Depressed Symptomatology in Systemic Lupus Erythematosus Patients

Kellahan, Sara R.; Huang, Xinliang; Lew, Daphne; Xian, Hong; Eisen, Seth A.; Kim, Alfred H.J.

doi:10.1002/acr.24833

Cited by 8 publications

(8 citation statements)

References 48 publications

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“…Patients' depression severity was also found to be consistently associated with anxiety symptoms over time. We previously reported that severity of depressed affect can also be classified into distinct trajectory groups that were similarly durable over time ( 18 ). When we examined baseline depression scores across the four anxiety trajectory groups, a dose–response relationship was observed.…”

Section: Discussionmentioning

confidence: 99%

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Anxiety Symptoms Among Patients With Systemic Lupus Erythematosus Persist Over Time and Are Independent of SLE Disease Activity

Lew

Huang

Kellahan

et al. 2022

ACR Open Rheumatology

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Objective. The objectives of this study are to identify patterns of anxiety symptomology over time among patients with systemic lupus erythematosus (SLE) and to assess the longitudinal relationship between SLE disease activity and anxiety symptomology.Methods. Longitudinal data from 139 patients with American College of Rheumatology or Systemic Lupus International Collborating Clinic (SLICC)-classified SLE were analyzed. Anxiety symptomology was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress: Anxiety Short Form 8a. SLE disease activity was measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 (S2K) and S2K Responder Index 50 (S2K RI-50). Group-based trajectory modeling (GBTM) identified longitudinal trajectories of anxiety symptomology. The relationship between disease activity and anxiety over time was assessed using multilevel linear regressions.Results. The mean patient age was 40.2 years (standard deviation [SD], 12.7); 90.6% were female, and 56.1% were of Black race. All patients had at least three PROMIS anxiety scores over an average of 30.9 months (SD, 13.0). GBTM identified four trajectories of anxiety symptomology, labeled as the following: low (LA), average (AA), moderate (MA), and high anxiety (HA). Black patients were 2.47 (95% confidence interval: 1.19-5.12) times as likely as White patients to be classified into the MA or HA groups compared with the LA or AA groups. On multivariable analysis, active SLE disease was not significantly associated with anxiety over time (P = 0.19).Conclusion. Anxiety trajectories remained stable over time, and racial differences in anxiety severity were observed. SLE disease activity was not longitudinally associated with anxiety after controlling for depression and other factors. Further understanding of the factors that contribute to the persistence of anxiety among individuals with SLE is necessary.

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Section: Discussionmentioning

confidence: 99%

“…With these considerations in mind, we recently reported that depressed affect is both persistent and largely severe for up to 4 years in a Washington University cohort of patients with SLE ( 18 ). We were further curious to determine whether similar findings may be present for anxiety in this cohort.…”

Section: Introductionmentioning

confidence: 99%

Anxiety Symptoms Among Patients With Systemic Lupus Erythematosus Persist Over Time and Are Independent of SLE Disease Activity

Lew

Huang

Kellahan

et al. 2022

ACR Open Rheumatology

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“…Our results are in agreement with a longitudinal study of 139 SLE patients which revealed four distinct anxiety trajectories that remained stable and not affected by disease activity over an average period of 30.9 months [ 58 ]. A similar analysis focusing on depression also showed persistence over time and a lack of association with temporal trends in SLEDAI-2K (average follow-up of 30.2 months) [ 59 ]. Collectively, and in line with a previous cohort study indicating that depression might be a long-term outcome of SLE [ 54 ], these data suggest that fluctuations of disease activity might not be major drivers of anxiety and depression, especially in the context of long-standing disease, although it has been argued that prolonged remission (i.e., lasting at least 5 years) might have a positive impact on depression [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

