The model used in the present study explained 70.9% of the variance in the depression.
Collapse
Affiliation(s)
- Hsuan-Man Hung
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan
| | - Ming-Fu Chen
- Internal Medical Department, St. Joseph Hospital, Kaohsiung, Taiwan
| | - Chung-Hey Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan.,Department of Nursing, Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
52
|
Grygiel-Górniak B, Limphaibool N, Puszczewicz M. Cytokine secretion and the risk of depression development in patients with connective tissue diseases. Psychiatry Clin Neurosci 2019; 73:302-316. [PMID: 30719813 DOI: 10.1111/pcn.12826] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Research in the past two decades has revolutionized our understanding of depressive illnesses. Proinflammatory cytokines have become a point of interest in the interconnecting areas of neuropsychiatric and autoimmune diseases. The cytokine hypothesis of depression suggests that pro-inflammatory cytokines play a primary role in the mediation of the pathophysiological characteristics of major depression, in which an inflammatory process may be induced by external and internal stressors, such as psychological and inflammatory diseases, respectively. The higher prevalence of depression, particularly in patients with chronic autoimmune connective tissue disorders (CTD), suggests that depression may present a dysfunctional adaptation of cytokine-induced sickness, which could manifest in times of an exacerbated activation of the innate immune system. Inflammation is thought to contribute to the development of clinical depression through its ability to induce sickness behaviors corresponding to the neurovegetative features of depression, through the dysregulation of the hypothalamic-pituitary-adrenal axis, alterations in neurotransmitter synthesis and reuptake, and through its involvement in the neuroprogression pathways. This review explores the complex interrelationships in which inflammatory responses alter neuroendocrine and neuropsychological regulation contributing to depressive symptoms in CTD. The prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD will be reviewed.
Collapse
Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Nattakarn Limphaibool
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Puszczewicz
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
53
|
Hong J, Aspey L, Bao G, Haynes T, Lim SS, Drenkard C. Chronic Cutaneous Lupus Erythematosus: Depression Burden and Associated Factors. Am J Clin Dermatol 2019; 20:465-475. [PMID: 30877492 PMCID: PMC6534449 DOI: 10.1007/s40257-019-00429-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Depression may occur in up to 30% of individuals with cutaneous lupus erythematosus (CLE), many of whom may also have systemic manifestations. Chronic cutaneous lupus erythematosus (CCLE) conditions are less likely to present systemic involvement than acute and subacute conditions but more often cause permanent scarring and dyspigmentation. However, little is known about depression in those who have CCLE confined to the skin (primary CCLE). As African Americans are at high risk for primary CCLE and depression, we aimed to investigate the prevalence of and explore the risk factors for depression in a population-based cohort of predominantly Black patients with primary CCLE. METHODS This was a cross-sectional analysis of a cohort of individuals with a documented diagnosis of primary CCLE, established in metropolitan Atlanta, GA, USA. Participants were recruited from the Centers for Disease Control and Prevention (CDC) population-based Georgia Lupus Registry, multicenter dermatology clinics, community practices, and self-referrals. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the primary outcome: depressive symptoms. Stand-alone questions were used to assess sociodemographics and healthcare utilization. Emotional, informational, and instrumental support were measured with PROMIS short forms, interpersonal processes of care with the IPC-29 survey, and skin-related quality of life with the Skindex-29+ tool. RESULTS Of 106 patients, 92 (86.8%) were female, 91 (85.8%) were Black, 45 (42.9%) were unemployed or disabled, and 28 (26.4%) reported moderate to severe depressive symptoms. Depression severity was lower in patients who were aged ≥ 60 years, were married, or had graduated from college. Univariate analysis showed that being employed (odds ratio [OR] 0.24; 95% confidence interval [CI] 0.10-0.61), insured (OR 0.23; 95% CI 0.09-0.60), reporting higher instrumental, informational, and emotional support (OR 0.75; 95% CI 0.60-0.94; OR 0.62; 95% CI 0.49-0.78; and OR 0.48; 95% CI 0.35-0.65, respectively), visiting a primary care physician in the last year (OR 0.16; 95% CI 0.04-0.61) and reporting better physician-patient interactions (OR 0.56; 95% CI 0.37-0.87) were negatively associated with depression. Patient's perception of staff disrespect (OR 2.30; 95% CI 1.19-4.47) and worse skin-related quality of life (OR 1.04; 95% CI 1.02-1.06) rendered higher risk. In multivariate analysis, only perception of staff disrespect (OR 2.35; 95% CI 1.06-5.17) and lower emotional support (OR 0.48; 95% CI 0.35-0.66) remained associated with depression. CONCLUSION Over one-quarter of a predominantly Black population-based cohort of individuals with primary CCLE reported moderate to severe depression, a rate three to five times higher than described previously in the general population from the same metropolitan Atlanta area. Our findings suggest that, while patient's perception of discrimination in the healthcare setting may play a role as a determinant of depression, social support may be protective. In addition to routine mental health screening and depression treatment, interventions directed at providing emotional support and improving office staff interpersonal interactions may contribute to reduce the risk of depression in patients with CCLE.
Collapse
Affiliation(s)
- Jennifer Hong
- Department of Medicine and Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Laura Aspey
- Department of Medicine and Department of Dermatology, Emory University, Atlanta, GA, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Tamara Haynes
- Department Medicine and Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA.
| |
Collapse
|
54
|
Fangtham M, Kasturi S, Bannuru RR, Nash JL, Wang C. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus 2019; 28:703-712. [PMID: 30961418 DOI: 10.1177/0961203319841435] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Non-pharmacologic therapies have been deemed as potentially beneficial for patients with systemic lupus erythematosus. We conducted an updated review to determine the effects of these therapies to inform practice. METHODS A literature search was performed using PubMed (MEDLINE), EMBASE, Cochrane, PsychINFO, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar from inception until August 2018. We included randomized controlled trials of non-pharmacologic therapies in systemic lupus erythematosus patients with sample size ≥10. Systemic lupus erythematosus was defined by 1982 or 1997 American College of Rheumatology criteria. Studies were synthesized separately by patient-reported outcomes and disease activity. Due to the heterogeneity of interventions and comparisons, a meta-analysis was not performed. RESULTS A total of 15 randomized controlled trials involving 846 participants met the inclusion criteria. Of the 15 trials, eight used exercise interventions, six used psychological interventions (one group psychotherapy, three cognitive behavioral therapies, one psychoeducation, one mindfulness-based cognitive therapy) and one used electro-acupuncture. Five of 15 studies utilized control groups consisting of usual medical care. Other studies included control interventions of relaxation, attention placebo, symptom monitoring support, education, minimal needling, isotonic and resistance exercise. Compared with the control conditions, non-pharmacological interventions were associated with a significant improvement in fatigue in three out of six studies. Three out of eight studies reported improved anxiety and depression, and one study reported improved pain after interventions. Seven out of 11 studies reported improvement in overall quality of life in at least one domain of the Short-Form Health Survey. Of note, no studies demonstrated an improvement in disease activity after 5-52 weeks of non-pharmacological therapies. CONCLUSION This review showed promising results for physical exercise and psychological interventions as adjuncts to traditional medical therapy for improvement in fatigue, depression, pain and quality of life for systemic lupus erythematosus. Further high-quality randomized controlled trials with longer follow-up periods are warranted.
Collapse
Affiliation(s)
- M Fangtham
- 1 Division of Rheumatology, University of New Mexico, Albuquerque, NM, USA
| | - S Kasturi
- 2 Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - R R Bannuru
- 3 Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - J L Nash
- 4 Health Sciences Library and Informatics Center, University of New Mexico, Albuquerque, NM, USA
| | - C Wang
- 3 Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
55
|
Lillis TA, Tirone V, Gandhi N, Weinberg S, Nika A, Sequeira W, Hobfoll SE, Block JA, Jolly M. Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus. Arthritis Care Res (Hoboken) 2019; 71:406-412. [PMID: 29726637 DOI: 10.1002/acr.23593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). METHODS A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress. RESULTS Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (β = 0.30) and depression symptoms (β = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (β = 0.20) and stress (β = 0.22) remained significantly linked to CD (overall model R2 = 0.53; all P < 0.05). CONCLUSION After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.
Collapse
Affiliation(s)
| | | | | | | | - Ailda Nika
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
| | | |
Collapse
|
56
|
|
57
|
Jordan J, Thompson NJ, Dunlop-Thomas C, Lim SS, Drenkard C. Relationships among organ damage, social support, and depression in African American women with systemic lupus erythematosus. Lupus 2019; 28:253-260. [PMID: 30482093 PMCID: PMC6415670 DOI: 10.1177/0961203318815573] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) disproportionately strikes African American women. Social support can potentially reduce disease impact. The purpose of this study is to understand the relationship between organ damage and depression in African American women and how social support influences this relationship. METHODS We used a mixed methods design, analyzing self-reported data on lupus-related organ damage, depression, and social support in 437 African American women with SLE recruited in the Georgians Organized Against Lupus (GOAL) cohort. Moreover, we conducted interviews among 15 GOAL participants to gather patients' perspectives about the role of social support in people who live with lupus. RESULTS We found a significant association between organ damage and depression ( r = 0.163, p = 0.001), as well as between depression and social support ( F = 17.574, p < 0.001). The quantitative analysis did not render social support as a significant moderator in the organ damage-depression relationship. Interviews, however, revealed that African American women with the most severe organ damage have the greatest need for support. CONCLUSIONS Social support is a key resource for lupus patients with high disease burden. Overall, these findings highlight the importance of monitoring depressive symptoms in this population and developing interventions aimed to increase social support available to lupus patients.
