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Bergmans RS, Loewenstein E, Aboul-Hassan D, Chowdhury T, Schaefer G, Wegryn-Jones R, Xiao LZ, Yu C, Moore MN, Kahlenberg JM. Social determinants of depression in systemic lupus erythematosus: A systematic scoping review. Lupus 2023; 32:23-41. [PMID: 36274579 PMCID: PMC9812916 DOI: 10.1177/09612033221135145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Social determinants of health (SDOH) influence inequities in systemic lupus erythematosus (SLE). While these inequities contribute to overall disease experience, there is little consensus guiding our understanding of the psychological implications of SDOH in SLE. Given the paucity of evidence in this area, the aim of this scoping review was to systematically assess the volume and features of available research literature on associations of SDOH with depression in SLE over the past 20 years, from 1 January 2000 to 16 November 2021. We developed a search strategy for PubMed and EMBASE that included keywords for depression and lupus. After screening 2188 articles, we identified 22 original articles that met our inclusion criteria. At least one SDOH was associated with depression in two of the six studies with unadjusted estimates and 13 of the 16 studies with adjusted estimates. Results provide consistent but sparse evidence that SDOH are associated with depression in SLE. Additionally, depression epidemiology in SLE may differ from the general population such that depression risk is more similar across genders and racial/ethnic groups. More work is needed to identify the SDOH that have the greatest impact on depression and mental health among SLE patients, as well as how and when to intervene.
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Affiliation(s)
- Rachel S. Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Emma Loewenstein
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Deena Aboul-Hassan
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Tasfia Chowdhury
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Grace Schaefer
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Riley Wegryn-Jones
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Lillian Z. Xiao
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | - Christine Yu
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Meriah N. Moore
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
| | - J. Michelle Kahlenberg
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
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2
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Patterson SL, Trupin L, Yazdany J, Dall'Era M, Lanata C, Dequattro K, Hartogensis W, Katz P. Physical Inactivity and Incident Depression in a Multiracial, Multiethnic Systemic Lupus Erythematosus Cohort. Arthritis Care Res (Hoboken) 2022; 74:1098-1104. [PMID: 33421358 PMCID: PMC9829076 DOI: 10.1002/acr.24555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/30/2020] [Accepted: 01/05/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Physical activity is known to improve depressive symptoms. The present study was undertaken to examine physical inactivity as a predictor of incident depression in systemic lupus erythematosus (SLE). METHODS Data derive from the California Lupus Epidemiology Study (CLUES), a longitudinal cohort with confirmed SLE diagnoses. Physical inactivity was assessed from a single item, "I rarely or never do any physical activities," and depressive symptoms by the 8-item Patient Health Questionnaire (PHQ-8). Analysis included those not depressed at baseline (PHQ-8 score <10) who completed an in-person baseline assessment and at least 1 follow-up visit (n = 225). Incident depression was defined as a PHQ-8 score of ≥10 at follow-up. Cox proportional hazards regression modeled incident depression over 2 years as a function of baseline physical inactivity, controlling for age, sex, race, income, comorbidities, disease activity, and disease damage. RESULTS At baseline, the mean ± SD age of the participants was 45 ± 15 years, 88% were female, and 70% identified as non-White. Mean PHQ scores for those without depression at baseline did not differ by activity status, but those who were inactive at baseline were significantly more likely to develop depression over the next 2 years (hazard ratio [HR] 2.89 [95% confidence interval (95% CI) 1.46-5.71]). After adjusting for covariates, the association remained strong, including a >3-fold increased risk of incident depression among the sedentary group (HR 3.88 [95% CI 1.67-9.03]). CONCLUSION In this diverse SLE cohort, a simple question about physical inactivity was highly predictive of incident depression over the subsequent 2 years. Results suggest an urgent need for approaches to reduce sedentary behavior in this high-risk population.
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3
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Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Int J Rheumatol 2022; 2022:6290736. [PMID: 35572065 PMCID: PMC9098355 DOI: 10.1155/2022/6290736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives. A significant number of patients with systemic lupus erythematosus (SLE) have depression, and many are untreated. We aim to assess the frequency of moderate to severe depression (MSD) in a multiethnic group of SLE patients with different sociodemographic backgrounds, identify modifiable factors associated with depression, and determine the impact of depression, disease activity, damage, cognitive function, and pain severity on health-related quality of life (HRQoL). Methods. Ninety-nine patients with SLE were evaluated in a cross-sectional study. Sociodemographic data, Beck Depression Inventory (BDI II), SLE disease activity index (SLEDAI-2K), SLICC Damage Index (SLICC-DI), pain severity (10 cm visual analogue scale), cognitive function (Automated Neuropsychologic Assessment Metrics (ANAM)), and the physical (PCS) and mental (MCS) component scores of the Short Form Health Survey (SF-36) were recorded. Bivariate analysis identified potential associations of relevant variables with BDI II and SF-36. Regression analysis determined independent correlates with MSD, PCS, and MCS. Results. Over 50% of subjects (50.5%) were African-American, 37.1% had a family income of ≤$20,000, and 31.3% had MSD. In the bivariate analysis, family income, SLEDAI-2K, cognitive function, and pain severity were associated with MSD. Using binary logistic regression, SLEDAI-2K and pain severity remained independently correlated with MSD (
). In the multiple linear regression analysis, pain severity was the only independent correlate of PCS (
), while cognitive function and BDI II were the main factors associated with MCS (
and
, respectively). Conclusion. Pain severity and disease activity are associated with MSD in our unique population, are potentially modifiable, and deserve further attention in the clinic. Depression and pain significantly affect HRQoL and should be aggressively managed.
