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Peła Z, Gałecka M, Murgrabia A, Kondratowicz A, Gałecki P. Depressive Disorder and Dermatological Autoimmune Diseases. J Clin Med 2024; 13:3224. [PMID: 38892934 PMCID: PMC11172791 DOI: 10.3390/jcm13113224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/22/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Depressive disorders are a growing problem worldwide. They are also characterized by high comorbidity, including from the circle of dermatological diseases. Autoimmune diseases seem to be particularly correlated with depressive comorbidity, raising the question of their possible common pathomechanism. The PubMed database was searched, focusing on results published after 2016. A particular reciprocal correlation of depressive disorders with psoriasis, atopic dermatitis, alopecia areata, impetigo, lupus and systemic scleroderma was found. One possible explanation for the co-occurrence of the above diseases is that the inflammatory theory may be applicable to depression, the various elements of which also apply to autoimmune diseases.
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Affiliation(s)
| | | | | | | | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, 92-213 Lodz, Poland; (Z.P.); (M.G.); (A.M.); (A.K.)
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2
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Eudy AM, Clowse MEB, Corneli A, McKenna K, Pisetsky DS, Maheswaranathan M, Burshell D, Doss J, Sun K, Sadun RE, Criscione-Schreiber LG, Rogers JL. The Type 1 & 2 systemic lupus erythematosus model: Perspectives of people living with systemic lupus erythematosus. Lupus 2024; 33:266-272. [PMID: 38238905 PMCID: PMC11034781 DOI: 10.1177/09612033241228343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE In the new Type 1 & 2 model for systemic lupus erythematosus (SLE), Type 1 SLE represents classic inflammatory manifestations, such as arthritis, while Type 2 SLE encompasses symptoms such as pain and fatigue where the relationship to inflammation is less clear. The objective of this study was to interview individuals living with SLE to determine the content and face validity of the Type 1 & 2 SLE model. METHODS We conducted a qualitative study using semi-structured interviews with a purposeful sample of participants who met classification criteria for SLE. Participants were asked to describe their experiences with Type 1 & 2 SLE symptoms and treatments, and they indicated if and how their personal experiences aligned with the Type 1 & 2 SLE model. All interviews were audio-recorded and transcribed; applied thematic analysis identified the most frequent and salient themes. RESULTS We interviewed 42 participants with SLE. Type 2 SLE symptoms, such as pain and fatigue, were very common, with almost all participants experiencing some Type 2 symptoms at some point during their disease course. Participants described Type 1 SLE symptoms as being acute flares and life-threatening and Type 2 SLE symptoms as "everyday lupus" that affected their daily lives and were a dominant part of their SLE disease experience. Most participants stated they want their rheumatologists to discuss Type 2 symptoms during clinical appointments in order to address their full symptom experience. CONCLUSION We demonstrated content and face validity of the Type 1 & 2 SLE model with people living with SLE. Participants in our study largely understood the model and felt it accurately reflected their experience living with SLE. Type 2 SLE symptoms are very common in individuals with SLE and impact patients' quality of life. Using the model to address Type 2 SLE symptoms allows the rheumatologist to incorporate the patient's perspective and provide patient-centered care.
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Affiliation(s)
- Amanda M. Eudy
- Department of Medicine, Duke University School of Medicine
| | | | - Amy Corneli
- Department of Medicine, Duke University School of Medicine
- Department of Population Health Sciences, Duke University School of Medicine
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine
| | - David S. Pisetsky
- Department of Medicine, Duke University School of Medicine
- Durham VA Medical Center
| | | | - Dana Burshell
- Department of Medicine, Duke University School of Medicine
| | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine
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3
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Sun K, Eudy AM, Harris N, Pisetsky DS, Criscione-Schreiber LG, Sadun RE, Doss J, Clowse MEB, Rogers JL. Using PROMIS-29 to determine symptom burdens in the context of the Type 1 and 2 systemic lupus erythematosus (SLE) model: a cross sectional study. J Patient Rep Outcomes 2023; 7:136. [PMID: 38127169 PMCID: PMC10739689 DOI: 10.1186/s41687-023-00678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To account for heterogeneity in systemic lupus erythematosus (SLE) and bridge discrepancies between patient- and physician-perceived SLE activity, we developed the Type 1 and 2 SLE model. We examined PROMIS-29 scores, a composite patient-reported outcome (PRO) measure, through the lens of the model. METHODS Patients completed PROMIS-29 and the polysymptomatic distress scale (PSD). Rheumatologists completed the SLE disease activity index (SLEDAI), and physician's global assessments (PGAs) for Type 1 and 2 SLE. We defined Type 1 SLE using SLEDAI, Type 1 PGA, and active nephritis, and Type 2 SLE using PSD and Type 2 PGA. We compared PROMIS-29 T-scores among Type 1 and 2 SLE groups and explored whether PROMIS-29 can predict Type 1 and 2 SLE activity. RESULTS Compared to the general population, patients with isolated Type 1 SLE reported greater pain and physical dysfunction but less depression and improved social functions; patients with high Type 2 SLE (irrespective of Type 1 activity) reported high levels of pain, fatigue, and social and physical limitations. Patients with minimal Type 1 and 2 SLE had less depression and greater physical functioning with other domains similar to national norms. PROMIS-29 predicted Type 2 but not Type 1 SLE activity. CONCLUSION PROMIS-29 similarities in patients with high Type 2 SLE, with and without active Type 1 SLE, demonstrate the challenges of using PROs to assess SLE inflammation. In conjunction with the Type 1 and 2 SLE model, however, PROMIS-29 identified distinct symptom patterns, suggesting that the model may help clinicians interpret PROs.