Collapse
Affiliation(s)
- J Jordan
- 1 Rollins School of Public Health, Atlanta, GA, United States
| | - N J Thompson
- 1 Rollins School of Public Health, Atlanta, GA, United States
| | - C Dunlop-Thomas
- 2 School of Medicine, Emory University, Atlanta, GA, United States
| | - S Sam Lim
- 2 School of Medicine, Emory University, Atlanta, GA, United States
| | - C Drenkard
- 2 School of Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
58
|
Conceição CTM, Meinão IM, Bombana JA, Sato EI. Psychoanalytic psychotherapy improves quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial. Adv Rheumatol 2019; 59:4. [PMID: 30670099 DOI: 10.1186/s42358-019-0047-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is an autoimmune disease which impairs the quality of life. The objective of study was to evaluate the effectiveness of Brief Group Psychoanalytic Psychotherapy to improve quality of life, depression, anxiety and coping strategies in SLE patients. METHODS In a randomized clinical trial, 80 female SLE patients were allocated into two groups: therapy group (n = 37) and control group (n = 43). Therapy group (TG) attended weekly psychotherapy sessions for 20 weeks; control group (CG) remained on a waiting list. Both groups received standard medical care. Questionnaires and scales were applied by blinded evaluators at baseline (T1) and after 20 weeks (T2): Socioeconomic Status, SLE International Collaborating Clinic/American College of Rheumatology-Damage Index, SLE International Disease Activity, SLE Specific Symptom Checklist, SLE Quality of life, Hospital Anxiety Depression Scale, Coping Strategies Inventory. Intent to treat intra- and inter-group analysis was performed for all variables in T1 and T2 using Qui-square, t-Student, Mann-Whitney and Wilcoxon tests. Analysis of Variance was used to compare categorical variables over time. P < 0.05 was considered significant. RESULTS The mean age of patients was 42 years; 54% were white, with mean disease duration of years 12. At baseline, both groups were homogeneous in all variables, including medications. After 20 weeks of psychotherapy TG was significantly different from CG, with lower frequency of symptoms (p = 0.001), lower level of anxiety (p = 0.019) and depression (p = 0.022), better index in five of six domains of quality of life scale (p ≤ 0.005), including total SLEQOL (p < 0.001) and with higher positive planful problem solving strategy (p = 0.017). No change in disease activity score was observed in both groups. CONCLUSIONS Psychoanalytic psychotherapy was effective to improve many domains of quality of life and one positive coping skill and to reduce SLE symptoms, anxiety and depression levels. Brief group psychotherapy can be a useful tool to complement medical care in SLE patients. TRIAL REGISTRATION Number NCT01840709 .
Collapse
Affiliation(s)
- Céu Tristão Martins Conceição
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740 - Disciplina de Reumatologia CEP 04023900, São Paulo, SP, Brazil
| | - Ivone Minhoto Meinão
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740 - Disciplina de Reumatologia CEP 04023900, São Paulo, SP, Brazil
| | - José Atilio Bombana
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Emília Inoue Sato
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740 - Disciplina de Reumatologia CEP 04023900, São Paulo, SP, Brazil.
| |
Collapse
|
59
|
Knight AM, Trupin L, Katz P, Yelin E, Lawson EF. Depression Risk in Young Adults With Juvenile- and Adult-Onset Lupus: Twelve Years of Followup. Arthritis Care Res (Hoboken) 2019; 70:475-480. [PMID: 28544568 DOI: 10.1002/acr.23290] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare major depression risk among young adults with juvenile-onset and adult-onset systemic lupus erythematosus (SLE), and to determine demographic and health-related predictors of depression. METHODS Young adults with SLE ages 18-45 years (n = 546) in the Lupus Outcomes Study completed annual telephone surveys from 2002-2015, including assessment of depression using the Center for Epidemiologic Studies Depression Scale (CES-D), and self-report measures of sociodemographics and health characteristics. Juvenile-onset SLE was defined as age <18 years at diagnosis (n = 115). Repeated-measures analysis was performed to assess the risk for major depression (CES-D ≥24) at any point in study, and logistic regression was used to assess for recurrent (present on ≥2 assessments) major depression. RESULTS Major depression was experienced by 47% of the cohort at least once during the 12-year study period. In adjusted analyses, juvenile-onset SLE patients had an increased risk of having a major depressive episode (odds ratio [OR] 1.7 [95% confidence interval (95% CI) 1.0-2.7]) and recurrent episodes (OR 2.2 [95% CI 1.2-4.3]), compared to participants with adult-onset SLE. Older age, lower educational attainment, and physical function, higher disease activity, and a history of smoking were associated with an increased depression risk. Juvenile-onset SLE patients had a higher risk of major depression across all educational groups. CONCLUSION Young adults with SLE, particularly those with juvenile-onset disease, are at high risk for major depression, which is associated with increased disease activity, poorer physical functioning, and lower educational attainment. Early depression intervention in young adults with SLE has the potential to improve both medical and psychosocial outcomes.
Collapse
Affiliation(s)
- Andrea M Knight
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | |
Collapse
|
60
|
Fábián B, Fábián AK, Bugán A, Csiki Z. Comparison of mental and physical health between patients with primary and secondary Raynaud's phenomenon Category: Article. J Psychosom Res 2019; 116:6-9. [PMID: 30654995 DOI: 10.1016/j.jpsychores.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare anxiety, depression, physical health and quality of life in patients with primary Raynaud's phenomenon (PRP) and patients with secondary Raynaud's phenomenon (SRP). METHOD Adult patients with Raynaud's phenomenon (RP) were assessed for the severity of anxiety and depressive symptoms, physical health and quality of life by using the General Anxiety Disorder Scale (GAD-7), the Beck Depression Inventory (BDI), the 12-item Short Form Health Survey: Physical Component Scale (PCS-12), and the Raynaud Specific Quality of Life Questionnaire (RQLQ), respectively. Patients with PRP and SRP were recruited for comparison at a single clinical center in Debrecen, Hungary from September to December 2017. RESULTS In total, 60 primary and 41 secondary patients with RP were studied. Gender distribution, family status, employment status and smoking were similar in the two groups. Significantly more patients with SRP had anxiety and depressive symptoms than patients with PRP. Patients with SRP had significantly higher GAD-7 and BDI; and lower overall PCS-12 and RQLQ scores than patients with PRP. CONCLUSION Anxiety and depression is more common in patients with SRP than in patients with PRP. Patients with SRP have a lower physical health condition and RP specific quality of life than patients with PRP. Anxiety, depression and quality of life impairments should be taken into account when managing all patients with RP. Further study is needed to assess whether appropriately designed interventions have the potential to reduce the mental and physical health burdens of RP on quality of life (QOL), especially in patients with SRP.
Collapse
Affiliation(s)
- Balázs Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - Anna Klaudia Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csiki
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
61
|
Yoon S, Kang DH, Choi TY. Psychiatric Symptoms in Systemic Lupus Erythematosus: Diagnosis and Treatment. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.2.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Seoyoung Yoon
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Hun Kang
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Tae Young Choi
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
62
|
Roberts AL, Kubzansky LD, Malspeis S, Feldman CH, Costenbader KH. Association of Depression With Risk of Incident Systemic Lupus Erythematosus in Women Assessed Across 2 Decades. JAMA Psychiatry 2018; 75:1225-1233. [PMID: 30208373 PMCID: PMC6583686 DOI: 10.1001/jamapsychiatry.2018.2462] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE It has long been hypothesized that depression may increase the risk of developing autoimmune disease; however, rigorous empirical evidence is sparse. OBJECTIVE To evaluate whether an association exists between depression and risk of incident systemic lupus erythematosus (SLE), a paradigmatic, systemic autoimmune disease. DESIGN, SETTING, AND PARTICIPANTS This 20-year prospective, longitudinal cohort study evaluated data collected from 2 cohorts of women participating in the Nurses' Health Study (1996-2012) and the Nurses' Health Study II (1993-2013). Data analyses were conducted from August 2017 to May 2018. MAIN OUTCOMES AND MEASURES Incident SLE with 4 or more American College of Rheumatology criteria was ascertained by self-report and confirmed by medical record review. Depression was assessed repeatedly throughout follow-up according to whether women reported having received a clinician's diagnosis of depression, regular antidepressant use, or a score of less than 60 on the 5-item Mental Health Inventory (MHI-5). Whether longitudinally assessed health risk factors (eg, cigarette smoking, body mass index, oral contraceptive use, menopause or postmenopausal hormone use, alcohol use, exercise, or diet) accounted for increased SLE risk among women with vs without depression was examined. Cox proportional hazards regression models were used to estimate risk of SLE. In addition, the association of depression lagged by 4 years, and depression status at baseline with incident SLE throughout follow-up was assessed. RESULTS Data from 194 483 women (28-93 years of age; 93% white) were included. During 20 years of follow-up, 145 cases of SLE occurred. Compared with women with no depression, women with a history of depression had a subsequent increased risk of SLE (HR, 2.67; 95% CI, 1.91-3.75; P < .001). Adjustment for body mass index, cigarette smoking, and oral contraception and postmenopausal hormone use slightly attenuated associations (adjusted HR, 2.45; 95% CI, 1.74-3.45; P < .001). The SLE risk was elevated with each of the 3 following depression indicators modeled separately: clinician's diagnosis of depression (HR, 2.19; 95% CI, 1.29-3.71), antidepressant use (HR, 2.80; 95% CI, 1.94-4.05), and MHI-5 scores indicating depressed mood (HR, 1.70; 95% CI, 1.18-2.44). Associations remained strong when depression status was lagged by 4 years with respect to the outcome (HR, 1.99; 95% CI, 1.32-3.00) and when depression status at baseline was used as the exposure (HR, 2.28; 95% CI, 1.54-3.37). CONCLUSIONS AND RELEVANCE This study contributes to increasing evidence that depression may be associated with increased risk of SLE and suggests that the association is not fully explained by measured health factors or behaviors.