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Wieczorek M, Gwinnutt JM, Ransay-Colle M, Balanescu A, Bischoff-Ferrari H, Boonen A, Cavalli G, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm TA, Walker-Bone K, Welling J, Zlatkovic-Svenda M, Verstappen SMM, Guillemin F. Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs): systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002170. [PMID: 35351808 PMCID: PMC8966569 DOI: 10.1136/rmdopen-2021-002170] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). The aim of this paper was to review the literature on the relationship between smoking and alcohol consumption with regard to RMD-specific outcomes. METHODS Two systematic reviews were conducted to identify systematic reviews and meta-analyses, published between 2013 and 2018, related to smoking and alcohol consumption in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), systemic sclerosis (SSc) and gout. Two additional systematic reviews were performed to identify original longitudinal studies on smoking and alcohol consumption and disease-specific outcomes. RESULTS Nine reviews and 65 original studies on smoking as well as two reviews and 14 original studies on alcohol consumption met the inclusion criteria. While most studies were moderate/poor quality, smoking was significantly associated with poorer outcomes: cardiovascular comorbidity; poorer response to RA treatment; higher disease activity and severity in early RA; axSpA radiographic progression. Results were heterogeneous for OA while there was limited evidence for PsA, SSc and gout. Available studies on alcohol mainly focused on RA, reporting a positive association between alcohol intake and radiographic progression. Five studies assessed alcohol consumption in gout, reporting a significant association between the number and type of alcoholic beverages and the occurrence of flares. CONCLUSION Current literature supports that smoking has a negative impact on several RMD-specific outcomes and that moderate or high alcohol consumption is associated with increased risk of flares in RA and gout.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland,EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - James Martin Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Ernst Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana Zlatkovic-Svenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Suzanne MM Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Francis Guillemin
- EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France,CIC-1433 Epidemiologie Clinique, Inserm, CHRU Nancy, University of Lorraine, Nancy, France
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5
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Narupan N, Seeherunwong A, Pumpuang W. Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand. BMC Psychiatry 2022; 22:103. [PMID: 35139821 PMCID: PMC8830079 DOI: 10.1186/s12888-022-03739-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/27/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE. METHODS This cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least 3 months, aged 18-59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9. We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index, the Systemic Lupus International Collaborating Clinics Damage Index, Numeric Rating Scale, Fatigue Severity Scale, Body Image Scale, and the ENRICHD Social Support Instrument. Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data. RESULTS The proportion of the participants with depressive symptoms was 43.2%, which 8.1% of those patients presented moderate to severe depressive symptoms. In a multivariable logistic regression model, SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95% CI: 1.35, 108.46), fatigue (aOR = 2.36, 95%CI: 1.08, 5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI: 1.76, 18.80), low satisfied of body image (aOR = 12.49, 95%CI: 2.23, 69.80), and low social support (aOR = 17.96, 95% CI: 1.86, 173.77). Disease flare, organ damage, and family income sufficiency did not significantly increase the risk of depressive symptoms in patients with SLE. CONCLUSIONS The findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.
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Affiliation(s)
- Nirunya Narupan
- grid.10223.320000 0004 1937 0490M.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand ,grid.10223.320000 0004 1937 0490Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Walailak Pumpuang
- grid.10223.320000 0004 1937 0490Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
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6
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Cui C, Li Y, Wang L. The Association of Illness Uncertainty and Hope With Depression and Anxiety Symptoms in Women With Systemic Lupus Erythematosus: A Cross-sectional Study of Psychological Distress in Systemic Lupus Erythematosus Women. J Clin Rheumatol 2021; 27:299-305. [PMID: 32084070 DOI: 10.1097/rhu.0000000000001280] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are commonly observed psychological symptoms in patients diagnosed with systemic lupus erythematosus (SLE). This study aimed to explore the possible factors that influence depression and anxiety symptoms development in SLE women. METHODS This cross-sectional study was conducted between October 2017 and December 2018 in Liaoning, China. Questionnaires including Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Mishel Uncertainty in Illness Scale for Adults, and Herth Hope Scale were completed by 205 participants. Factors related to depression and anxiety were examined using hierarchical multiple regression analysis, while the effect of hope was examined using structural equation model. RESULTS The prevalence of depression and anxiety symptoms in female SLE patients was 79.5% and 86.8%, respectively. Illness uncertainty was strongly positively correlated with depression and anxiety symptoms. In contrast, hope was negatively associated with depression and anxiety symptoms. Up to 66.6% and 59.4% of the variance explained by all the variables was 66.6% in depression symptoms and 59.4% in anxiety symptoms. Interestingly, hope was able to alter the relationship of illness uncertainty with depression and anxiety symptoms. CONCLUSIONS While illness uncertainty can increase depression and anxiety symptoms, hope can reduce these symptoms. Therefore, hope-based targeted interventions should be employed to prevent and treat depression and anxiety symptoms among SLE women.
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Affiliation(s)
- Chunying Cui
- From the Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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7
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Khedr EM, Gamal RM, Rashad SM, Yacoub M, Ahmed GK. Impact of depression on quality of life in systemic lupus erythematosus patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00343-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Abstract
Background
Depression is common in systemic lupus erythematosus (SLE) and is an unmeasured risk factor, yet its symptoms can be neglected in standard disease evaluations. The purpose of this study was to assess the frequency and the impact of depression on quality of life in SLE patients. We recruited 32 patients with SLE and 15 healthy control volunteers in the study. The following investigations were undertaken in each patient: clinical and rheumatologic assessment, SLE Disease Activity Index-2k (SLEDAI-2k), Beck Depression Inventory (BDI), Short-Form Health Survey (SF-36) questionnaire, and routine laboratory tests.