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Affiliation(s)
- Kai Sun
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA.
| | - Amanda M Eudy
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - Nathaniel Harris
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - David S Pisetsky
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Lisa G Criscione-Schreiber
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - Rebecca E Sadun
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - Jayanth Doss
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
| | - Jennifer L Rogers
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, DUMC 2978, Durham, NC, 27710, USA
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4
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Zhao Q, Li X, Chen H, Wang L, Wu N, Ma J, Shen B. Association between depression and pain, functional disability, disease activity and health-related quality of life in patients with systemic lupus erythematosus: a meta-analysis. BMJ Open 2023; 13:e068683. [PMID: 37821132 PMCID: PMC10583069 DOI: 10.1136/bmjopen-2022-068683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the effect of depression on pain, disease activity, functional disability and health-related quality of life measured by Visual Analogue Scale, Systemic Lupus Erythematosus Disease Activity Index, Health Assessment Questionnaire and Short Form-36 in patients with systemic lupus erythematosus. DESIGN Meta-analysis. DATA SOURCES The PubMed, EMBASE, Cochrane Library and Web of Science were searched for obtaining available studies from inception to 7 March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the impact of depression on pain, disease activity, functional disability and quality of life were included. DATA EXTRACTION AND SYNTHESIS Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were conducted with RevMan V.5.3.0. Data were pooled using a fixed-effects or random-effects model according to heterogeneity. RESULTS A total of 13 identified studies met the inclusion criteria, reporting on a total of 1911 patients with systemic lupus erythematosus. The Visual Analogue Scale score was significantly higher in patients with depression than those without depression (standardised mean difference (SMD)=0.84 (95% CI 0.27 to 1.42), p=0.004). The Health Assessment Questionnaire score was significantly higher in patients with depression than those without depression (SMD=1.05 (95% CI 0.14 to 1.95), p<0.05). The Systemic Lupus Erythematosus Disease Activity Index score was significantly higher in patients with depression than those without depression (SMD=0.46 (95% CI 0.27 to 0.64), p<0.00001). Scores in most Short Form-36 dimensions (physical function, role physical function, emotional role function, vitality, mental health, social function, general health, physical component scale, mental component scale) were lower in patients with depression than those without depression. CONCLUSION This meta-analysis showed that depression was associated with increased in pain, functional disability and disease activity, and decline in health-related quality of life in patients with systemic lupus erythematosus. Awareness of the importance of the relationship between depression in systemic lupus erythematosus patients and pain, functional disability and the quality of life might assist rheumatology physicians and nurses in assessing and preventing these symptoms. PROSPERO REGISTRATION NUMBER CRD42021265694.
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Affiliation(s)
- Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xin Li
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Haoyang Chen
- Department of Nursing, Nantong University Affiliated Rehabilitation Hospital, Nantong, China
| | - Lili Wang
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ning Wu
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ji Ma
- The Orthopaedic Spinal Ward, Shanxi Provincial People's hospital, Taiyuan, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
- School of Nursing, Shanghai Jiaotong University School of Medicine, Shanghai, China
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5
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Eudy AM, Rogers JL, Corneli A, McKenna K, Maheswaranathan M, Pisetsky DS, Criscione-Schreiber LG, Doss J, Sadun RE, Sun K, Clowse MEB. Intermittent and Persistent Type 2 lupus: patient perspectives on two distinct patterns of Type 2 SLE symptoms. Lupus Sci Med 2022; 9:9/1/e000705. [PMID: 36927502 PMCID: PMC9362789 DOI: 10.1136/lupus-2022-000705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We have developed a new conceptual model to characterise the signs and symptoms of SLE: the Type 1 and 2 SLE Model. Within the original model, Type 1 SLE consists of inflammatory manifestations like arthritis, nephritis and rashes; Type 2 SLE includes symptoms of fatigue, myalgia, mood disturbance and cognitive dysfunction. Through in-depth interviews, we explored how the Type 1 and 2 SLE Model fits within the lived experience of patients with SLE, with a focus on the connection between Type 1 and Type 2 SLE symptoms. METHODS Semistructured in-depth interviews were conducted among adult participants meeting 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria for SLE. Participants were purposefully selected for age, race, sex and nephritis history. All interviews were audio-recorded and transcribed. Data were analysed through episode profile and thematic analysis. RESULTS Through interviews with 42 patients with SLE, two patterns of Type 2 SLE emerged: Intermittent (n=18) and Persistent (n=24). Participants with Intermittent Type 2 SLE described feeling generally well when Type 1 is inactive; these participants were younger and had more internal SLE manifestations. Participants with Persistent Type 2 described always experiencing Type 2 symptoms despite inactive Type 1, although the severity may fluctuate. Participants with Persistent Type 2 SLE experienced traditional lupus symptoms of joint pain, hair loss and rash, but less often had severe organ system involvement. CONCLUSIONS By listening to the stories of our patients, we found two underlying patterns of Type 2 SLE: Intermittent Type 2 symptoms that resolve in synchrony with Type 1 inflammatory symptoms, and Persistent Type 2 symptoms that continue despite remission of Type 1 symptoms.