Collapse
Affiliation(s)
- Andrea L. Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts,Lee Kum Sheung Center for Health and Happiness, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Malspeis
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candace H. Feldman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
63
|
Rodriguez-Zas SL, Wu C, Southey BR, O'Connor JC, Nixon SE, Garcia R, Zavala C, Lawson M, McCusker RH, Romanova EV, Sweedler JV, Kelley KW, Dantzer R. Disruption of microglia histone acetylation and protein pathways in mice exhibiting inflammation-associated depression-like symptoms. Psychoneuroendocrinology 2018; 97:47-58. [PMID: 30005281 PMCID: PMC6138522 DOI: 10.1016/j.psyneuen.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/22/2018] [Accepted: 06/29/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Peripheral immune challenge can elicit microglia activation and depression-related symptoms. The balance of inflammatory signals in the tryptophan pathway can skew the activity of indoleamine-pyrrole 2,3 dioxygenase (IDO1) towards the metabolization of tryptophan into kynurenine (rather than serotonin), and towards neuroprotective or neurotoxic metabolites. The proteome changes that accompany inflammation-associated depression-related behaviors are incompletely understood. METHODS The changes in microglia protein abundance and post-translational modifications in wild type (WT) mice that exhibit depression-like symptoms after recovery from peripheral Bacille Calmette-Guerin (BCG) challenge were studied. This WT_BGG group was compared to mice that do not express depression-like symptoms after BCG challenge due to IDO1 deficiency by means of genetic knockout (BCG_KO group), and to WT Saline-treated (Sal) mice (WT_Sal group) using a mass spectrometry-based label-free approach. RESULTS The comparison of WT_BCG relative to WT_Sal and KO_BCG mice uncovered patterns of protein abundance and acetylation among the histone families that could influence microglia signaling and transcriptional rates. Members of the histone clusters 1, 2 and 3 families were less abundant in WT_BCG relative to WT_Sal whereas members in the H2A family exhibited the opposite pattern. Irrespective of family, the majority of the histones were less abundant in WT_BCG relative to KO_BCG microglia. Homeostatic mechanisms may temper the potentially toxic effects of high histone levels after BCG challenge to levels lower than Sal. Histone acetylation was highest in WT_BCG and the similar levels observed in WT_Sal and KO_BCG. This result suggest that histone acetylation levels are similar between IDO1 deficient mice after immune challenge and unchallenged WT mice. The over-abundance of tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation proteins (14-3-3 series) in WT_BCG relative to KO_BCG is particularly interesting because these proteins activate another rate-limiting enzyme in the tryptophan pathway. The over-representation of alcoholism and systemic lupus erythematosus pathways among the proteins exhibiting differential abundance between the groups suggest that these disorders share microglia activation pathways with BCG challenge. The over-representation of phagosome pathway among proteins differentially abundant between WT_BCG and KO_BCG microglia suggest an association between IDO1 deficiency and phagocytosis. Likewise, the over-representation of the gap junction pathway among the differentially abundant proteins between KO_BCG and WT_Sal suggest a multifactorial effect of BCG and IDO1 deficiency on cell communication. CONCLUSIONS The present study of histone acetylation and differential protein abundance furthers the understanding of the long lasting effects of peripheral immune challenges. Our findings offer insights into target proteins and mechanisms that provide clues for therapies to ameliorate inflammation-associated depression-related behaviors.
Collapse
Affiliation(s)
- Sandra L Rodriguez-Zas
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Cong Wu
- Department of Biochemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bruce R Southey
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jason C O'Connor
- Department of Pharmacology, University of Texas Health San Antonio and Audie L. Murphy VA Hospital, South Texas Veterans Health System, San Antonio, TX, USA
| | - Scott E Nixon
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robmay Garcia
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Cynthia Zavala
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Marcus Lawson
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert H McCusker
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Elena V Romanova
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jonathan V Sweedler
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Keith W Kelley
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert Dantzer
- Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
64
|
Kwiatkowska B, Kłak A, Raciborski F, Maślińska M. The prevalence of depression and insomnia symptoms among patients with rheumatoid arthritis and osteoarthritis in Poland: a case control study. PSYCHOL HEALTH MED 2018; 24:333-343. [PMID: 30286609 DOI: 10.1080/13548506.2018.1529325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The objective of the study was to assess the prevalence of symptoms of depression and insomnia among patients with rheumatoid arthritis and osteoarthritis in comparison with individuals without chronic diseases. The study was carried out at National Institute of Geriatrics, Rheumatology and Rehabilitation, included 229 persons. The participants were divided into the following groups: group I - 120 patients with rheumatoid arthritis, group II - 58 patients with osteoarthritis, group III - 51 healthy individuals no confirmed depression (control group). Symptoms of depression were confirmed by a multiple-choice self-reported Beck Depression Inventory questionnaire. Symptoms of depression confirmed with depression inventory≥ 10 occurred as follows: patients with rheumatoid arthritis - 75.83%, patients with osteoarthritis - 50%, control group - 23.53% (p<0.0001), with the prevalence of insomnia (AIS≥6) at: 71%, 32% and 33%, respectively (p<0.001). In group I mean values of FIRST and AIS were 23.06 and 8.36 respectively, with group II: 21.71 and 7.84, respectively. In all subjects with AIS≥6, the depression inventory was statistically significantly (p<0.005) higher than in the subjects with AIS<6 (respectively: 17.02 vs 12.13; 15.6 vs 8.05; 5.45 vs 1.81). Patients with rheumatoid arthritis find it difficult to cope with stress. Insomnia as a reaction to stress occurs more often in this group.
Collapse
Affiliation(s)
- Brygida Kwiatkowska
- a Clinic of Early Arthritis , National Institute of Geriatrics, Rheumatology and Rehabilitation , Warsaw , Poland
| | - Anna Kłak
- b Department of Gerontology, Public Health and Didactics , National Institute of Geriatrics, Rheumatology and Rehabilitation , Warsaw , Poland
| | - Filip Raciborski
- c Department of Prevention of Environmental Hazards and Allergology , Medical University of Warsaw , Warsaw , Poland
| | - Maria Maślińska
- a Clinic of Early Arthritis , National Institute of Geriatrics, Rheumatology and Rehabilitation , Warsaw , Poland
| |
Collapse
|
65
|
Hesselvig J, Egeberg A, Kofoed K, Gislason G, Dreyer L. Increased risk of depression in patients with cutaneous lupus erythematosus and systemic lupus erythematosus: a Danish nationwide cohort study. Br J Dermatol 2018; 179:1095-1101. [DOI: 10.1111/bjd.16831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/19/2022]
Affiliation(s)
- J.H. Hesselvig
- Department of Dermatology and Allergy; Herlev and Gentofte University Hospital; Copenhagen Denmark
- CORGIS - Copenhagen Research Group for Inflammatory Skin; Herlev and Gentofte University Hospital; Copenhagen Denmark
| | - A. Egeberg
- Department of Dermatology and Allergy; Herlev and Gentofte University Hospital; Copenhagen Denmark
- CORGIS - Copenhagen Research Group for Inflammatory Skin; Herlev and Gentofte University Hospital; Copenhagen Denmark
| | - K. Kofoed
- Department of Dermatology and Allergy; Herlev and Gentofte University Hospital; Copenhagen Denmark
- CORGIS - Copenhagen Research Group for Inflammatory Skin; Herlev and Gentofte University Hospital; Copenhagen Denmark
| | - G. Gislason
- Department of Cardiology; Herlev and Gentofte University Hospital; Copenhagen Denmark
| | - L. Dreyer
- Department of Rheumatology; Herlev and Gentofte University Hospital; Copenhagen Denmark
- The Parker Institute; Bispebjerg and Frederiksberg Hospital; Frederiksberg Denmark
- Department of Clinical Medicine; Aalborg University and Aalborg University Hospital; Aalborg Denmark
- Department of Rheumatology; Aalborg University and Aalborg University Hospital; Aalborg Denmark
| |
Collapse
|
66
|
Chiang YC, Huang JL, Wang CH, Lee HC, Lee MY, Hsiao YC. Symptom clustering in patients with childhood-onset systemic lupus erythematosus. J Adv Nurs 2018; 75:54-62. [DOI: 10.1111/jan.13825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Yi-Chien Chiang
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Linkou; Taiwan
| | - Jing-Long Huang
- Department of Pediatrics; Chang Gung Memorial Hospital at Linkou; Taiwan
- School of Medicine; Chang Gung University; Taiwan
| | - Chao-Hui Wang
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
- Department of Nursing; Chang Gung University; Taiwan
| | - Hsiang-Chun Lee
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
| | - Ming-Ying Lee
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
| | - Ya-Chu Hsiao
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
- Department of Nursing; Chang Gung University; Taiwan
| |
Collapse
|
67
|
Factors of depression among patients with rheumatoid arthritis. Reumatologia 2018; 56:219-227. [PMID: 30237626 PMCID: PMC6142018 DOI: 10.5114/reum.2018.77973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives The aim of this study was to assess the correlation between symptoms of depression and the course and clinical picture of rheumatoid arthritis (RA). Material and methods 120 patients with RA were included in the study: 104 (87%) female patients and 16 (13%) male patients. All studied patients completed the following questionnaires: Beck Depression Inventory (BDI), Ford Insomnia Response to Stress Test (FIRST), Athens Insomnia Scale (AIS) and Health Assessment Questionnaire (HAQ). The serum levels of IL-1β, TNF-α, and IL-6 were measured using standard ELISA assays at the time of the first questionnaire assessment. Results Symptoms of depression were found in 91 patients (76%), including 79 (87%) women and 12 (13%) men. There were no significant differences between the prevalence of depression in women and men (p = 0.93). Symptoms of depression occurred more often in patients who were professionally inactive, compared with the professionally active patients (p = 0.04). Significant correlations was demonstrated between the value of BDI and the patient’s pain assessed by the visual analogue scale (VAS) value (r = 0.36), the disease activity assessed by the patient and the physician evaluated in millimetres on the VAS scale (r = 0.38 and r = 0.30, respectively), the number of painful and swollen joints (r = 0.22 and r = 0.26, respectively), DAS28 (r = 0.31) as well as the Health Assessment Questionnaire (HAQ) value (r = 0.46). Longer duration of the disease was observed in patients with symptoms of depression (p = 0.02). Also a significant difference in the assessment of BDI between patients treated with biological drugs and those receiving no such treatment was observed (p = 0.042). Conclusions Professional inactivity and longer disease duration are important factors influencing symptoms of depression in patients with RA. Higher values of HAQ increase the probability of the occurrence of depression symptoms. The use of biological drugs that reduce the level of proinflammatory cytokines may have a positive effect on reducing the severity of depressive symptoms.