Results
There was a high percentage of depression (46.9%) in the SLE patients. Regarding quality of life (SF-36), there were significant affection of the physical and mental composite summary domains (PCS and MCS) scores in lupus patients compared with controls (P < 0.000 for both) with the same significant in depressed compared with non-depressed patients. SF-36 subscales (physical function, limit emotional, emotional wellbeing, and social function) were significantly affected in depressed lupus patients compared with non-depressed patients. There was a significant negative correlation between the score of MCS domain of SF-36 with BDI (P < 0.000) while positive correlation between SLEDAI score with depression score. In contrast, there were no significant correlations between MCS or PCS with age, duration of illness, or SLEDAI-2K.
Conclusions
Depression is common in SLE patients and had a negative impact on quality of life particularly on MCS domain and positive correlation with disease severity score.
Trial registration
This study was registered on clinical trial with registration number: NCT03165682 https://clinicaltrials.gov/ct2/show/NCT03165682 on 24 May 2017.
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8
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Ejiri H, Uchida H, Tsuchiya K, Fujiwara K, Kikuchi S, Hirao K. Effects of Smartphone-Delivered Positive-Word Stimulation on Depressed Mood in People with Subthreshold Depression: Protocol for a Pilot Randomized Controlled Trial. Neuropsychiatr Dis Treat 2021; 17:2739-2748. [PMID: 34456565 PMCID: PMC8385547 DOI: 10.2147/ndt.s323126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/06/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is an important public health problem. Thus, preventive interventions against subthreshold depression (StD), which is one of the key risk factors for the development of MDD, are important. The study developed a smartphone application (SPSRS) that improves depressive symptoms in people with StD by automatically presenting positive word stimuli during videos. The SPSRS application has the potential to improve depressive symptoms in people with StDs. However, whether it can immediately improve depressed moods in people with StD is unclear. The study presents a protocol for investigating the immediate effects of the SPSRS application intervention on depressed mood in people with StD. METHODS The study is designed as an open-label, parallel-group, and pilot randomized controlled trial (RCT). Thirty-two people who meet the criteria for StD (Beck Depression Inventory-II score of 10 points or more and fails to meet the diagnostic criteria for MDD) will be recruited and studied. It compares the immediate effects of the SPSRS application intervention (with positive word stimulus in a 10-minute video; n = 16) and YouTube application intervention (without positive word stimulus in 10-minute video; n = 16). The primary outcome is the change in the score for the Profile of Mood States 2nd Edition-Adult Short after 10 minutes of intervention. The secondary outcome is the change in the State-Trait Anxiety Inventory State after 10 min of intervention. DISCUSSION The pilot RCT is the first to evaluate the immediate effects of the SPSRS application intervention on depressed mood in people with StD. The results are expected to provide a preliminary outcome of the immediate effect of the SPSRS application on the depressed mood of people with StD and aid in planning a full-scale trial. TRIAL REGISTRATION ClinicalTrials.gov; Identifier: NCT03864484.
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Affiliation(s)
- Hitomi Ejiri
- School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Uchida
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan.,Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuhiko Fujiwara
- Department of Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Nishikyusyu University, Kanzaki, Japan
| | - Senichiro Kikuchi
- School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan.,Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuki Hirao
- School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan.,Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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9
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Eldeiry D, Zandy M, Tayer-Shifman OE, Kwan A, Marzouk S, Su J, Bingham K, Touma Z. Association between depression and anxiety with skin and musculoskeletal clinical phenotypes in systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:3211-3220. [DOI: 10.1093/rheumatology/keaa098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Abstract
Objectives
To study the clinical phenotypes, determined based on cumulative disease activity manifestations, and sociodemographic factors associated with depression and anxiety in SLE.
Methods
Patients attending a single centre were assessed for depression and anxiety. SLE clinical phenotypes were based on the organ systems of cumulative 10-year SLE Disease Activity Index 2000 (SLEDAI-2K), prior to visit. Multivariable logistic regression analyses for depression, anxiety, and coexisting anxiety and depression were performed to study associated SLE clinical phenotypes and other factors.
Results
Among 341 patients, the prevalence of anxiety and depression was 34% and 27%, respectively, while 21% had coexisting anxiety and depression. Patients with skin involvement had significantly higher likelihood of anxiety compared with patients with no skin involvement [adjusted odds ratio (aOR) = 1.8; 95% CI: 1.1, 3.0]. Patients with skin involvement also had higher likelihood of having coexisting anxiety and depression (aOR = 2.0, 95% CI: 1.2, 3.9). Patients with musculoskeletal (MSK) (aOR = 1.9; 95% CI: 1.1, 3.5) and skin system (aOR = 1.8; 95% CI: 1.04, 3.2) involvement had higher likelihood of depression compared with patients without skin or musculoskeletal involvement. Employment status and fibromyalgia at the time of the visit, and inception status were significantly associated with anxiety, depression, and coexisting anxiety and depression, respectively.
Conclusion
SLE clinical phenotypes, specifically skin or MSK systems, along with fibromyalgia, employment and shorter disease duration were associated with anxiety or depression. Routine patient screening, especially among patients with shorter disease duration, for these associations may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis.
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Affiliation(s)
- David Eldeiry
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Moe Zandy
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Oshrat E Tayer-Shifman
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Andrew Kwan
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | | | - Jiandong Su
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Kathleen Bingham
- Centre for Mental Health, Psychiatry Department, University Health Network, Toronto General Hospital
| | - Zahi Touma
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
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10
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Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev 2019; 15:90-98. [PMID: 30255761 DOI: 10.2174/1573397114666180926101513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression and anxiety are common neuropsychiatric complaints in patients with Systemic Lupus Erythematosus (SLE). While numerous studies have been performed to investigate the prevalence, impact, and associated factors of depression and anxiety, current literature presents mixed results. In particular, the prevalence of anxiety and depression varies substantially between studies due to methodological limitations, and heterogeneity in defining anxiety and depression, patient selection, and metrics used. Moreover, there is a lack of studies evaluating the validity, reliability, and interpretability of commonly used screening tools for depression and anxiety in SLE patients. RESULT AND CONCLUSION Further investigations should aim to reach a consensus surrounding the role of controversial associated factors in depression and anxiety of SLE patients, while also focusing on the identification of novel factors that have not yet been highlighted in the literature.