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Affiliation(s)
- Amanda M Eudy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer L Rogers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mithu Maheswaranathan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David S Pisetsky
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca E Sadun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E B Clowse
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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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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7
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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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Eudy AM, Reeve BB, Coles T, Lin L, Rogers JL, Pisetsky DS, Criscione-Schreiber LG, Doss J, Sadun R, Sun K, Clowse MEB. The use of patient-reported outcome measures to classify type 1 and 2 systemic lupus erythematosus activity. Lupus 2022; 31:697-705. [PMID: 35343853 PMCID: PMC9348758 DOI: 10.1177/09612033221090885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We developed a model that categorizes systemic lupus erythematosus (SLE) activity into two dimensions: Type 1 SLE consists of inflammatory activity, including arthritis, nephritis, and rashes; Type 2 SLE includes fatigue, myalgia, mood disturbance, and cognitive dysfunction. Patient-reported outcome (PRO) measures have received attention as a way to capture symptomatology of SLE. The objective of this study was to explore the use of existing PRO measures to classify Type 1 and 2 SLE activity. METHODS Systemic lupus erythematosus patients completed three questionnaires: Systemic Lupus Activity Questionnaire (SLAQ), Polysymptomatic Distress Scale (PSD), and Patient Health Questionnaire (PHQ-2). SLE Disease Activity Index (SLEDAI) and physician global assessments (PGA; 0-3) for Type 1 and Type 2 activity were also recorded. High Type 1 SLE activity was defined as cSLEDAI ≥4 (scored without labs), SLEDAI ≥6, active nephritis, or Type 1 PGA ≥1.0. High Type 2 SLE activity was defined as Type 2 PGA ≥1.0. Patients with both high Type 1 and 2 activity were defined as Mixed SLE, and patients with low Type 1 and 2 activity were defined as Minimal SLE. Data were reduced with a factor analysis. Using a reduced set of 13 variables, multinomial logistic regression models estimated the probability of Minimal, Type 1, Type 2, and Mixed SLE classification. RESULTS The study included 208 patients with SLE. The model accurately predicted the clinician-based Type 1 and 2 SLE classification in 63% of patients; 73% of patients had their Type 1 SLE activity accurately predicted; and 83% had their Type 2 SLE activity accurately predicted. Performance varied by group: 87% of Minimal patients were correctly predicted to be in the Minimal SLE group, yet only about one-third of patients in the Type 1 group were correctly predicted to be in the Type 1 group. CONCLUSIONS Our findings indicate Type 2 SLE activity can be identified by patient-reported data. The use of PROs was not as accurate at predicting Type 1 activity. These findings highlight the challenges of using PROs to categorize and classify SLE symptoms since some manifestations of Type 1 activity (e.g., nephritis) may be essentially clinically silent while other Type 1 manifestations may cause severe symptoms.
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Affiliation(s)
- Amanda M. Eudy
- Department of Medicine, Duke University School of Medicine
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine
| | - Li Lin
- Department of Population Health Sciences, Duke University School of Medicine
| | | | - David S. Pisetsky
- Department of Medicine, Duke University School of Medicine,Medical Research Service Durham VAMC
| | | | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine
| | - Rebecca Sadun
- Department of Medicine, Duke University School of Medicine
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine
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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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10
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Rahimian R, Belliveau C, Chen R, Mechawar N. Microglial Inflammatory-Metabolic Pathways and Their Potential Therapeutic Implication in Major Depressive Disorder. Front Psychiatry 2022; 13:871997. [PMID: 35782423 PMCID: PMC9245023 DOI: 10.3389/fpsyt.2022.871997] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022] Open
Abstract
Increasing evidence supports the notion that neuroinflammation plays a critical role in the etiology of major depressive disorder (MDD), at least in a subset of patients. By virtue of their capacity to transform into reactive states in response to inflammatory insults, microglia, the brain's resident immune cells, play a pivotal role in the induction of neuroinflammation. Experimental studies have demonstrated the ability of microglia to recognize pathogens or damaged cells, leading to the activation of a cytotoxic response that exacerbates damage to brain cells. However, microglia display a wide range of responses to injury and may also promote resolution stages of inflammation and tissue regeneration. MDD has been associated with chronic priming of microglia. Recent studies suggest that altered microglial morphology and function, caused either by intense inflammatory activation or by senescence, may contribute to depression and associated impairments in neuroplasticity. In this context, modifying microglia phenotype by tuning inflammatory pathways might have important translational relevance to harness neuroinflammation in MDD. Interestingly, it was recently shown that different microglial phenotypes are associated with distinct metabolic pathways and analysis of the underlying molecular mechanisms points to an instrumental role for energy metabolism in shaping microglial functions. Here, we review various canonical pro-inflammatory, anti-inflammatory and metabolic pathways in microglia that may provide new therapeutic opportunities to control neuroinflammation in brain disorders, with a strong focus on MDD.