Collapse
|
68
|
Depression as the First Manifestation in a Young Girl With Juvenile Systemic Lupus Erythematosus. Arch Rheumatol 2018; 33:105-106. [PMID: 29901024 DOI: 10.5606/archrheumatol.2018.6485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/21/2022] Open
|
69
|
Moon SJ, Kang KY, Kwok SK, Ju JH, Hong YS, Park SH, Jeon CH, Choi ST, Song JS, Min JK. Differences in quality of life determinants according to the presence of fibromyalgia in middle-aged female patients with systemic lupus erythematosus: a multicenter, cross-sectional, single-ethnicity cohort. Int J Rheum Dis 2018; 21:1173-1184. [DOI: 10.1111/1756-185x.13320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Su-Jin Moon
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Kwi Young Kang
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seung-Ki Kwok
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Ji Hyeon Ju
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Yeon-Sik Hong
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Chan Hong Jeon
- Division of Rheumatology; Department of Internal Medicine; Soonchunhyang University Bucheon Hospital; Bucheon Korea
| | - Sang Tae Choi
- Division of Rheumatology; Department of Internal Medicine; Chung-Ang University College of Medicine; Seoul Korea
| | - Jung-Soo Song
- Division of Rheumatology; Department of Internal Medicine; Chung-Ang University College of Medicine; Seoul Korea
| | - Jun-Ki Min
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| |
Collapse
|
70
|
Tenorio JDR, Figueiredo MA, Espindula A, Gallottini M, Ortega KL. An interesting case of systemic lupus erythematosus in a patient with Moebius syndrome. SPECIAL CARE IN DENTISTRY 2018; 38:112-115. [PMID: 29356035 DOI: 10.1111/scd.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moebius' syndrome (MS) is characterized by a nonprogressive facial palsy associated with impairment in eye abduction, which can be uni- or bilateral. Some authors raise the possibility that patients with MS may suffer from social stigmatism due to their facial dysmorphism and that constant teasing and bullying perpetrated by people in the same social circle are adjuvants in the development of low self-esteem, behavioral problems, and even psychiatric disorders. Psychological stress, anxiety, and depression are factors contributing to both development and impairment of autoimmune diseases, such as systemic lupus erythematosus (SLE). The objective of this work is to report the case of a patient with MS who developed SLE. In the present case report, we have emphasized the importance of both clinical dental examination and surgeon-dentist in the early diagnosis of systemic diseases by considering that these conditions can affect both syndromic and normoreactive patients.
Collapse
Affiliation(s)
| | | | - Aline Espindula
- Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Gallottini
- Department of Oral Pathology, Special Care Dentistry Centre, University of São Paulo, São Paulo, Brazil
| | - Karem López Ortega
- Department of Oral Pathology, Special Care Dentistry Centre, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
71
|
Mills SD, Azizoddin D, Gholizadeh S, Racaza GZ, Nicassio PM. The mediational role of helplessness in psychological outcomes in systemic lupus erythematosus. Lupus 2018; 27:1185-1189. [PMID: 29320976 DOI: 10.1177/0961203317751046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can result in disability and psychological distress. Although pain has been associated with depressive symptomatology and stress in SLE, a paucity of theoretical models have been used to explain the relationship between pain and psychological distress in this population. Thus, the present study examined helplessness as a mediator of the relationship between pain and psychological distress among patients with SLE. Methods Multiple mediation analysis was used to examine the hypothesis that learned helplessness mediates the relationship between pain and symptoms of anxiety, depression, and stress in a sample of patients with SLE ( N = 136) receiving medical care at Cedars Sinai Medical Center. Results The mean score on the Helplessness subscale was 14.5 ( SD = 5.4). Helplessness fully mediated the relationship between pain vitality and symptoms of anxiety (BCa 95% CI (-0.073, -0.015)), depression (BCa 95% CI (-0.502, -0.212)), and stress (BCa 95% CI (-0.063, -0.027)). Conclusion Participants reported a high level of perceived inability to control one's disease. Helplessness fully mediated the relationship between pain and measures of anxiety, depression, and perceived stress among patients with SLE.
Collapse
Affiliation(s)
- S D Mills
- 1 464916 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
| | - D Azizoddin
- 2 Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - S Gholizadeh
- 1 464916 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
| | - G Z Racaza
- 3 University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - P M Nicassio
- 4 Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
72
|
Hall LS, Adams MJ, Arnau-Soler A, Clarke TK, Howard DM, Zeng Y, Davies G, Hagenaars SP, Maria Fernandez-Pujals A, Gibson J, Wigmore EM, Boutin TS, Hayward C, Scotland G, Porteous DJ, Deary IJ, Thomson PA, Haley CS, McIntosh AM. Genome-wide meta-analyses of stratified depression in Generation Scotland and UK Biobank. Transl Psychiatry 2018; 8:9. [PMID: 29317602 PMCID: PMC5802463 DOI: 10.1038/s41398-017-0034-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/28/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
Few replicable genetic associations for Major Depressive Disorder (MDD) have been identified. Recent studies of MDD have identified common risk variants by using a broader phenotype definition in very large samples, or by reducing phenotypic and ancestral heterogeneity. We sought to ascertain whether it is more informative to maximize the sample size using data from all available cases and controls, or to use a sex or recurrent stratified subset of affected individuals. To test this, we compared heritability estimates, genetic correlation with other traits, variance explained by MDD polygenic score, and variants identified by genome-wide meta-analysis for broad and narrow MDD classifications in two large British cohorts - Generation Scotland and UK Biobank. Genome-wide meta-analysis of MDD in males yielded one genome-wide significant locus on 3p22.3, with three genes in this region (CRTAP, GLB1, and TMPPE) demonstrating a significant association in gene-based tests. Meta-analyzed MDD, recurrent MDD and female MDD yielded equivalent heritability estimates, showed no detectable difference in association with polygenic scores, and were each genetically correlated with six health-correlated traits (neuroticism, depressive symptoms, subjective well-being, MDD, a cross-disorder phenotype and Bipolar Disorder). Whilst stratified GWAS analysis revealed a genome-wide significant locus for male MDD, the lack of independent replication, and the consistent pattern of results in other MDD classifications suggests that phenotypic stratification using recurrence or sex in currently available sample sizes is currently weakly justified. Based upon existing studies and our findings, the strategy of maximizing sample sizes is likely to provide the greater gain.
Collapse
Affiliation(s)
- Lynsey S. Hall
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK ,0000 0001 0462 7212grid.1006.7Institute of Genetic Medicine, Newcastle University, NE1 7RU Newcastle upon Tyne, UK
| | - Mark J. Adams
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - Aleix Arnau-Soler
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Toni-Kim Clarke
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - David M. Howard
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - Yanni Zeng
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Gail Davies
- 0000 0004 1936 7988grid.4305.2Department of Psychology, University of Edinburgh, EH8 9YL Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Saskia P. Hagenaars
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Department of Psychology, University of Edinburgh, EH8 9YL Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Ana Maria Fernandez-Pujals
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - Jude Gibson
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - Eleanor M. Wigmore
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK
| | - Thibaud S. Boutin
- 0000 0004 1936 7988grid.4305.2Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Caroline Hayward
- 0000 0004 1936 7988grid.4305.2Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK ,A collaboration between the University Medical Schools and National Health Service in Aberdeen, Dundee, Edinburgh and Glasgow UK
| | - Generation Scotland
- A collaboration between the University Medical Schools and National Health Service in Aberdeen, Dundee, Edinburgh and Glasgow UK
| | | | - David J. Porteous
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Ian J. Deary
- 0000 0004 1936 7988grid.4305.2Department of Psychology, University of Edinburgh, EH8 9YL Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Pippa A. Thomson
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Chris S. Haley
- 0000 0004 1936 7988grid.4305.2Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Andrew M. McIntosh
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, EH10 5HF Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK
| |
Collapse
|
73
|
Lentine KL, Naik AS, Ouseph R, Zhang Z, Axelrod DA, Segev DL, Dharnidharka VR, Brennan DC, Randall H, Gadi R, Lam NN, Hess GP, Kasiske BL, Schnitzler MA. Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study. Transpl Int 2018; 31:20-31. [PMID: 28771882 PMCID: PMC6334638 DOI: 10.1111/tri.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/11/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Abstract
We examined a novel database wherein national US transplant registry identifiers were linked to records from a large pharmaceutical claims warehouse (2008-2015) to characterize antidepressant use before and after kidney transplantation, and associations [adjusted hazard ratio (aHR) 95% CI] with death and graft failure. Among 72 054 recipients, 12.6% filled antidepressant medications in the year before transplant, and use was more common among women and patients who were white, unemployed, and had limited functional status. Pre-transplant antidepressant use was associated with 39% higher 1-year mortality (aHR 1.39, 95% CI 1.18-1.64) and 15% higher all-cause graft loss risk (aHR 1.15, 95% CI 1.02-1.30). More than 50% of patients who filled antidepressants pre-transplant continued fill post-transplant. Antidepressant use in the first year after transplant was associated with twofold higher risk of death (aHR 1.94, 95% CI 1.60-2.35), 38% higher risk of death-censored graft failure, and 61% higher risk of all-cause graft failure in the subsequent year. Pre-listing antidepressant use was also associated with increased mortality, but transplantation conferred a survival benefit regardless of prelisting antidepressant use status. While associations may in part reflect underlying behaviors or comorbidities, kidney transplant candidates and recipients treated with antidepressant medications should be monitored and supported to reduce the risk of adverse outcomes.