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Affiliation(s)
- Andrew Kwan
- Queen's University, Kingston, Ontario, Canada.,University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Patricia Katz
- Department of Medicine, UCSF, Philip R. Lee Institute for Health Policy Studies, St, San Francisco, CA 94117, United States
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
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11
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Moustafa AT, Moazzami M, Engel L, Bangert E, Hassanein M, Marzouk S, Kravtsenyuk M, Fung W, Eder L, Su J, Wither JE, Touma Z. Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 50:84-94. [PMID: 31303437 DOI: 10.1016/j.semarthrit.2019.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To systematically review and synthesize literature on 1) the overall prevalence of depression and anxiety in SLE patients in identified studies, and 2) the pooled prevalence per metrics of depression and anxiety in adult SLE patients. METHODS This review used (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines and in-depth searches in four databases (1954-2016; Ovid-based Medline, Embase, PsycINFO and CINAHL) to identify articles on the prevalence of depression and/or anxiety in adult SLE patients. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all included studies, and whenever possible, pooled prevalence (PP) was determined for more commonly used metrics. Statistical and publication bias was assessed using funnel plots. RESULT A total of 3103 references were identified, 226 were selected for detailed review and 72 were included in the final analysis. OVERALL PREVALENCE The depression PP, obtained from 69 studies representing 23,386 SLE patients, was 35.0% (95% CI: 29.9%-40.3%). The anxiety PP, obtained from 38 studies representing 4439 SLE patients, was 25.8% (95% CI: 19.2%-32.9%). PREVALENCE PER METRICS USED The more commonly used instruments included the Centre for Epidemiological Studies - Depression (CES-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scales (HADS-A/D), and Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)]. The CES-D was utilized in 13 studies including 1856 SLE patients; depression PP was 41.5% (95% CI: 35.1%-48.1%). The BDI was utilized in 14 studies including 1355 SLE patients and the BAI in 3 studies including 489 patients; depression PP was 39.9% (95% CI: 31.1%-49.1) and anxiety PP was 38.4% (95% CI: 34.2%-42.8%). The HADS-D was utilized in 14 studies including 1238 SLE patients and the HADS-A in 12 studies including 1099 patients respectively; its depression PP was 24.4% (95% CI: 19.1%-30.1%) and anxiety PP was 38.3% (95% CI: 29.1%-47.9%). The HAM-D was utilized in 4 studies including 267 SLE patients and the HAM-A in 4 studies including 213 patients respectively; its depression PP was 40.0% (95% CI: 23.0%-59.0%) and anxiety PP was 39.0% (95% CI: 32.0%-45.0%). CONCLUSION There was high variability in the prevalence of depression and anxiety, ranging from 8.7%-78.6% and 1.1%-71.4%, respectively. This could be attributed to the lack of consistency in the metrics used and its definition for depression and anxiety in SLE. Studies that used a specific metric, such as the CES-D, BDI or HAM-D, yielded similar depression prevalence. The HADS-D had the lowest prevalence. All metrics of anxiety yielded similar anxiety prevalence.
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Affiliation(s)
- Ahmed T Moustafa
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Mitra Moazzami
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lisa Engel
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Elvira Bangert
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Mohamed Hassanein
- Michigan State University, College of Human Medicine, East Lansing, Michigan, United States.
| | - Sherief Marzouk
- Lecturer, Faculty of Medicine, Department of Psychiatry, Neuropsychiatry Division, University of Toronto, Toronto, Ontario, Canada.
| | - Maryana Kravtsenyuk
- Forensic Psychiatrist, Alberta Hospital Edmonton, Assistant Clinical Professor, Department of Psychiatry, University of Alberta, Alberta, Canada.
| | - William Fung
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lihi Eder
- Assistant Professor of Medicine, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada.
| | - Jiandong Su
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Joan E Wither
- Departments of Medicine and Immunology, University of Toronto, Division of Rheumatology, Toronto Western Hospital, Senior Scientist, Krembil Research Institute, Toronto, Ontario, Canada.
| | - Zahi Touma
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
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Chi JM, Mackay M, Hoang A, Cheng K, Aranow C, Ivanidze J, Volpe B, Diamond B, Sanelli PC. Alterations in Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus. AJNR Am J Neuroradiol 2019; 40:470-477. [PMID: 30792254 DOI: 10.3174/ajnr.a5990] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Neuropsychiatric systemic lupus erythematosus refers to central and peripheral nervous system involvement, which may occur secondary to antineuronal antibodies crossing the blood-brain barrier that preferentially target cells in the hippocampus leading to abnormal hypermetabolism and atrophy. Thus, we hypothesized that alterations in BBB permeability, detected on dynamic contrast-enhanced MR imaging, occur in the hippocampus in patients with systemic lupus erythematosus before development of neuropsychiatric systemic lupus erythematosus. MATERIALS AND METHODS Six patients with systemic lupus erythematosus without neuropsychiatric systemic lupus erythematosus and 5 healthy controls underwent dynamic contrast-enhanced MR imaging with postprocessing into BBB permeability parameters (K trans and Ve) and CBF. Standardized methods selected ROI sampling of the abnormal brain regions detected on FDG-PET. The mean and SD of K trans, Ve, and CBF were calculated. Linear regression and nonparametric Spearman rank correlation analyses of K trans and Ve with CBF were performed. Dynamic contrast-enhanced curves and the area under the curve were generated for each brain region. Student t test comparisons were performed. RESULTS Quantitative data revealed that patients with systemic lupus erythematosus have statistically increased K trans (P < .001) and Ve (P < .001) compared with controls. In patients with systemic lupus erythematosus, statistically significant positive correlations were seen between K trans (P < .001) and Ve (P < .001) with CBF. Furthermore, the mean area under the curve revealed statistically increased BBB permeability in the hippocampus (P = .02) compared with other brain regions in patients with systemic lupus erythematosus compared with controls. CONCLUSIONS These initial findings are proof-of-concept to support the hypothesis that patients with systemic lupus erythematosus have increased BBB permeability, specifically in the hippocampus, compared with other brain regions. These findings may advance our understanding of the underlying pathophysiology affecting the brain in autoimmune diseases.