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Affiliation(s)
- Reza Rahimian
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Verdun, QC, Canada
| | - Claudia Belliveau
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Verdun, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Rebecca Chen
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Verdun, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Naguib Mechawar
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Verdun, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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11
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Parperis K, Psarelis S, Chatzittofis A, Michaelides M, Nikiforou D, Antoniade E, Bhattarai B. Association of clinical characteristics, disease activity and health-related quality of life in SLE patients with major depressive disorder. Rheumatology (Oxford) 2021; 60:5369-5378. [PMID: 33547787 DOI: 10.1093/rheumatology/keab123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the contributing factors associated with major depressive disorder (MDD) in SLE patients and examine the association between disease-specific health-related quality of life [lupus quality of life (LupusQoL)] domains and MDD. METHODS Depression was assessed by the patient health questionnaire (PHQ)-9, and scores ≥10 indicate MDD. Demographic data, LupusQoL domains, clinical and other features of the SLE patients were described and compared between MDD (PHQ-9 ≥10) and non-MDD (PHQ-9 <10) groups using χ2 tests for categorical variables and Wilcoxon rank sum tests for non-normal continuous variables. The risk of MDD was evaluated for the patient and physician-reported features individually using log-binomial models to estimate relative risks and 95% confidence limits. RESULTS Eighty-eight patients with SLE met eligibility criteria, with a mean (range) age of 48.6 (19-80), mostly female (80%) and with a mean disease duration of 13.2 years. Compared with the non-MDD group, patients with MDD (n = 32, 36%) were more likely to have the following SLE manifestations: mucocutaneous, vascular, ocular, pulmonary and musculoskeletal involvement. Self-rated health described as poor/fair was markedly associated with MDD (P < 0.001, relative risk = 0.48). Based on relative risks, higher pain visual analogue score, and patient and physician global assessment scores were also linked to MDD. The LupusQoL domain scores were notably lower in the MDD patients, with a statistically significant reduction in all LupusQoL domains. CONCLUSION Predictors of MDD in SLE patients include higher scores in pain and global assessment, poor or fair self-reported health, and specific organ involvement. These findings may help clinicians to recognize and manage MDD promptly.
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Affiliation(s)
- Konstantinos Parperis
- Department of Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus and University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | | | | | - Elpida Antoniade
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Bikash Bhattarai
- Department of Biostatistics, Valleywise Health and University of Arizona College of Medicine, Phoenix, Arizona, USA
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Longitudinal relationships between cognitive domains and DEPRESSION and anxiety symptoms in systemic lupus erythematosus. Semin Arthritis Rheum 2021; 51:1186-1192. [PMID: 34607183 DOI: 10.1016/j.semarthrit.2021.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine i) the relationship between neuropsychological performance and depression and anxiety over time, and ii) the overlap between classification of cognitive dysfunction, anxiety, and depression in SLE. METHODS 301 patients with SLE were included. Cognition was measured using a modified version of the ACR neuropsychological battery; cognitive dysfunction was defined as z-scores ≤-1.5 on ≥2 domains. Depression and anxiety were measured using the Beck Depression Inventory-II and the Beck Anxiety Inventory, respectively. All measures were assessed at baseline, 6, and 12 months. Their relationships were analyzed using Multiple Factor Analysis (MFA). RESULTS Anxiety and depression and neuropsychological performance were stable across time. Factor analysis identified two dimensions explaining 42.2% of the variance in neuropsychological performance. The first dimension (33.1% of the variance) included primarily complex cognitive tests measuring executive function; verbal, visual, and working memory; and complex processing speed. The second dimension (9.1% of the variance) included primarily measures of simple information processing speed or motor dexterity. Anxiety and depression scores were consistently related to the first cognitive dimension. There was substantial overlap in participants classified with cognitive dysfunction and anxiety and depression. CONCLUSIONS Depression and anxiety symptoms in SLE patients are related to a cognitive dimension incorporating memory, executive function and complex processing speed in a stable manner across one year. Many patients with cognitive dysfunction exhibit clinically significant anxiety and depression. Further research should examine whether cognition improves when anxiety and depression are treated and mechanistic links between anxiety and depression and cognitive dysfunction in SLE.
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Pisetsky DS, Eudy AM, Clowse MEB, Rogers JL. The Categorization of Pain in Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2021; 47:215-228. [PMID: 33781491 DOI: 10.1016/j.rdc.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematous is a systemic autoimmune disease that can cause severe pain and impair quality of life. Pain in lupus can arise from a variety of mechanisms and is usually assessed in terms of activity and damage. In contrast, categorization of symptoms as type 1 and type 2 manifestations encompasses a broader array of symptoms, including widespread pain, fatigue, and depression that may track together. The categorization of symptoms as type 1 and type 2 manifestations can facilitate communication between patient and provider as well as provide a framework to address more fully the complex symptoms experienced by patients.