Collapse
Affiliation(s)
- Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis
University School of Medicine, St. Louis, MO, USA
- Division of Nephrology, Department of Medicine, Saint Louis
University School of Medicine, St. Louis, MO, USA
| | - Abhijit S Naik
- Division of Nephrology, Department of Medicine, University
of Michigan, Ann Arbor, MI
| | - Rosemary Ouseph
- Center for Abdominal Transplantation, Saint Louis
University School of Medicine, St. Louis, MO, USA
- Division of Nephrology, Department of Medicine, Saint Louis
University School of Medicine, St. Louis, MO, USA
| | - Zidong Zhang
- Center for Abdominal Transplantation, Saint Louis
University School of Medicine, St. Louis, MO, USA
| | - David A. Axelrod
- Division of Abdominal Transplantation, Department of
Surgery, Brody School of Medicine, Greenville, NC, USA
| | - Dorry L. Segev
- Division of Transplantation, Department of Surgery, Johns
Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Daniel C. Brennan
- Transplant Nephrology, Washington University School of
Medicine, St. Louis, MO, USA
| | - Henry Randall
- Center for Abdominal Transplantation, Saint Louis
University School of Medicine, St. Louis, MO, USA
| | - Raj Gadi
- Division of Nephrology, Department of Medicine, Saint Louis
University School of Medicine, St. Louis, MO, USA
| | - Ngan N. Lam
- Division of Nephrology, University of Alberta, Edmonton,
AB, Canada
| | - Gregory P. Hess
- Symphony Health, Conshohocken, PA, USA
- Leonard Davis Institute for Health Economics, University of
Pennsylvania, Philadelphia PA, USA
| | - Bertram L. Kasiske
- Division of Nephrology, Hennepin County Medical Center,
Minneapolis, MN, USA
| | - Mark A. Schnitzler
- Center for Abdominal Transplantation, Saint Louis
University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
74
|
Mccormick N, Trupin L, Yelin EH, Katz PP. Socioeconomic Predictors of Incident Depression in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 70:104-113. [PMID: 28371529 DOI: 10.1002/acr.23247] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess different measures of socioeconomic status (SES) as predictors of incident depression among women with systemic lupus erythematosus (SLE). METHODS Data were derived from the 2010-2015 waves of the Lupus Outcomes Study, where individuals with confirmed SLE were interviewed annually by telephone. Depression was assessed using the Center for Epidemiologic Studies Depression Scale, using a validated lupus-specific cutoff (≥23) for major depressive disorder. Women interviewed in ≥2 consecutive waves, with scores <23 in the first wave (T1), were included. The level of financial strain was classified as high, moderate, or none based on responses to 3 questions. Generalized estimating equations were used to assess the impact of poverty status, income, education, and financial strain at T1 on the risk of incident depression the next year (T2), with adjustment for sociodemographic and disease status measures. Individuals could contribute more than one 2-year dyad to the analysis. RESULTS In total, 682 women contributed 2,097 observations, with 19% having high financial strain, 47% moderate strain, and 34% no strain. There were 166 women who had 184 episodes of incident depression (rate = 8.8/100 person-years). In bivariate analysis, poverty, lower income and education, disease activity, and high financial strain were associated with depression onset; race/ethnicity was not. Poverty, income, and education were not significant in multivariate analyses, but disease activity and high financial strain were (odds ratio 1.85 [95% confidence interval 1.06-3.23]). CONCLUSION High financial strain was a significant predictor of new-onset depression in women with SLE, controlling for disease factors and other SES measures. Determining specific, modifiable sources of financial strain may help prevent the development of depression.
Collapse
Affiliation(s)
- Natalie Mccormick
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
| | | | | | | |
Collapse
|
75
|
Buji RI, Abdul Murad NA, Chan LF, Maniam T, Mohd Shahrir MS, Rozita M, Shamsul AS, Mohamad Hussain R, Abdullah N, Jamal R, Nik Jaafar NR. Suicidal ideation in systemic lupus erythematosus: NR2A gene polymorphism, clinical and psychosocial factors. Lupus 2017; 27:744-752. [PMID: 29161964 DOI: 10.1177/0961203317742711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Systemic lupus erythematosus (SLE) patients are a high-risk population for suicide. Glutamatergic neurosystem genes have been implicated in the neurobiology of depression in SLE and suicidal behaviour in general. However, the role of glutamate receptor gene polymorphisms in suicidal behaviour among SLE patients remains unclear in the context of established clinical and psychosocial factors. We aimed to investigate the association of NR2A gene polymorphism with suicidal ideation in SLE while accounting for the interaction between clinical and psychosocial factors. Methods A total of 130 SLE patients were assessed for mood disorders (MINI International Neuropsychiatric Interview), severity of depression (Patient Health Questionnaire-9), suicidal behaviour (Columbia-Suicide Severity Rating Scale), socio-occupational functioning (Work and Social Adjustment Scale), recent life events (Social Readjustment Rating Scale) and lupus disease activity (SELENA-SLE Disease Activity Index). Eighty-six out of the 130 study participants consented for NR2A genotyping. Results Multivariable logistic regression showed nominal significance for the interaction effect between the NR2A rs2072450 AC genotype and higher severity of socio-occupational impairment with lifetime suicidal ideation in SLE patients ( p = 0.038, odds ratio = 1.364, 95% confidence interval = 1.018-1.827). However, only the association between lifetime mood disorder and lifetime suicidal ideation remained significant after Bonferroni correction ( p < 0.001, odds ratio = 33.834, 95% confidence interval = 7.624-150.138). Conclusions Lifetime mood disorder emerged as a more significant factor for suicidal ideation in SLE compared with NR2A gene polymorphism main and interaction effects. Clinical implications include identification and treatment of mood disorders as an early intervention for suicidal behaviour in SLE. More adequately-powered gene-environment interaction studies are required in the future to clarify the role of glutamate receptor gene polymorphisms in the risk stratification of suicidal behaviour among SLE patients.
Collapse
Affiliation(s)
- R I Buji
- 1 Hospital Mesra Bukit Padang, Kota Kinabalu, Sabah, Malaysia
| | - N A Abdul Murad
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - L F Chan
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - T Maniam
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.,7 Mind Faculty, Mont Kiara, Kuala Lumpur, Malaysia
| | - M S Mohd Shahrir
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - M Rozita
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - A S Shamsul
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,5 Department of Community Health, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - R Mohamad Hussain
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - N Abdullah
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - R Jamal
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,6 Department of Pediatrics, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - N R Nik Jaafar
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| |
Collapse
|
76
|
Roberts AL, Malspeis S, Kubzansky LD, Feldman CH, Chang SC, Koenen KC, Costenbader KH. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women. Arthritis Rheumatol 2017; 69:2162-2169. [PMID: 28929625 DOI: 10.1002/art.40222] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/20/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To conduct the first longitudinal study examining whether trauma exposure and posttraumatic stress disorder (PTSD) are associated with increased risk of incident systemic lupus erythematosus (SLE) in a civilian cohort. METHODS We examined the association of trauma exposure and PTSD symptoms with SLE incidence over 24 years of follow-up in a US longitudinal cohort of women (n = 54,763). Incident SLE in women meeting ≥4 American College of Rheumatology criteria was ascertained by self-report and confirmed by medical record review. PTSD and trauma exposure were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD and the Brief Trauma Questionnaire, respectively. Women were categorized as having no trauma, trauma and no PTSD symptoms, subclinical PTSD (1-3 symptoms), or probable PTSD (4-7 symptoms). We examined whether longitudinally assessed health risk factors (e.g., smoking, body mass index [BMI], oral contraceptive use) accounted for increased SLE risk among women with trauma exposure and PTSD versus those without. RESULTS During follow-up, 73 cases of SLE occurred. Compared to women with no trauma, probable PTSD was associated with increased SLE risk (for 4-7 symptoms, hazard ratio [HR] 2.94 [95% confidence interval {95% CI} 1.19-7.26], P < 0.05). Subclinical PTSD was associated with increased SLE risk, although this did not reach statistical significance (for 1-3 symptoms, HR 1.83 [95% CI 0.74-4.56], P = 0.19). Smoking, BMI, and oral contraceptive use slightly attenuated the associations (e.g., for 4-7 symptoms, adjusted HR 2.62 [95% CI 1.09-6.48], P < 0.05). Trauma exposure, regardless of PTSD symptoms, was strongly associated with incident SLE (HR 2.83 [95% CI 1.29-6.21], P < 0.01). CONCLUSION This study contributes to growing evidence that psychosocial trauma and associated stress responses may lead to autoimmune disease.
Collapse
Affiliation(s)
- Andrea L Roberts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Malspeis
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Karestan C Koenen
- Harvard T. H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
77
|
Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus. Rheumatol Int 2017; 37:1999-2004. [DOI: 10.1007/s00296-017-3819-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
|
78
|
Alsowaida N, Alrasheed M, Mayet A, Alsuwaida A, Omair MA. Medication adherence, depression and disease activity among patients with systemic lupus erythematosus. Lupus 2017; 27:327-332. [PMID: 28825347 DOI: 10.1177/0961203317725585] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Medication non-adherence is an important cause of treatment failure among patients with systemic lupus erythematosus (SLE). Depression is a common neuropsychiatric disorder associated with SLE. The aims of this study are to assess the prevalence of both medication non-adherence and depressed mood among Saudi patients with SLE by using validated tools and to explore the impact of both depressive symptoms and disease activity on medication non-adherence. Methods A cross-sectional study was conducted in outpatients with SLE. Medication non-adherence was assessed by using the Morisky Medication Adherence Scale, and the severity of depressed mood was evaluated with the Beck's Depression Inventory. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Multiple logistic regression models were used to identify the multivariate predictors of medication non-adherence. Results Out of 140 patients, 134 (95.7%) were females with a mean (±SD) age of 35.6 (±11.3) years and a disease duration of 8.8 (±6.7) years. Medication non-adherence and depressed mood were detected in 62.1% and 35% of the patients, respectively. A moderate or severe depressed mood was significantly associated with medication non-adherence ( p = 0.04). There was a significant correlation between disease activity and the severity of depressed mood ( r = 0.31, p = 0.003). Disease activity did not correlate with medication non-adherence. Logistic regression demonstrated that moderate-to-severe depressed mood increased the probability of medication non-adherence (OR 2.62; 1.02-6.71). Conclusion Medication non-adherence and depressive symptoms are highly prevalent among Saudi SLE patients. Routine screening could facilitate the early detection and management of depression and medication adherence.