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Affiliation(s)
- J M Chi
- From the Department of Radiology (J.M.C., K.C.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - M Mackay
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - A Hoang
- Department of Radiology (A.H.), Northwell Health, Manhasset, New York
| | - K Cheng
- From the Department of Radiology (J.M.C., K.C.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - C Aranow
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - J Ivanidze
- Department of Radiology (J.I.), Weill Cornell Medical College, New York, New York
| | - B Volpe
- Feinstein Institute for Medical Research (B.V.), The Center for Biomedical Science, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - B Diamond
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - P C Sanelli
- Feinstein Institute for Medical Research (P.C.S.), The Center for Health Innovations and Outcomes Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.,Department of Radiology (P.C.S.), Northwell Health, Imaging Clinical Effectiveness and Outcomes Research Program, Manhasset, New York
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13
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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.
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Affiliation(s)
- Andrea M Knight
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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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.
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Affiliation(s)
- Natalie Mccormick
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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16
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Abd-Alrasool ZA, Gorial FI, Hashim MT. Prevalence and severity of depression among Iraqi patients with systemic lupus erythematosus: A descriptive study. Mediterr J Rheumatol 2017; 28:142-146. [PMID: 32185272 PMCID: PMC7046054 DOI: 10.31138/mjr.28.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Systemic lupus erythematosus (SLE) patients have high risk for depression which is a potentially life-threatening disorder. OBJECTIVES: To evaluate the prevalence and severity of depression in a sample of Iraqi patients with SLE if present. PATIENTS AND METHODS: This cross-sectional study involved 60 patients with SLE diagnosed according to revised American College of Rheumatology (ACR) classification criteria. Demographics and clinical data were collected. All patients were screened for depression by using the diagnostic and statistical manual of mental disorders-5 (DSM5) diagnostic criteria of depression. Severity of their depression was determined by using the Beck Depression Inventory criteria. RESULTS: The prevalence of depression was 31.7%. A severe form of depression was observed in 13.3% of SLE cases, moderate depression in 10%, and a mild degree of depression was 8.3% of the cases. Patients with high SLE disease activity index (SLEDAI score >12) had an obviously higher rate of depression (40%) compared to 20% among those with mild or moderate disease. There was no important or statistically significant difference in median SLEDAI score between depression severity categories (p > 0.05). CONCLUSIONS: Prevalence of depression in SLE patients was relatively high. SLE disease activity increase depression rate.
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Affiliation(s)
| | - Faiq I Gorial
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Mushtaq T Hashim
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
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17
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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.
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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.
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18
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Fluharty M, Taylor AE, Grabski M, Munafò MR. The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review. Nicotine Tob Res 2017; 19:3-13. [PMID: 27199385 PMCID: PMC5157710 DOI: 10.1093/ntr/ntw140] [Citation(s) in RCA: 616] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 05/13/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies. METHODS Studies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome. RESULTS Outcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results. CONCLUSIONS The literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences. IMPLICATIONS We systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.
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Affiliation(s)
- Meg Fluharty
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom;
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Amy E Taylor
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Meryem Grabski
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
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Jorge A, Lertratanakul A, Lee J, Pearce W, McPherson D, Thompson T, Barinas-Mitchell E, Ramsey-Goldman R. Depression and Progression of Subclinical Cardiovascular Disease in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 69:5-11. [PMID: 27390248 DOI: 10.1002/acr.22992] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/19/2016] [Accepted: 07/05/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Women with systemic lupus erythematosus (SLE) have an increased incidence of premature cardiovascular disease (CVD). A relationship between depression and increased inflammation leading to CVD has been proposed. The aim of this study was to evaluate the relationship between depression and the progression of subclinical atherosclerosis in women with SLE. METHODS In this prospective case-control study, 149 participants with SLE and 126 controls were followed over 5 years. Evaluation included laboratory studies, assessment of CVD risk factors, depression screening, ultrasound evaluations of carotid intima-media thickness (CIMT) and carotid plaque, and assessment of SLE disease activity for the SLE cases. RESULTS The SLE group had a higher rate of depression: 29% compared with 11% in the control group (P = 0.003). When controlling for traditional CVD risk factors, the presence of baseline depression correlated with increased progression of CIMT in the SLE group, but not in the control group. The mean increase in CIMT was 0.026 mm in the SLE group without depression versus 0.064 mm in the depressed SLE group (P = 0.0096). There was no association between depression and carotid plaque in either group, with a calculated odds ratio for plaque progression in the depressed SLE group of 1.118 (95% confidence interval 0.476, 2.623) in the adjusted model. CONCLUSION Women with SLE and concomitant depression have an increased risk of developing subclinical atherosclerosis, as measured by CIMT, but not by carotid plaque. The data suggest that depression, a potentially modifiable risk factor, may contribute to the increased risk of subclinical atherosclerosis in women with SLE.
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Affiliation(s)
- April Jorge
- Massachusetts General Hospital, Boston, and Northwestern University, Chicago, Illinois
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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.
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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.
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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.