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Affiliation(s)
- David S Pisetsky
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA; Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA.
| | - Amanda M Eudy
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer L Rogers
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
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Chessa E, Piga M, Floris A, Devilliers H, Cauli A, Arnaud L. Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology (Oxford) 2021; 59:3622-3632. [PMID: 32789462 DOI: 10.1093/rheumatology/keaa383] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. METHODS This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients' age. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. RESULTS The literature search identified 91 studies. Face validity was reported in all the articles retrieved in which the PGA was used alone or as part of composite indices (Systemic Responder Index, Safety of Estrogen in Lupus Erythematosus National Assessment Flare Index, Lupus Low Disease Activity State, Definitions of Remission in Systemic Lupus Erythematosus criteria). Content validity was reported in 89 studies. Construct validity was demonstrated by a good correlation (r ≥ 0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). Criterion validity was assessed exploring the PGA correlation with quality of life measurements, biomarker levels and treatment changes in 28 studies, while no study has evaluated correlation with damage. A good responsiveness for PGA was shown in eight studies. A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67-0.98). CONCLUSION PGA is a valid, responsive and feasible instrument, though its reliability was impacted by the scale adopted, suggesting the major need for standardization of its scoring.
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Affiliation(s)
| | - Matteo Piga
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Alberto Floris
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François-Mitterrand, service de médecine interne et maladies systémiques (médecine interne, 2) et Centre d'Investigation Clinique, Inserm CIC-EC 1432, Dijon, France
| | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Référence des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Strasbourg, France
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15
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Kenney-Riley K, Berkowitz SS, Rapoza K. Understanding patient-provider discordance in adolescents with lupus: The role of pain and antidepressant medication use. Health Psychol Open 2020; 7:2055102920977714. [PMID: 33343916 PMCID: PMC7727063 DOI: 10.1177/2055102920977714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study examines depression and pain as potential contributors to patient-provider discordance in the assessment of lupus disease activity. The study conducted a secondary analysis of data obtained from the Childhood Arthritis and Rheumatology Research Alliance registry, with N = 859 adolescent participants. Assessments of pain, disease activity, and antidepressant medication use were collected from the patient and provider. Results indicated that depression might be underdiagnosed in pediatric lupus patients. While psychotropic medication and pain scores were independently related to greater patient-provider discordance regarding health status, pain mediated this relationship. Implications for treatment outcomes are discussed.
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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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Koleck M, Raymond I, Martin-Lasserre MP, Faury S. Travailler l’acceptation de la maladie en éducation thérapeutique : exemple d’une intervention « ateliers théâtre » pour des personnes porteuses d’un lupus. PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hunter EA, Spears EC, Martz CD, Chung K, Fuller-Rowell TE, Lim SS, Drenkard C, Chae DH. Racism-related stress and psychological distress: Black Women's Experiences Living with Lupus study. J Health Psychol 2020; 26:2374-2389. [PMID: 32228184 DOI: 10.1177/1359105320913085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Disparate health consequences in African American women with systemic lupus erythematosus include greater severity of physical and psychological distress. Racism-related stress is also related to psychological distress correlates in this population. This study examined the relationships between racism-related experiences, psychological distress, and systemic lupus erythematosus activity in 430 African American women from the Black Women's Experiences Living with Lupus study. The structural equation model suggests that psychological distress mediates the relationship between racism-related stress and systemic lupus erythematosus disease activity. The impact of racism-related stress on systemic lupus erythematosus disease activity may occur primarily through their impact on psychological health variables. Implications for clinical care and future directions are explored.
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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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20
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Pisetsky DS, Clowse MEB, Criscione-Schreiber LG, Rogers JL. A Novel System to Categorize the Symptoms of Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:735-741. [PMID: 30354033 DOI: 10.1002/acr.23794] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/16/2018] [Indexed: 12/17/2022]
Affiliation(s)
- David S Pisetsky
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina
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Dodd S, Mitchell PB, Bauer M, Yatham L, Young AH, Kennedy SH, Williams L, Suppes T, Lopez Jaramillo C, Trivedi MH, Fava M, Rush AJ, McIntyre RS, Thase ME, Lam RW, Severus E, Kasper S, Berk M. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry 2018; 19:330-348. [PMID: 28984491 DOI: 10.1080/15622975.2017.1379609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
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Affiliation(s)
- Seetal Dodd
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia
| | - Philip B Mitchell
- f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia
| | - Michael Bauer
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Lakshmi Yatham
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Allan H Young
- i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK
| | - Sidney H Kennedy
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Lana Williams
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia
| | - Trisha Suppes
- k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA
| | | | - Madhukar H Trivedi
- m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Maurizio Fava
- n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - A John Rush
- o Duke-National University of Singapore Medical School , Singapore , Singapore
| | - Roger S McIntyre
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada.,q Brain and Cognition Discovery Foundation , Toronto , ON , Canada
| | - Michael E Thase
- r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA
| | - Raymond W Lam
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Emanuel Severus
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Siegfried Kasper
- s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria
| | - Michael Berk
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia.,e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia
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Figueiredo-Braga M, Cornaby C, Bernardes M, Figueiredo M, Mesquita CDS, Costa L, Poole BD. Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease. PLoS One 2018; 13:e0195579. [PMID: 29659589 PMCID: PMC5901990 DOI: 10.1371/journal.pone.0195579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects a large number of people throughout the world. Anxiety, depression and fatigue are common symptoms of SLE that substantially contribute to decreased quality of life. This study investigates the interplay between physical and psychiatric manifestations of lupus. To this end, an SLE patient cohort was examined for correlations between clinical presentation, laboratory tests, and psychological indicators. METHODS Seventy-two lupus patients were evaluated for psychological status using a battery of instruments, including assessments for fatigue (CFS & FSS), depression (HADS), anxiety (HADS), overall health (SF-36 & PSQI) and intimate relationship satisfaction (RAS & CSI). Scores from these assessments were correlated with lupus clinical profiles and laboratory test values. RESULTS The prevalence of depression in the SLE patient cohort was 41.7%, as measured by the hospital depression and anxiety scale. The study identified that pain (p = 0.001), body mass index (p = 0.026), Chalder's fatigue scale (p < 0.001), fatigue severity scale (p < 0.001), and anxiety (p = 0.001) are all positively correlated with depression in SLE patients. Total complement (CH50) (p = 0.032), and SF-36 physical and mental characteristic assessments are negatively correlated with depression. Longitudinal analysis indicated that the disease related complaint alopecia (p = 0.008) and relationship assessment scale scores (p = 0.004) may also be correlated to depression in SLE patients. Multivariant scrutiny of the clinical and psychosocial characteristics identified the fatigue severity scale (p = 0.026), SF-36 physical function (p = 0.040), physical role function (0.030), and mental health (p = 0.002) as the best indicators directly correlated with depression for the SLE cohort. CONCLUSION These results reveal the influence of physical manifestations of lupus including fatigue, pain, body mass index and anxiety, as well as decreased physical and mental function, on depression. Fatigue is the strongest factor correlated with depression in SLE patients in the cohort. Both physical and social/psychological aspects likely contribute to the depression and anxiety in lupus.