Collapse
Affiliation(s)
- N Alsowaida
- 1 Pharmacy Services, 37850 King Saud University Medical City, Riyadh, Saudi Arabia
| | - M Alrasheed
- 2 College of Pharmacy, 37850 King Saud University , Riyadh, Saudi Arabia
| | - A Mayet
- 3 Department of Clinical Pharmacy, College of Pharmacy, 37850 King Saud University , Riyadh, Saudi Arabia
| | - A Alsuwaida
- 4 Division of Nephrology, Department of Medicine, College of Medicine, 37850 King Saud University , Riyadh, Saudi Arabia
| | - M A Omair
- 5 Division of Rheumatology, Department of Medicine, College of Medicine, 37850 King Saud University , Riyadh, Saudi Arabia
| |
Collapse
|
79
|
Al-Homood IA, Omran NE, Alwahibi AS, Aldosoghy M, Alharthy A, Aljohani GS. Depression in Patients with Systemic Lupus Erythematosus: A Multicenter Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:248-253. [PMID: 30787797 PMCID: PMC6298309 DOI: 10.4103/sjmms.sjmms_79_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and Objective: Neuropsychiatric disorders including depression are common clinical manifestations of systemic lupus erythematosus (SLE). Depression in patients with SLE is under-recognized, although it is a treatable clinical entity. The present study aimed to determine the prevalence of depression and identify the relationship between depression and SLE disease characteristics. Patients and Methods: This multicenter cross-sectional study was conducted in the rheumatology clinics of four tertiary referral hospitals in Saudi Arabia between April and September 2014. Patients' demographic data and SLE disease characteristics such as disease duration, severity and drug treatments were collected. A validated Arabic Beck Depression Inventory (BDI) score was used to estimate the prevalence of depression. Results: A total of 68 patients with SLE (64 women, 4 men) were enrolled in the study. Forty-six (67.6%) patients were found to have BDI scores indicating depression; of them, only four patients (8.7%) were receiving antidepressant treatments. Higher prevalence of depression was associated with steroid treatment (P = 0.046). Conclusions: The study results revealed high prevalence of depression among Saudi patients with SLE. Most of the study population were not adequately treated, suggesting inadequate recognition and treatment of depression in SLE.
Collapse
Affiliation(s)
| | - Narges E Omran
- Department of Internal Medicine, Al Noor Specialist Hospital, Mecca, Kingdom of Saudi Arabia
| | - Abdulrahman S Alwahibi
- Department of Psychiatry, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Maha Aldosoghy
- Department of Internal Medicine, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Amal Alharthy
- Department of Internal Medicine, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ghassan S Aljohani
- Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
80
|
Macêdo EA, Appenzeller S, Costallat LTL. Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Lupus 2017; 27:179-189. [PMID: 28587586 DOI: 10.1177/0961203317713142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.
Collapse
Affiliation(s)
- E A Macêdo
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| |
Collapse
|
81
|
Saito T, Tamura M, Chiba Y, Katsuse O, Suda A, Kamada A, Ikura T, Abe K, Ogawa M, Minegishi K, Yoshimi R, Kirino Y, Ihata A, Hirayasu Y. Regional cerebral glucose metabolism in systemic lupus erythematosus patients with major depressive disorder. J Neurol Sci 2017; 379:127-130. [PMID: 28716225 DOI: 10.1016/j.jns.2017.05.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Depression is frequently observed in patients with systemic lupus erythematosus (SLE). Neuropsychiatric SLE (NPSLE) patients often exhibit cerebral hypometabolism, but the association between cerebral metabolism and depression remains unclear. To elucidate the features of cerebral metabolism in SLE patients with depression, we performed brain 18F-fluoro-d-glucose positron emission tomography (FDG-PET) on SLE patients with and without major depressive disorder. METHODS We performed brain FDG-PET on 20 SLE subjects (5 male, 15 female). The subjects were divided into two groups: subjects with major depressive disorder (DSLE) and subjects without major depressive disorder (non-DSLE). Cerebral glucose metabolism was analyzed using the three-dimensional stereotactic surface projection (3D-SSP) program. Regional metabolism was evaluated by stereotactic extraction estimation (SEE), in which the whole brain was divided into segments. RESULTS Every SLE subject exhibited cerebral hypometabolism, in contrast to the normal healthy subjects. Regional analysis revealed a significantly lower ER in the left medial frontal gyrus (p=0.0055) and the right medial frontal gyrus (p=0.0022) in the DSLE group than in the non-DSLE group. CONCLUSION Hypometabolism in the medial frontal gyrus may be related to major depressive disorder in SLE. Larger studies are needed to clarify this relationship.
Collapse
Affiliation(s)
- Tomoyuki Saito
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Maasa Tamura
- Department of Stem Cell and Immune Regulation, Yokohama City University School of Medicine, Japan
| | - Yuhei Chiba
- Department of Psychiatry, Yokohama City University School of Medicine, Japan.
| | - Omi Katsuse
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Ayuko Kamada
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Takahiro Ikura
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Kie Abe
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Matsuyoshi Ogawa
- Department of Radiology, Yokohama City University School of Medicine, Japan
| | - Kaoru Minegishi
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University School of Medicine, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University School of Medicine, Japan
| | - Atsushi Ihata
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| |
Collapse
|
82
|
O'Dwyer T, Durcan L, Wilson F. Exercise and physical activity in systemic lupus erythematosus: A systematic review with meta-analyses. Semin Arthritis Rheum 2017; 47:204-215. [PMID: 28477898 DOI: 10.1016/j.semarthrit.2017.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/05/2017] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE) associates with enhanced cardiovascular (CV) risk frequently unexplained by traditional risk factors. Physical inactivity, common in SLE, likely contributes to the burden of CV risk and may also be a factor in co-morbid chronic fatigue. This systematic review evaluates whether exercise has a deleterious effect on disease activity in SLE, and explores effects on CV function and risk factors, physical fitness and function and health-related measures. MATERIALS AND METHODS A systematic review, with meta-analyses, was conducted; quasi-randomised and randomised controlled trials in SLE comparing at least one exercise group to controls were included. MEDLINE/PubMed, EMBASE, PEDro, AMED, CINAHL, The Cochrane Central Register of Controlled Trials, and relevant conference abstracts were searched. Random-effects meta-analyses were used to pool extracted data as mean differences. Heterogeneity was evaluated with χ2 test and I2, with p < 0.05 considered significant. RESULTS The search identified 3068 records, and 31 full-texts were assessed for eligibility. Eleven studies, including 469 participants, were included. Overall risk of bias of these studies was unclear. Exercise interventions were reported to be safe, while adverse effects were rare. Meta-analyses suggest that exercise does not adversely affect disease activity, positively influences depression, improves cardiorespiratory capacity and reduces fatigue, compared to controls. Exercise programmes had no significant effects on CV risk factors compared to controls. CONCLUSION Therapeutic exercise programmes appear safe, and do not adversely affect disease activity. Fatigue, depression and physical fitness were improved following exercise-based interventions. A multimodal approach may be suggested, however the optimal exercise protocol remains unclear.
Collapse
Affiliation(s)
- Tom O'Dwyer
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Laura Durcan
- Division of Rheumatology, University of Washington, Seattle, WA
| | - Fiona Wilson
- Discipline of Physiotherapy, Trinity College, Dublin, Ireland
| |
Collapse
|
83
|
Zheng Q, Xu MJ, Cheng J, Chen JM, Zheng L, Li ZG. Serum levels of brain-derived neurotrophic factor are associated with depressive symptoms in patients with systemic lupus erythematosus. Psychoneuroendocrinology 2017; 78:246-252. [PMID: 28237708 DOI: 10.1016/j.psyneuen.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/26/2016] [Accepted: 12/03/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to explore potential relationships between serum BDNF levels and depression in systemic lupus erythematosus (SLE) patients. METHODS We included 208 consecutive SLE patients and 100 age-and sex-matched healthy controls. The presence of depressive symptoms was determined through the Beck Depression Inventory-II (BDI-II) score. RESULTS The serum BDNF levels were significantly (P<0.0001) higher in SLE patients as compared to normal controls. There was a negative correlation between levels of BDNF and the SLE disease activity index 2000 (SLEDAI-2K) (r=-0.349, P<0.0001). Depression (defined as BDI-II score≥18) was identified in 54 SLE patients (26.0%, 95%CI: 20%-31.9%). The serum BDNF levels were significantly lower in depression patients at the time of admission as compared with patients without depression [27.6(IQR, 23.2-30.4)ng/ml vs. 36.2(IQR, 31.7-42.3)ng/ml; P<0.0001]. Compared with the first quartile of serum BDNF levels, the second quartile OR for depression was 0.72 (95% CI, 0.61-0.80, P=0.033). For the third and fourth quartiles, it was 0.42 (95% CI, 0.33-0.52, P=0.002) and 0.16 (95% CI, 0.09-0.24; P<0.001). CONCLUSION Serum BDNF levels are decreased in SLE patients with depressive symptoms. In SLE, serum BNDF levels are independently associated with depressive disorders, suggesting the role of neurotrophic factors in depression.
Collapse
Affiliation(s)
- Qing Zheng
- Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Ming-Jun Xu
- Health Science Center, University of Sydney, Sydney, Australia
| | - Jing Cheng
- Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jun-Min Chen
- Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ling Zheng
- Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhan-Guo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.
| |
Collapse
|
84
|
Zamora-Racaza G, Azizoddin DR, Ishimori ML, Ormseth SR, Wallace DJ, Penserga EG, Sumner L, Ayeroff J, Draper T, Nicassio PM, Weisman MH. Role of psychosocial reserve capacity in anxiety and depression in patients with systemic lupus erythematosus. Int J Rheum Dis 2017; 21:850-858. [PMID: 28261991 DOI: 10.1111/1756-185x.13033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine the relationship between reserve capacity measures and anxiety/depression among patients with systemic lupus erythematosus (SLE) from Southern California (SoCal), United States and Manila, Philippines. METHODS A total of 235 participants with SLE completed self-reported scales to assess anxiety/depression and psychosocial reserve capacity measures (self-esteem, optimism, personal mastery/coping skills, social support), socioeconomic status (SES) data, and Mexican SLE Disease Activity Index. Statistical analyses included independent sample t-tests, Chi-square, and point-biserial and Pearson correlations. RESULTS Overall, participants from Manila reported lower SES than SoCal participants. Over half of Manila and SoCal participants (69% and 59.1%, respectively) reported high anxiety scores. SoCal participants had higher depression scores than Filipinos (66%, 27%, respectively, P < 0.001) despite appearing to be more resilient by exhibiting higher scores for all reserve capacity measures (P < 0.001). Participants with low self-esteem scores from both groups had higher anxiety and depression scores. SoCal participants who reported lower optimism, lower personal mastery and lower social support were more anxious and depressed, while Filipinos low on these three variables reported less depressive symptoms. CONCLUSION Reduced psychosocial reserve capacity in individuals leads to vulnerabilities that may ultimately result in greater disease burden and psychological distress. Low self-esteem, optimism, coping and social support were associated with depression and low self-esteem was associated with anxiety for both groups. Despite the Filipino cohort's lower reserve capacity and SES, Filipino patients exhibited less depression than their SoCal counterparts, suggesting that other factors may protect them from experiencing depression.