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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: 102] [Impact Index Per Article: 12.8] [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.
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Knight AM, Xie M, Mandell DS. Disparities in Psychiatric Diagnosis and Treatment for Youth with Systemic Lupus Erythematosus: Analysis of a National US Medicaid Sample. J Rheumatol 2016; 43:1427-33. [PMID: 27134262 DOI: 10.3899/jrheum.150967] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the national prevalence and racial/ethnic differences in psychiatric diagnoses and pharmacologic treatment in a US Medicaid beneficiary population of youth with systemic lupus erythematosus (SLE). METHODS We included youth aged 10 to 18 years with a diagnosis of SLE (defined as ≥ 3 outpatient visit claims with an International Classification of Diseases, 9th ed. code of 710.0, each > 30 days apart) in the US Medicaid Analytic Extract database from 2006 and 2007. This database contains all inpatient and outpatient Medicaid claims from 49 states and the District of Columbia. We calculated the prevalence of psychiatric diagnoses and treatment, and used logistic regression to compare depression and anxiety diagnoses, antidepressant, and anxiolytic use among racial/ethnic groups. RESULTS Of 970 youth with SLE, 15% were white, 42% were African American, 27% were Latino, and 16% were of other races/ethnicities. Diagnoses of depression were present for 19%, anxiety for 7%, acute stress/adjustment for 6%, and other psychiatric disorders for 18%. Twenty percent were prescribed antidepressants, 7% were prescribed anxiolytics, 6% were prescribed antipsychotics, and 5% were prescribed stimulants. In adjusted analyses, African Americans were less likely than whites to be diagnosed with depression (OR 0.56, 95% CI 0.34-0.90) or anxiety (OR 0.49, 95% CI 0.25-0.98), or to be prescribed anxiolytics (OR 0.23, 95% CI 0.11-0.48). CONCLUSION We present population-level estimates showing high psychiatric morbidity in youth with SLE, but less prevalent diagnosis and treatment in African Americans. Mental health interventions should address potential racial/ethnic disparities in care.
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Affiliation(s)
- Andrea M Knight
- From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania.
| | - Ming Xie
- From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - David S Mandell
- From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania
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Vina ER, Hausmann LRM, Utset TO, Masi CM, Liang KP, Kwoh CK. Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study. Lupus Sci Med 2015; 2:e000110. [PMID: 26322238 PMCID: PMC4548064 DOI: 10.1136/lupus-2015-000110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/12/2022]
Abstract
Background Racial disparities in the clinical outcomes of systemic lupus erythematosus (SLE) exist. Perceived racial discrimination may contribute to disparities in health. Objectives To determine if perceived racism in healthcare differs by race among patients with SLE and to evaluate its contribution to racial disparities in SLE-related outcomes. Methods 163 African–American (AA) and 180 white (WH) patients with SLE were enrolled. Structured interviews and chart reviews were done to determine perceptions of racism, SLE-related outcomes (Systemic Lupus International Collaborating Clinics (SLICC) Damage Index, SLE Disease Activity, Center for Epidemiologic Studies-Depression (CES-D)), and other variables that may affect perceptions of racism. Serial hierarchical multivariable logistic regression models were conducted. Race-stratified analyses were also performed. Results 56.0% of AA patients compared with 32.8% of WH patients had high perceptions of discrimination in healthcare (p<0.001). This difference remained (OR 4.75 (95% CI 2.41 to 8.68)) after adjustment for background, identity and healthcare experiences. Female gender (p=0.012) and lower trust in physicians (p<0.001) were also associated with high perceived racism. The odds of having greater disease damage (SLICC damage index ≥2) were higher in AA patients than in WH patients (crude OR 1.55 (95% CI 1.01 to 2.38)). The odds of having moderate to severe depression (CES-D ≥17) were also higher in AA patients than in WH patients (crude OR 1.94 (95% CI 1.26 to 2.98)). When adjusted for sociodemographic and clinical characteristics, racial disparities in disease damage and depression were no longer significant. Among AA patients, higher perceived racism was associated with having moderate to severe depression (adjusted OR 1.23 (95% CI 1.05 to 1.43)) even after adjusting for sociodemographic and clinical variables. Conclusions Perceptions of racism in healthcare were more common in AA patients than in WH patients with SLE and were associated with depression. Interventions aimed at modifiable factors (eg, trust in providers) may reduce higher perceptions of race-based discrimination in SLE.