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Affiliation(s)
- Margarida Figueiredo-Braga
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Caleb Cornaby
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
| | - Miguel Bernardes
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Marta Figueiredo
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lúcia Costa
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
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Mani A, Rostami A, Aflaki E, Ravanfar P. Temperament and character in patients with systemic lupus erythematosus. Compr Psychiatry 2018; 80:104-108. [PMID: 29080410 DOI: 10.1016/j.comppsych.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In addition to identified neuropsychiatric characteristic of systemic lupus erythematosus (SLE), changes in personality seem to occur in patients with SLE. Even in absence of an axis I psychiatric diagnosis, personality variations play important role in general wellbeing of these patients. This study investigated personality features in patients with SLE using Temperament and Character Inventory (TCI). METHOD In this case-control study personality features of 59 patients with confirmed diagnosis of SLE were evaluated using Persian version of TCI-125 questionnaire. Collected data from patients with SLE were statistically compared with normative data for Iranian population. RESULTS Among four subscales of temperament, reward dependence (RD) and harm-avoidance (HA) were significantly lower than general population. Self-directedness (SD) character dimension was significantly lower in SLE patients compared to normative data. No significant difference was noted in novelty-seeking (NS) and persistence (PS) temperament scales and cooperativeness (CO) and self-transcendence (ST) character scales. CONCLUSION Personality changes in SLE is characterized by higher HA and RD along with low SD. These features are associated with higher anxiety, social withdrawal and lower resourcefulness and purposefulness.
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Affiliation(s)
- Arash Mani
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Iran
| | - Anahita Rostami
- School of Medicine, Shiraz University of Medical Sciences, Iran
| | - Elham Aflaki
- Department of rheumatology, Shiraz University of Medical Sciences, Iran
| | - Parsa Ravanfar
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Iran.
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Azizoddin DR, Weinberg S, Gandhi N, Arora S, Block JA, Sequeira W, Jolly M. Validation of the LupusPRO version 1.8: an update to a disease-specific patient-reported outcome tool for systemic lupus erythematosus. Lupus 2017; 27:728-737. [PMID: 29087259 DOI: 10.1177/0961203317739128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives LupusPRO has shown good measurement properties as a disease-specific patient-reported outcome tool in systemic lupus erythematosus (SLE). For the purpose of clinical trials, the version 1.7 (v1.7) domain of Pain-Vitality was separated into distinct Pain, Vitality and Sleep domains in v1.8, and the psychometric properties examined. Methods A total of 131 consecutive SLE patients were self-administered surveys assessing fatigue (FACIT, SF-36), pain (Pain Inventory, SF-36), insomnia (Insomnia Severity Index), emotional health (PHQ-9, SF-36) and quality of life (SF-36, LupusPRO) at routine care visits. Internal consistency reliability (ICR) for each domain was obtained using Cronbach's alpha. The convergent construct validity of LupusPRO domains with corresponding SF-36 domains or tools were tested using Spearman correlation. Varimax rotations were conducted to assess factor structures of the LupusPRO v1.8. Results Mean (SD) age was 40.04 (14.10) years. Scores from the LupusPRO-Sleep domain strongly correlated with insomnia scores, while LupusPRO-Vitality correlated strongly with fatigue (FACIT) and SF-36 vitality. The LupusPRO-Pain domain correlated strongly with pain (SF36 Bodily-Pain, Pain Inventory) scores. Similarly, the LupusPRO domains of Physical and Emotional Health had significant correlations with corresponding SF-36 domains. The ICR for HRQoL and non-HRQoL were 0.96 and 0.81. LupusPRO (domains HRQoL and QoL) scores correlated with disease activity. Principal component analysis included seven factor loadings presenting for the HRQOL subscales (combined Sleep, Vitality, and Pain), and three factors for the NHRQoL (Combined Coping and Social Support). Conclusions LupusPRO v1.8 (including its Sleep, Vitality, and Pain domains) has acceptable reliability and validity. Use of LupusPRO as an outcome measure in clinical trials would facilitate responsiveness assessment.
