Background Depressive and anxiety symptoms are common in children and youth and may impact outcomes for individuals with childhood-onset systemic lupus erythematosus. Research into the prevalence of depressive and anxiety symptoms and childhood-onset systemic lupus erythematosus comorbidity has reported conflicting results. Objective To synthesize current knowledge regarding the prevalence of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus. Methods Studies were identified through a comprehensive search of MEDLINE, EMBASE, PsychINFO, LILACS and Web of Science (from database inception to July 2018) using MESH headings and keywords for ‘lupus erythematosus’, and ‘depression’ or ‘anxiety’. Included studies measured depressive and/or anxiety symptoms prospectively among children and youth aged 8 to 21 years with a diagnosis of childhood-onset systemic lupus erythematosus. Neuropsychiatric systemic lupus erythematosus was included. Studies without use of validated screening tools for major depressive disorder or anxiety disorders were excluded, as were studies where diagnosis was by retrospective analysis of patient charts. Data were extracted by two independent coders and where discrepancies occurred, agreement was reached by consensus. Results In total, 70 studies met the criteria for full text review and of these, 14 were included in the final analysis. The majority (70%) of studies were of cross-sectional design, with sample sizes ranging from 20 to 100 (mean = 48) participants. The mean age of participants was 15.9 years and participants were predominantly female. Prevalence rates for depressive symptoms ranged from 6.7% to 59%. Anxiety symptom prevalence was 34% to 37%. All studies employed self-report instruments to assess depressive and anxiety symptoms; none of the studies utilized a semi-structured diagnostic interview to make psychiatric diagnoses. Significant heterogeneity precluded meta-analysis of the data. Conclusions Depressive and anxiety symptoms may be common comorbidities of childhood-onset systemic lupus erythematosus; however, current research is limited by a paucity of studies, small sample sizes and an inability to confirm psychiatric diagnoses. Future research addressing these limitations is needed.
Background There are no validated screening measures for depressive or anxiety disorders in childhood Systemic Lupus Erythematosus (cSLE). We investigated cross-sectionally (1) the prevalence of depressive and anxiety disorder in cSLE. (2) the validity of the Centre for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Childhood Anxiety and Related Disorders (SCARED) measures in identifyingthese disorders. Methods Participants 8-18 years with cSLE/incipient cSLE completed CES-DC, SCARED, and Quality OfMy Life (QOML) measures. Parents completed the SCARED-Parent measure. Diagnosis was by gold-standard psychiatric interview and determined prevalence of psychiatric disorder. Receiver Operating Characteristics Area under the Curve (ROCAUC) evaluated screening measure diagnostic performance. Results Ofseventy-two parent-child dyads, 56 interviews were completed. Mean screen scores were: CES-DC = 15 (range 1-49, SD 12), SCARED-C = 22 (range 2-61, SD 14), SCARED-P = 13 (range 0-36, SD 8). Depressive disorder screen positivity (CES-DC ≥ 15) was 35% (vs. prevalence 5%). Anxiety disorder screen positivity (SCARED ≥ 25) was 39% (vs. prevalence 16%). CES-DC ROCAUC = 0.98 and SCARED-C ROCAUC = 0.7 (cut-points 38 and 32 respectively). Conclusions Diagnostic thresholds for depressive and anxiety disorderscreening measures are high for both CES-DC and SCARED-C in cSLE. Brief focused interview should follow to determine whether psychiatric evaluation is warranted.
BackgroundDepression and anxiety are common and treatable childhood mental health disorders that have been reported to impact outcomes for individuals with childhood-onset Systemic Lupus Erythematosus (cSLE)1. Research into the prevalence of depression/anxiety and cSLE comorbidity has reported conflicting results, and to our knowledge, no previous review of these data has been undertaken.ObjectivesTo synthesise current knowledge regarding the association of depression and anxiety disorders with cSLE among paediatric patients.MethodsStudies were identified through a comprehensive search of MEDLINE, EMBASE, PsychINFO, LILACS and Web Of Science (from database inception – July 2017) using MESH headings and Keywords for ‘lupus erythematosus’, and ‘depression’ or ‘anxiety’. Included studies measured depression and/or anxiety symptoms prospectively among children and youth 8 to 21 years of age with a diagnosis cSLE. Data were extracted by two independent coders and where discrepancies occurred, agreement was reached by consensus.ResultsSixty-two studies met criteria for full text review, and of these, 13 studies were included in the final analysis. The majority (80%) of studies were of cross-sectional design, with sample sizes ranging from 14 to 100 (mean=47) participants. The mean age of participants was 15.6 years and participants were predominantly female. Prevalence rates for depression ranged from 6.7% to 54%. Anxiety symptom prevalence was 20% to 34%. All studies employed self-report instruments to assess depression and anxiety; none of the studies utilised semi-structured diagnostic interview to make psychiatric diagnoses. Significant heterogeneity precluded meta-analysis of the data.ConclusionsDepression and anxiety may be common comorbidities of cSLE however current research is limited by a paucity of studies, small sample sizes and an inability to confirm psychiatric diagnoses. Future research addressing these limitations is needed.Reference[1] Kohut SA, Williams T, Jayanthikumar J, Landolt-Marticorena C, Lefebvre A, Silverman E, Levy D: Depressive symptoms are prevalent in childhood-onset systemic lupus erythematosus (cSLE). Lupus2013, 22(7):712–720Disclosure of InterestNone declared
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