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Affiliation(s)
- Ernest R Vina
- University of Arizona School of Medicine and University of Arizona Arthritis Center, Tucson, Arizona, USA
| | - Leslie R M Hausmann
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tammy O Utset
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Christopher M Masi
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
- NorthShore University Health System, Evanston, Illinois, USA
| | - Kimberly P Liang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - C Kent Kwoh
- University of Arizona School of Medicine and University of Arizona Arthritis Center, Tucson, Arizona, USA
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Chang SH, Cho JH, Shin NH, Oh HJ, Choi BY, Yoon MJ, Lee EY, Lee EB, Lee YJ, Lee TJ, Hahm BJ, Song YW. Depression and Quality of Life in Patients with Systemic Lupus Erythematosus. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.6.346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Sung Hae Chang
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ja Hyun Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Na Hee Shin
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hye Jin Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Myeong Jae Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jin Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Bong Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Young Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Medical Research Center, Seoul National University, Seoul, Korea
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol 2014; 10:579-96. [DOI: 10.1038/nrneurol.2014.148] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Medici M, Direk N, Visser WE, Korevaar TIM, Hofman A, Visser TJ, Tiemeier H, Peeters RP. Thyroid function within the normal range and the risk of depression: a population-based cohort study. J Clin Endocrinol Metab 2014; 99:1213-9. [PMID: 24564323 DOI: 10.1210/jc.2013-3589] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Overt hypo- and hyperthyroidism are associated with an increased risk of depression. Little is known about the effects of variation in thyroid function within the normal range on the risk of depression. OBJECTIVE The objective of the study was to examine the association between normal-range thyroid function and the risk of depression. DESIGN, SETTING, AND PARTICIPANTS This was a cohort study in 1503 Dutch men and women, aged 70.6 (7.3) (mean [SD]) years. At baseline, serum TSH, thyroperoxidase antibody levels, and depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D)] were assessed. A CES-D of 16 or greater is indicative of a depressive disorder. During follow-up (mean 8.0 y), participants were continuously monitored for the occurrence of incident depressive syndromes (n = 156). RESULTS Cross-sectionally, persons in the lowest TSH tertile (0.3-1.0 mU/L) had more depressive symptoms [CES-D score (mean): 7.95 vs 6.63, P = .014] as well as an increased risk of a CES-D of 16 or greater [10.7% vs 5.0%, odds ratio (95% confidence interval) 2.22 (1.18-4.17)], compared with persons in the highest normal range TSH tertile (1.6-4.0 mU/L). In the prospective analyses, persons in the lowest TSH tertile who were depression free at baseline had a higher risk of incident depressive syndromes [12.3% vs 7.6%, odds ratio (95% confidence interval) 1.85 (1.10-3.11)]. Thyroid autoimmunity (thyroperoxidase antibody positivity) was not associated with CES-D scores or incident depressive syndromes. CONCLUSIONS Elderly persons with low-normal TSH levels have more concurrent depressive symptoms as well as a substantially increased risk of developing a depressive syndrome in the subsequent years. This study identifies low-normal TSH as an important risk factor for depression in the elderly.
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Affiliation(s)
- Marco Medici
- Departments of Internal Medicine (M.M., W.E.V., T.I.M.K., T.J.V., R.P.P.) and Epidemiology (N.D., A.H., H.T.), Erasmus Medical Center, 3000 CA, Rotterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Neuropsychiatric manifestations pose diagnostic and therapeutic challenges in systemic lupus erythematosus (SLE). We review recently published studies on the epidemiology, pathogenesis, neuroimaging, and treatment of NPSLE. RECENT FINDINGS Generalized SLE activity or damage and antiphospholipid antibodies are identified as major risk factors for neuropsychiatric involvement. NPSLE patients have increased genetic burden and novel genomic approaches are expected to elucidate its pathogenesis. Animal data suggest that, in cases of disturbed blood-brain barrier, autoantibodies against the NR2 subunits of the N-methyl-D-aspartate receptor and 16/6 idiotype antibodies may cause diffuse neuropsychiatric manifestations through neuronal apoptosis or brain inflammation; data in humans are still circumstantial. In NPSLE, advanced neuroimaging uncovers structural and metabolic abnormalities in brain regions with normal appearance on conventional MRI. Treatment includes corticosteroids/immunosuppressants for inflammatory manifestations or generalized SLE activity, and antiplatelets/anticoagulation for manifestations related to antiphospholipid antibodies. In refractory cases, uncontrolled studies suggest a beneficial role of rituximab. SUMMARY We have begun to better understand how brain-reactive autoantibodies, present in a proportion of SLE patients, can cause brain injury and diffuse NPSLE. Further testing will be required to determine the clinical utility of advanced neuroimaging. Controlled trials are needed to guide therapeutic decisions.
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Dua AB, Touma Z, Toloza S, Jolly M. Top 10 Recent Developments in Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Curr Rheumatol Rep 2013; 15:380. [DOI: 10.1007/s11926-013-0380-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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van Exel E, Jacobs J, Korswagen LA, Voskuyl AE, Stek M, Dekker J, Bultink IEM. Depression in systemic lupus erythematosus, dependent on or independent of severity of disease. Lupus 2013; 22:1462-9. [PMID: 24135079 DOI: 10.1177/0961203313508443] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the prevalence of depression in subjects with systemic lupus erythematosus (SLE) in relation to the general population and to unravel the relation between depression and SLE disease characteristics. METHODS One hundred and two subjects with SLE (mean age 44.4 years) were studied using the Beck Depression Inventory (BDI) score to estimate the prevalence of depression. The BDI scores in subjects with SLE were compared with BDI scores from a pan-European population based study (Outcome in Depression International Network (ODIN) study, n = 7934), i.e. the general population. RESULTS The mean BDI score was higher in SLE subjects (10.1 points) compared with the BDI scores derived from the general population (10.1 versus 5.6 points, respectively, p < 0.001). This corresponds to a prevalence of depression of 16.6% and 6.7%, respectively. There was no association between disease activity or organ damage and BDI scores in subjects with SLE (p > 0.1). Only 7% of SLE subjects with high BDI scores used antidepressants. CONCLUSION The mean BDI score and prevalence of depression are significantly higher in SLE subjects compared with the general population. No association was found between SLE disease characteristics and BDI scores. The number of depressed SLE subjects treated with antidepressants is low, suggesting inadequate recognition and treatment of depression in SLE.