Collapse
Affiliation(s)
- Geraldine Zamora-Racaza
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Desiree R Azizoddin
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - Mariko L Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sarah R Ormseth
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine UCLA, Los Angeles, California, USA
| | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ester G Penserga
- Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Lekeisha Sumner
- Department of Psychology, Alliant University, Alhambra, California, USA
| | - Julia Ayeroff
- Post-baccalaureate Premedical Program, University of Southern California, Los Angeles, California, USA
| | - Taylor Draper
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - Perry M Nicassio
- Cousins Center for Psychoneuroimmunology, University of California Los Angeles, Los Angeles, California, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
85
|
Alvarenga-Filho H, Salles M, Hygino J, Ferreira TB, Sacramento PM, Monteiro C, Vasconcelos CCF, Alvarenga RMP, Bento CA. Fatigue favors in vitro Th1 and Th17-like cell expansion and reduces corticoid sensitivity in MS patients. J Neuroimmunol 2017; 303:81-89. [DOI: 10.1016/j.jneuroim.2016.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/29/2016] [Accepted: 12/20/2016] [Indexed: 12/28/2022]
|
86
|
Brundin L, Bryleva EY, Thirtamara Rajamani K. Role of Inflammation in Suicide: From Mechanisms to Treatment. Neuropsychopharmacology 2017; 42:271-283. [PMID: 27377015 PMCID: PMC5143480 DOI: 10.1038/npp.2016.116] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
Suicidal behavior is complex and manifests because of a confluence of diverse factors. One such factor involves dysregulation of the immune system, which has been linked to the pathophysiology of suicidal behavior. This review will provide a brief description of suicidality and discuss the contribution of upstream and downstream factors in the etiology of suicidal behavior, within the contextual framework of inflammation. The contribution of inflammatory conditions such as traumatic brain injury, autoimmune disorders, and infections to neuropsychiatric symptoms and suicidality is only beginning to be explored. We will summarize studies of inflammation in the etiology of suicide, and provide a neurobiological basis for different mechanisms by which inflammation might contribute to the pathophysiology. Finally, we will review treatments that affect upstream and downstream pathways related to inflammation in suicidality.
Collapse
Affiliation(s)
- Lena Brundin
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Elena Y Bryleva
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Keerthi Thirtamara Rajamani
- Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA,Department of Behavioral Medicine, Laboratory of Behavioral Medicine, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI 49503, USA, Tel:+1 616 234 5321, Fax: +1 616 234 5180, E-mail:
| |
Collapse
|
87
|
Alessi H, Dutra LA, Braga Neto P, Pedroso JL, Toso FF, Kayser C, Barsottini OGP. Neuropsychiatric Lupus in clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:1021-1030. [DOI: 10.1590/0004-282x20160150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.
Collapse
Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Estadual do Ceará, Brasil; Universidade Federal do Ceará, Brasil
| | | | | | | | | |
Collapse
|
88
|
Son MB, Sergeyenko Y, Guan H, Costenbader KH. Disease activity and transition outcomes in a childhood-onset systemic lupus erythematosus cohort. Lupus 2016; 25:1431-1439. [PMID: 27013665 PMCID: PMC5035166 DOI: 10.1177/0961203316640913] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The chronicity and severity of childhood-onset systemic lupus erythematosus (cSLE) necessitate effective transition from pediatric to adult providers. We studied transition outcomes in a cSLE cohort. Methods We identified patients at an adult lupus clinic diagnosed with SLE ≤ 18 years who had been followed by a pediatric rheumatologist. Data extracted from the first three years in adult care ("post-transition period") included: sociodemographics, depression, anxiety, SLE manifestations, SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC) scores, non-adherence, and gaps in care (no appointments in the recommended time frame). Multivariable logistic regression analyses for predictors of: (1) time between pediatric and adult providers, (2) gaps in care, (3) unscheduled utilization (emergency department visits and admissions) (4) depression and/or anxiety were performed, as was a multivariable Poisson regression analysis for number of missed appointments. Results In 50 patients, SLEDAI scores were stable (mean 5.7 ± 5.0 at start vs. 4.7 ± 4.8 at year 3, p = 0.2), but SLICC scores increased (0.46 ± 0.84, vs. 0.78 ± 1.25, p = 0.01). Depression and anxiety increased significantly (10% vs. 26%, p = 0.02). Mean time from last pediatric to first adult provider visit was almost nine months (253 ± 392 days). Nearly 75% of patients had ≥ 1 gap in care. White race, low education level and non-adherence were significantly associated with missed appointments. Conclusion Despite moderate disease activity in this cSLE transition cohort, prolonged time between pediatric and adult providers and gaps in care in the post-transition period occurred. Anxiety and depression were frequently reported. Future work should identify methods to improve transition.
Collapse
Affiliation(s)
- M B Son
- 1 Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Y Sergeyenko
- 2 University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Guan
- 3 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - K H Costenbader
- 3 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
89
|
Depressive and Anxiety Disorders in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations. J Immunol Res 2016; 2016:2829018. [PMID: 27747246 PMCID: PMC5056298 DOI: 10.1155/2016/2829018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/31/2016] [Indexed: 11/17/2022] Open
Abstract
Depressive and anxiety disorders are frequently observed in patients with Systemic Lupus Erythematosus (SLE). However, the underlying mechanisms are still unknown. We conducted this survey to understand the prevalence of depression and anxiety in SLE patients without major neuropsychiatric manifestations (non-NPSLE) and to explore the relationship between emotional disorders, symptoms, autoantibodies, disease activity, and treatments in SLE. 176 SLE patients were included, and SLE disease activity index (SLEDAI), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were recorded to evaluate their disease activity and emotional status. We found that depressive and anxiety disorders were common among SLE patients: 121 (68.8%) patients were in depression status while 14 (8.0%) patients could be diagnosed with depression. Accordingly, 101 (57.4%) were in anxiety status and 21 (11.9%) could be diagnosed with anxiety. Depression was associated with disease activity, and anxiety was associated with anti-P0 antibody, while both of them were associated with proteinuria. HAMA and HAMD scores were in strong positive correlation and they were independent risk factors of each other. We concluded that the high prevalence of depression and anxiety and the association between depression and SLE disease activity might reveal the covert damage of central nervous system in SLE. The role of anti-P0 antibody in SLE patients with emotional disorders warrants more researches.
Collapse
|
90
|
Lupus brain fog: a biologic perspective on cognitive impairment, depression, and fatigue in systemic lupus erythematosus. Immunol Res 2016; 63:26-37. [PMID: 26481913 DOI: 10.1007/s12026-015-8716-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cognitive disturbances, mood disorders and fatigue are common in SLE patients with substantial adverse effects on function and quality of life. Attribution of these clinical findings to immune-mediated disturbances associated with SLE remains difficult and has compromised research efforts in these areas. Improved understanding of the role of the immune system in neurologic processes essential for cognition including synaptic plasticity, long term potentiation and adult neurogenesis suggests multiple potential mechanisms for altered central nervous system function associated with a chronic inflammatory illness such as SLE. This review will focus on the biology of cognition and neuroinflammation in normal circumstances and potential biologic mechanisms for cognitive impairment, depression and fatigue attributable to SLE.
Collapse
|
91
|
Xie X, Wu D, Chen H. Prevalence and risk factors of anxiety and depression in patients with systemic lupus erythematosus in Southwest China. Rheumatol Int 2016; 36:1705-1710. [PMID: 27580610 DOI: 10.1007/s00296-016-3559-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/25/2016] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) patients have high risk for anxiety and depression. We aimed to investigate the prevalence and risk factors of anxiety and depression in SLE patients in Southwest China. Participants were recruited by convenience sampling from Rheumatic Outpatient Clinic of West China Hospital Sichuan University between August and October 2014. The prevalence of anxiety and depression was evaluated using Hospital Anxiety and Depression Scale (HADS). Risk factors were explored by multiple logistic regression analyses. A total of 352 participants were enrolled, of who 64 (18.2 %) met the HADS criteria for anxiety and 82 (23.3 %) for depression. In multivariable analysis, higher levels of pain (OR = 1.17, P = 0.02) and fatigue (OR = 1.19, P < 0.01) predicted a higher risk of anxiety. Similarly, a higher level of fatigue (OR = 1.2, P < 0.01) was associated with a higher risk of depression. The results suggest that anxiety and depression are common in patients with SLE in Southwest China. Health care providers and SLE patients should take some measures to cope with them as early as possible. Strengthening management of pain and fatigue may be useful. But further studies are needed to verify these findings.
Collapse
Affiliation(s)
- Xia Xie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei Wu
- Pain Management Ward of West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
92
|
The diagnosis and clinical management of the neuropsychiatric manifestations of lupus. J Autoimmun 2016; 74:41-72. [PMID: 27427403 DOI: 10.1016/j.jaut.2016.06.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Abstract
Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.