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Affiliation(s)
- D R Azizoddin
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Weinberg
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - N Gandhi
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Arora
- 2 Division of Rheumatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - J A Block
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - W Sequeira
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - M Jolly
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
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Macêdo EA, Appenzeller S, Costallat LTL. Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Lupus 2017; 27:179-189. [PMID: 28587586 DOI: 10.1177/0961203317713142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
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26
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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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Sambamoorthi U, Shah D, Zhao X. Healthcare burden of depression in adults with arthritis. Expert Rev Pharmacoecon Outcomes Res 2017; 17:53-65. [PMID: 28092207 PMCID: PMC5512931 DOI: 10.1080/14737167.2017.1281744] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/10/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Arthritis and depression are two of the top disabling conditions. When arthritis and depression exist in the same individual, they can interact with each other negatively and pose a significant healthcare burden on the patients, their families, payers, healthcare systems, and society as a whole. Areas covered: The primary objective of this review is to summarize, identify knowledge gaps and discuss the challenges in estimating the healthcare burden of depression among individuals with arthritis. Electronic literature searches were performed on PubMed, Embase, EBSCOhost, Scopus, the Cochrane Library, and Google Scholar to identify relevant studies. Expert Commentary: Our review revealed that the prevalence of depression varied depending on the definition of depression, type of arthritis, tools and threshold points used to identify depression, and the country of residence. Depression exacerbated arthritis-related complications as well as pain and was associated with poor health-related quality of life, disability, mortality, and high financial burden. There were significant knowledge gaps in estimates of incident depression rates, depression attributable disability, and healthcare utilization, direct and indirect healthcare costs among individuals with arthritis.
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Affiliation(s)
- Usha Sambamoorthi
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
| | - Drishti Shah
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
| | - Xiaohui Zhao
- a Department of Pharmaceutical Systems and Policy , School of Pharmacy, West Virginia University , Morgantown , WV , USA
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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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29
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Macêdo EA, Appenzeller S, Costallat LTL. Gender differences in systemic lupus erythematosus concerning anxiety, depression and quality of life. Lupus 2016; 25:1315-27. [DOI: 10.1177/0961203316638934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Several studies have demonstrated a high prevalence of depression and anxiety in patients with systemic lupus erythematosus (SLE); however, few data address gender differences regarding these manifestations. This study aimed to investigate gender differences in the prevalence of depressive and anxiety symptoms, and their effect on the quality of life (QOL) of male and female SLE patients. This study included 54 male SLE patients, 54 female SLE patients, 54 male controls and 54 female controls. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale (HADS); the anxiety symptoms were examined using HADS. We used the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to assess QOL. Depressive symptoms were found in 22.2% of BDI respondents, 24.1% of CES-D respondents and 13% of HADS-D respondents who were male SLE patients; while in the female SLE patient group, they were found in 38.9% of BDI respondents ( p = 0.063), 51.9% of CES-D respondents ( p = 0.653) and 31.5% of HADS-D respondents ( p = 0.003). Anxiety symptoms were found in 16.7% of the male SLE patients and 38.9% of the female SLE patients ( p = 0.024). Lower scores on the SF-36 (for QOL) were found in both male and female SLE patients with depression and anxiety symptoms. In conclusion, we observed significant gender differences regarding the prevalence of depressive and anxiety symptoms in patients with SLE, with significantly higher values in the female group. The presence of these symptoms appears to have a negative effect on the QOL of patients of both genders.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, State University of Campinas, Campinas, Brazil
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30
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Abstract
Up to 50% of patients with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs, but also mediates behavior abnormalities including fatigue and depression-like symptoms. This review focuses on the different pathways involved in the communication of the immune system with the neuronal network and the body's timing system. The latter is built up by a hierarchically organized expression of clock genes. As discussed here, the activation of the immune system interferes with high amplitude expression of clock genes, an effect which may play a pivotal role in depression-like behavior in autoimmune diseases.
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Affiliation(s)
- Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy & Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Adriano Fontana
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
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31
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Nishimura K, Omori M, Katsumata Y, Sato E, Kawaguchi Y, Harigai M, Yamanaka H, Ishigooka J. Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study. Lupus 2015; 25:463-71. [PMID: 26527504 DOI: 10.1177/0961203315615223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence. RESULTS Prevalence of depression was higher in patients (n = 11, 25.6%) than in controls (n = 2, 6.7%; p = 0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n = 15; controls: 16.7%, n = 5; p = 0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p = 0.027) as an independent risk factor for depression. CONCLUSION Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.