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Affiliation(s)
- E van Exel
- 1Department of Psychiatry, VU University Medical Center, the Netherlands
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Maneeton B, Maneeton N, Louthrenoo W. Prevalence and predictors of depression in patients with systemic lupus erythematosus: a cross-sectional study. Neuropsychiatr Dis Treat 2013; 9:799-804. [PMID: 23766649 PMCID: PMC3678948 DOI: 10.2147/ndt.s44248] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence and examine the predictors of depression in patients with systemic lupus erythematosus (SLE). METHODS This cross-sectional study was conducted in the rheumatology clinic of a university hospital. All SLE patients that met the revised American College of Rheumatology (ACR) classification were included in the study. Sociodemographic data and medications were recorded. Disease activity for SLE was assessed with the Mexican-SLE Disease Activity Index (Mex-SLEDAI). All subjects were screened for anxiety and depression by using the Hamilton Anxiety Rating Scale (HAM-A) and the 17-item version of the Hamilton Depression Rating Scale (HAM-D17). Multiple linear regression analyses were used to determine predictors of depressive disorder. RESULTS A total of 62 SLE (61 females and 1 male) patients participated in the study. Based on HAM-D17 and HAM-A, rates of depression and anxiety in SLE patients were 45.2% and 37.1%, respectively. The multiple linear regression analysis revealed that HAM-A score and younger age were significant predictors of depression in SLE patients. CONCLUSION The findings suggest that depression and anxiety are common in SLE patients. In addition, higher levels of anxiety and a younger age may increase the risk of depression. Because of the small sample size, further studies should be conducted to confirm these results.
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Murray SG, Yazdany J, Kaiser R, Criswell LA, Trupin L, Yelin EH, Katz PP, Julian LJ. Cardiovascular disease and cognitive dysfunction in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:1328-33. [PMID: 22549897 PMCID: PMC3705733 DOI: 10.1002/acr.21691] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cognitive dysfunction and cardiovascular disease are common and debilitating manifestations of systemic lupus erythematosus (SLE). In this study, we evaluated the relationship between cardiovascular events, traditional cardiovascular risk factors, and SLE-specific risk factors as predictors of cognitive dysfunction in a large cohort of participants with SLE. METHODS Subjects included 694 participants from the Lupus Outcomes Study (LOS), a longitudinal study of SLE outcomes based on an annual telephone survey querying demographic and clinical variables. The Hopkins Verbal Learning Test-Revised and the Controlled Oral Word Association Test were administered to assess cognitive function. Multiple logistic regression was used to identify cardiovascular events (myocardial infarction, stroke), traditional cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking), and SLE-specific risk factors (antiphospholipid antibodies [aPL], disease activity, disease duration) associated with cognitive impairment in year 7 of the LOS. RESULTS The prevalence of cognitive impairment as measured by verbal memory and verbal fluency metrics was 15%. In adjusted multiple logistic regression analyses, aPL (odds ratio [OR] 2.10, 95% confidence interval [95% CI] 1.3-3.41), hypertension (OR 2.06, 95% CI 1.19-3.56), and a history of stroke (OR 2.27, 95% CI 1.16-4.43) were significantly associated with cognitive dysfunction. In additional analyses evaluating the association between these predictors and severity of cognitive impairment, stroke was significantly more prevalent in participants with severe impairment when compared to those with mild or moderate impairment (P = 0.036). CONCLUSION These results suggest that the presence of aPL, hypertension, and stroke are key variables associated with cognitive impairment, which may aid in identification of patients at greatest risk.
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Affiliation(s)
- Sara G Murray
- University of California, San Francisco, 94143-0320, USA.
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Yelin E, Tonner C, Trupin L, Gansky SA, Julian L, Katz P, Yazdany J, Kaiser R, Criswell LA. Longitudinal study of the impact of incident organ manifestations and increased disease activity on work loss among persons with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:169-75. [PMID: 22006458 DOI: 10.1002/acr.20669] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There is increasing evidence of the impact of systemic lupus erythematosus (SLE) on employment, but few studies have had sufficient sample size and longitudinal followup to estimate the impact of specific manifestations or of increasing disease activity on employment. METHODS Data were derived from the University of California, San Francisco, Lupus Outcomes Study, a longitudinal cohort of 1,204 persons with SLE sampled between 2002 and 2009. Of the 1,204 persons, 484 were working at baseline and had at least 1 followup interview. We used the Kaplan-Meier method to estimate the time between onset of thrombotic, neuropsychiatric, or musculoskeletal manifestations, or of increased disease activity, and work loss. We used Cox proportional hazards regression to estimate the risk of work loss associated with the onset of specific manifestations, the number of manifestations, and increased activity, with and without adjustment for sociodemographic, employment, and SLE duration characteristics. RESULTS By 4 years of followup, 57%, 34%, and 38% of those with thrombotic, musculoskeletal, and neuropsychiatric manifestations, respectively, had stopped working, as had 42% of those with increased disease activity. On a bivariable basis, the risk of work loss was significantly higher among persons ages 55-64 years and those with increased disease activity and each kind of manifestation. In multivariable analysis, older age, shorter job tenure, thrombotic and musculoskeletal manifestations, greater number of manifestations, and high levels of activity increased the risk of work loss. CONCLUSION Incident thrombosis and musculoskeletal manifestations, multiple manifestations, and increased disease activity are associated with the risk of work loss in SLE.
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Affiliation(s)
- Edward Yelin
- Rosalind Russell Medical Research Center for Arthritis and Institute for Health Policy Studies, University of California, San Francisco, USA.
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Kim SJ, Persad P, Erkan D, Kirou K, Horton R, Salmon JE. Research studies and their implications for social work practice in a multidisciplinary center for lupus care. SOCIAL WORK IN HEALTH CARE 2012; 51:652-660. [PMID: 22905980 DOI: 10.1080/00981389.2012.683711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The complexity of systemic lupus erythematosus (SLE) and its psychosocial impact creates management challenges that require a multidisciplinary team approach for optimal patient care and outcomes. This article provides a brief report on current lupus-related research studies at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery. Studies and their social work implications highlight a comprehensive, integrated model for research, education, and patient care emphasizing interdisciplinary collaboration. Both basic science and clinical research are discussed, with a focus on the role of social workers as an integral part of the health care team in providing assessments and interventions and as support for patients in research studies.
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Affiliation(s)
- Su Jin Kim
- Department of Social Work Programs, Hospital for Special Surgery, New York, New York 10021, USA.
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