Nikoloudaki

Repa

Pitsigavdaki

et al. 2022

JCM

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Mental disorders such as anxiety and depression are prevalent in systemic lupus erythematosus (SLE) patients, yet their association with the underlying disease activity remains uncertain and has been mostly evaluated at a cross-sectional level. To examine longitudinal trends in anxiety, depression, and lupus activity, a prospective observational study was performed on 40 adult SLE outpatients with active disease (SLE Disease Activity Index [SLEDAI]-2K ≥ 3 [excluding serology]) who received standard-of-care. Anxiety and depression were determined at baseline and 6 months by the Hospital Anxiety and Depression Scale. Treatment adherence was assessed with the Morisky Medication Adherence Scale-4. Increased anxiety (median [interquartile range] HADS-A: 11.0 [7.8]) and depression (HADS-D: 8.0 [4.8]) were found at inclusion, which remained stable and non-improving during follow-up (difference: 0.0 [4.8] and −0.5 [4.0], respectively) despite reduced SLEDAI-2K by 2.0 (4.0) (p < 0.001). Among possible baseline predictors, paid employment—but not disease activity—correlated with reduced HADS-A and HADS-D with corresponding standardized beta-coefficients of −0.35 (p = 0.017) and −0.27 (p = 0.093). Higher anxiety and depression correlated with lower treatment adherence (p = 0.041 and p = 0.088, respectively). These results indicate a high-mental disease burden in active SLE that persists despite disease control and emphasize the need to consider socioeconomic factors as part of comprehensive patient assessment.

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“…The most extended observation period for mood disorders in SLE was 48 months, and this study’s results emphasize that the level of SLE disease activity was associated with depression scores in the multivariate analysis. Still, no significant association was evident in the univariate analysis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…This study also highlighted that SLE activity was not longitudinally linked to anxiety when managing depression and other factors [ 18 ]. Another study on the longitudinal progression of depression, covering a similar four-year period, found that a significant portion (61.2%) of patients exhibited consistent symptoms of depression or major depressive disorder as per the Center for Epidemiologic Studies Depression Scale—Revised (CESD-R) scores [ 19 ]. Since anxiety and depression seem to be the most encountered psychiatric manifestations of NPSLE [ 20 ], the study presented in this paper aimed to investigate the progression of anxiety and depression in patients with NPSLE over a year.…”

Section: Introductionmentioning

confidence: 99%

One-Year Outcomes for Depression and Anxiety in SLE Patients

Duca,

Roman,

Ifteni

et al. 2024

Biomedicines

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Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) is a severe form of SLE involving the nervous system, resulting in neurological and psychiatric symptoms. Although research has shown that SLE patients often suffer from cognitive impairments, depression, and anxiety, there are no specialized guidelines for psychiatric assessment and treatment. This study aimed to investigate the progression of neuropsychiatric symptoms in SLE patients, explicitly focusing on anxiety and depression, over a year. It also aimed to identify potential biomarkers linked to NPSLE and explore the connection between NPSLE and the overall progression of SLE. Our research involved a longitudinal study with 65 adults diagnosed with SLE. Participants underwent various physical, biochemical, and serological tests and were assessed using disease activity indexes like BILAG-2004 and SLEDAI-2K. Participants also underwent psychological assessments using the Hamilton Anxiety and Depression Rating Scales. The study did not find any significant impact of antidepressant therapy on the evolution of anxiety and depression among participants. However, medications like Methotrexate and Plaquenil showed a substantial reduction in these symptoms. Moreover, anxiolytic therapy seems to influence depression in SLE patients. The study also noted that anxiety levels tend to increase over time but are not directly associated with SLE activity. This study concludes that although specific SLE medications can affect the level of anxiety and depression, the overall effectiveness of neuropsychiatric therapy in managing these symptoms is limited. The findings suggest that further research into the tailored management of NPSLE symptoms and a deeper understanding of the disease’s psychiatric aspects are needed.

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Depressed Symptomatology in Systemic Lupus Erythematosus Patients

Cited by 8 publications

References 48 publications

Anxiety Symptoms Among Patients With Systemic Lupus Erythematosus Persist Over Time and Are Independent of SLE Disease Activity

Anxiety Symptoms Among Patients With Systemic Lupus Erythematosus Persist Over Time and Are Independent of SLE Disease Activity

Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

One-Year Outcomes for Depression and Anxiety in SLE Patients

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