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Affiliation(s)
- K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - M Omori
- Kanagawa Psychiatric Center, Yokohama, Japan
| | - Y Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - E Sato
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - J Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Barbasio C, Vagelli R, Marengo D, Querci F, Settanni M, Tani C, Mosca M, Granieri A. Illness perception in systemic lupus erythematosus patients: The roles of alexithymia and depression. Compr Psychiatry 2015; 63:88-95. [PMID: 26555496 DOI: 10.1016/j.comppsych.2015.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Alexithymia and depressive mood have been described as important dimensions of several medical diseases. Systemic lupus erythematosus is a chronic condition characterized by unpredictable clinical manifestations. The relationships between alexithymia, depression, and illness perception were examined in systemic lupus erythematosus patients. The interrelationships between psychological factors, such as alexithymia and depressive mood, were explored in systemic lupus erythematosus patients, and associations between these factors and illness perception in SLE were examined. We hypothesized that alexithymia and negative perceptions of illness would be associated in SLE patients, and depression would mediate this relationship. METHODS Subjects were 100 consecutive systemic lupus erythematosus patients attending the outpatient clinic at the University of Pisa rheumatology unit. They completed the Toronto Alexithymia Scale, Beck Depression Inventory, and Revised Illness Perceptions Questionnaire. Clinical variables were measured, disease activity was evaluated using the European Consensus Lupus Activity Measure, and damage was assessed using the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index. RESULTS There were no associations between clinical variables, alexithymia, and depression. The results highlight the existence of significant links between alexithymia and illness perception for systemic lupus erythematosus patients. Moreover, our data suggest that some of these links are mediated by depression, which is the direct predictor of different aspects of perceived health. CONCLUSION Our findings suggest that studying the role of psychological factors, such as alexithymia and depression, may contribute to a more comprehensive perspective of systemic lupus erythematosus, including their impact on patients' beliefs about treatment effectiveness and emotional adaptation to chronic disease.
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Affiliation(s)
| | - Roberta Vagelli
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Italy; Department of social sciences and humanities, University of Aosta Valley, Italy.
| | - Francesca Querci
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | | | - Chiara Tani
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
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Tay SH, Cheung PPM, Mak A. Active disease is independently associated with more severe anxiety rather than depressive symptoms in patients with systemic lupus erythematosus. Lupus 2015; 24:1392-9. [DOI: 10.1177/0961203315591026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Abstract
Objective The inter-correlation between and co-existence of depression and anxiety may engender inconsistency in addressing the relationship between the severity of depression and disease activity of systemic lupus erythematosus (SLE). We aimed at identifying whether lupus disease activity is independently associated with depression and anxiety in lupus patients. Methods Adult lupus patients were assessed for the severity of depressive and anxiety symptoms and lupus disease activity by using the Hospital Anxiety and Depression Scale (HADS) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), respectively. Age- and gender-matched healthy controls (HCs) were recruited for comparison. Prevalence and severity of depressive and anxiety symptoms were compared between lupus patients and HCs. Independent relationships between the severity of anxiety (HADS-Anxiety) and depressive (HADS-Depression) symptoms, and SLEDAI were studied with regression models. Results In total, 110 lupus patients and 110 HCs were studied. Lupus patients had significantly higher HADS scores than HCs (10.82 ± 6.5 vs 7.34 ± 4.9, p < 0.001). Significantly more lupus patients had anxiety (40.9 vs 21.8%, p = 0.002) and depressive symptoms (15.5 vs 6.4%, p = 0.025) than HCs. Multiple linear regression analyses revealed that SLEDAI (β = 0.160, p = 0.016), calcineurin inhibitor non-use (β = –1.929, p = 0.041) and past cyclophosphamide non-use (β = –1.603, p = 0.039) independently predicted HADS-Anxiety amongst lupus patients even after adjusting for HADS-Depression. Conversely, SLEDAI (β = 0.014, p = 0.834) lost its significant univariate correlation with HADS-Depression after controlling for HADS-Anxiety and other covariates. Conclusion Anxiety is more common in lupus patients than in HCs, and its severity is independently associated with more active SLE regardless of the presence or absence of concomitant depression.
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Affiliation(s)
- S H Tay
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P P M Cheung
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Mak
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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Huang X, Magder LS, Petri M. Predictors of incident depression in systemic lupus erythematosus. J Rheumatol 2014; 41:1823-33. [PMID: 25128512 DOI: 10.3899/jrheum.140111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Findings from previous studies of predictors of depression among patients with systemic lupus erythematosus (SLE) have been inconsistent. The aim of our study was to identify risk factors that preceded incident depression based on a large, closely followed longitudinal cohort. METHODS Data regarding 1609 patients with SLE in the Hopkins Lupus Cohort who had no history of depression prior to cohort entry were analyzed. Demographic variables, SLE manifestations, laboratory tests, physician's global assessment, Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and onset of depression were recorded at enrollment and each quarterly visit. Rates of incident depression were calculated overall, and in subgroups defined by demographic and clinical variables. Adjusted estimates of association were derived using pooled logistic regression. RESULTS The incidence of depression was 29.7 episodes per 1000 person-years. In the multivariable analysis, these variables remained as independent predictors of incident depression: recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, longitudinal myelitis, and current prednisone use of 20 mg/day or higher. Global disease activity (SELENA-SLEDAI) was not a significant predictor after controlling for prednisone use. CONCLUSION Depression in SLE is multifactorial. Higher-dose prednisone (≥ 20 mg daily) is 1 important independent risk factor. Global disease activity is not a risk factor, but cutaneous activity and certain types of neurologic activity (myelitis) are predictive of depression. The independent effect of prednisone provides clinicians with an additional incentive to avoid and reduce high-dose prednisone exposure in SLE.
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Affiliation(s)
- Xiangyang Huang
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.
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