Collapse
|
93
|
Macêdo EA, Appenzeller S, Costallat LTL. Gender differences in systemic lupus erythematosus concerning anxiety, depression and quality of life. Lupus 2016; 25:1315-27. [DOI: 10.1177/0961203316638934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Several studies have demonstrated a high prevalence of depression and anxiety in patients with systemic lupus erythematosus (SLE); however, few data address gender differences regarding these manifestations. This study aimed to investigate gender differences in the prevalence of depressive and anxiety symptoms, and their effect on the quality of life (QOL) of male and female SLE patients. This study included 54 male SLE patients, 54 female SLE patients, 54 male controls and 54 female controls. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale (HADS); the anxiety symptoms were examined using HADS. We used the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to assess QOL. Depressive symptoms were found in 22.2% of BDI respondents, 24.1% of CES-D respondents and 13% of HADS-D respondents who were male SLE patients; while in the female SLE patient group, they were found in 38.9% of BDI respondents ( p = 0.063), 51.9% of CES-D respondents ( p = 0.653) and 31.5% of HADS-D respondents ( p = 0.003). Anxiety symptoms were found in 16.7% of the male SLE patients and 38.9% of the female SLE patients ( p = 0.024). Lower scores on the SF-36 (for QOL) were found in both male and female SLE patients with depression and anxiety symptoms. In conclusion, we observed significant gender differences regarding the prevalence of depressive and anxiety symptoms in patients with SLE, with significantly higher values in the female group. The presence of these symptoms appears to have a negative effect on the QOL of patients of both genders.
Collapse
Affiliation(s)
- E A Macêdo
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, State University of Campinas, Campinas, Brazil
| |
Collapse
|
94
|
Palagini L, Mauri M, Faraguna U, Carli L, Tani C, Dell’Osso L, Mosca M, Riemann D. Insomnia symptoms, perceived stress and coping strategies in patients with systemic lupus erythematosus. Lupus 2016; 25:988-96. [DOI: 10.1177/0961203316631630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
Objective The aim of this study is to evaluate perceived stress and coping strategies in individuals with systemic lupus erythematosus (SLE) according to the presence of insomnia symptoms, using a set of variables that include anxiety and depressive symptoms evaluation. Methods Ninety SLE women were evaluated in a cross-sectional study using the Perceived Stress Scale (PSS), Brief COPE, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI) and Self-rating Anxiety Scale (SAS). Results Individuals with insomnia symptoms ( n = 57, 66%) presented higher PSS ( p < 0.001), PSQI ( p < 0.0001), BDI, ( p < 0.0001) scores and showed less-effective coping strategies such as the use of behavioral disengagement ( p = 0.04), self-blame ( p = 0.02) and emotional-focused coping ( p = 0.001). In a multi-regression model ISI was the independent determinant of high PSS and of behavioral disengagement; PSQI was the only determinant of self-blame ( p = 0.02) and emotional-focused coping. Conclusions SLE individuals with insomnia symptoms show high levels of perceived stress and more frequent use of disengaging and emotional-focused coping strategies. This body of evidence suggests that individuals with SLE and comorbid insomnia symptoms may therefore require additional interventions for insomnia.
Collapse
Affiliation(s)
- L Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - M Mauri
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - U Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - L Carli
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - C Tani
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - L Dell’Osso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - M Mosca
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - D Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Freiburg University Medical Center, Germany
| |
Collapse
|
95
|
Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E. Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:81-90. [PMID: 25779719 DOI: 10.1002/acr.22577] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/17/2015] [Accepted: 03/03/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Fatigue is a major concern for individuals with rheumatoid arthritis (RA). However, in order to treat fatigue adequately, its sources need to be identified. METHODS Data were collected during a single home visit (number of participants = 158). All participants had physician-diagnosed RA. Assessments of self-reported sleep quality, depression, physical activity, RA disease activity, muscle strength, functional limitations, and body composition were made. Information on demographics, medications, and smoking was collected. The Fatigue Severity Inventory (FSI; measuring average fatigue over the past 7 days) was used as the primary outcome. Analyses were first conducted to evaluate bivariate relationships with fatigue. Correlations among risk factors were examined. Multivariate analyses identified independent predictors of fatigue. RESULTS The mean ± SD age was 59 ± 11 years, the mean ± SD disease duration was 21 ± 13 years, and 85% of subjects were female. The mean ± SD FSI rating was 3.8 ± 2.0 (range 0-10). In multivariate analyses, self-reported disease activity, poor sleep, depression, and obesity were independently associated with fatigue. Physical inactivity was correlated with poor sleep, depression, and obesity. Mediation analyses indicated that physical inactivity had an indirect association with fatigue, mediated by poor sleep, depression, and obesity. CONCLUSION This cross-sectional study suggests that fatigue may not be solely a result of RA disease activity, but may result from a constellation of factors that includes RA disease activity or pain, but also includes inactivity, depression, obesity, and poor sleep. The results suggest new avenues for interventions to improve fatigue in individuals with RA, such as increasing physical activity or addressing depression or obesity.
Collapse
|
96
|
Abstract
Successful management of complex conditions such as systemic lupus erythematosus (SLE) and comorbid conditions benefit from patient-reported outcomes (PRO). Measuring health-related quality of life with PROs provides SLE patients with an opportunity to participate in their treatment and to facilitate better communication with the multidisciplinary team involved in their care. Health outcomes research has produced well-validated instruments that can be used across diseases; others have been specifically developed for SLE. The use of generic and SLE-specific PROs depends on needs, including population monitoring, treatment decision making, clinical trials research, and for evaluating and comparing the effect of therapies.
Collapse
|
97
|
Nicoloro-SantaBarbara J, Lobel M, Wolfe D. Psychosocial impact of mast cell disorders: Pilot investigation of a rare and understudied disease. J Health Psychol 2016; 22:1277-1288. [DOI: 10.1177/1359105315626784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mast cell disorders are rare, chronic diseases involving unpredictable physical symptoms ranging in severity, duration, and frequency. Almost two-thirds of participants with these disorders ( n = 180) experienced clinically meaningful depressive symptoms. Depressed mood was associated with somatic symptomatology, poorer quality of life, lower resilience, and indirectly with ways of coping. Newly developed measures for this population performed psychometrically well. There was no gender difference in depression but women reported greater use of several ways of coping, greater disease-related distress, poorer quality of life, and more symptoms. Results underscore the need for further research and development of effective psychosocial interventions for this population.
Collapse
|
98
|
Abstract
Up to 50% of patients with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs, but also mediates behavior abnormalities including fatigue and depression-like symptoms. This review focuses on the different pathways involved in the communication of the immune system with the neuronal network and the body's timing system. The latter is built up by a hierarchically organized expression of clock genes. As discussed here, the activation of the immune system interferes with high amplitude expression of clock genes, an effect which may play a pivotal role in depression-like behavior in autoimmune diseases.
Collapse
Affiliation(s)
- Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy & Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Adriano Fontana
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| |
Collapse
|
99
|
Andersson NW, Gustafsson LN, Okkels N, Taha F, Cole SW, Munk-Jørgensen P, Goodwin RD. Depression and the risk of autoimmune disease: a nationally representative, prospective longitudinal study. Psychol Med 2015; 45:3559-3569. [PMID: 26271451 DOI: 10.1017/s0033291715001488] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Autoimmune diseases are associated with substantial morbidity and mortality, yet the etiology remains unclear. Depression has been implicated as a risk factor for various immune-related disorders but little is known about the risk of autoimmune disease. This study examined the association between depression and the risk of autoimmune disease, and investigated the temporal and dose-response nature of these relationships. METHOD A prospective population-based study including approximately 1.1 million people was conducted using linked Danish registries. Depression and autoimmune diseases were diagnosed by physicians and documented in medical records. In total, 145 217 individuals with depression were identified between 1995 and 2012. Survival analyses were used to estimate the relative risk of autoimmune disease among those with, compared to without, depression. Analyses were adjusted for gender, age, and co-morbid mental disorders. RESULTS Depression was associated with a significantly increased risk of autoimmune disease [incidence rate ratio (IRR) 1.25, 95% CI 1.19-1.31], compared to those without a history of depression. Results suggest a general increased risk of autoimmune diseases following the onset of depression during first year (IRR 1.29, 95% CI 1.05-1.58), which remained elevated for the ensuing 11 years and beyond (IRR 1.53, 95% CI 1.34-1.76). Findings did not support a dose-response relationship. CONCLUSIONS Depression appears to be associated with an increased risk of a range of autoimmune diseases. Depression may play a role in the etiology of certain autoimmune conditions. If replicated, findings could highlight additional clinical implications in the treatment and management of depression. Future studies are needed to investigate the possible social, genetic, and neurobiological underpinnings of these relationships.
Collapse
Affiliation(s)
- N W Andersson
- Department of Organic Psychiatric Disorders and Emergency Ward,Aarhus University Hospital,Risskov,Denmark
| | - L N Gustafsson
- Department of Organic Psychiatric Disorders and Emergency Ward,Aarhus University Hospital,Risskov,Denmark
| | - N Okkels
- Department of Organic Psychiatric Disorders and Emergency Ward,Aarhus University Hospital,Risskov,Denmark
| | - F Taha
- Department of Psychology, Queens College and The Graduate Center,City University of New York (CUNY),Queens,New York,USA
| | - S W Cole
- Division of Hematology-Oncology,Department of Medicine,UCLA,School of Medicine,Los Angeles,USA
| | - P Munk-Jørgensen
- Department of Organic Psychiatric Disorders and Emergency Ward,Aarhus University Hospital,Risskov,Denmark
| | - R D Goodwin
- Department of Psychology, Queens College and The Graduate Center,City University of New York (CUNY),Queens,New York,USA
| |
Collapse
|
100
|
Nishimura K, Omori M, Katsumata Y, Sato E, Kawaguchi Y, Harigai M, Yamanaka H, Ishigooka J. Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study. Lupus 2015; 25:463-71. [PMID: 26527504 DOI: 10.1177/0961203315615223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence. RESULTS Prevalence of depression was higher in patients (n = 11, 25.6%) than in controls (n = 2, 6.7%; p = 0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n = 15; controls: 16.7%, n = 5; p = 0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p = 0.027) as an independent risk factor for depression. CONCLUSION Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.
Collapse
Affiliation(s)
- K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - M Omori
- Kanagawa Psychiatric Center, Yokohama, Japan
| | - Y Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - E Sato
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - J Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|