Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand

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.

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

“…We found paid employment status to be protective against both anxiety and depression with corresponding odds ratios of 0.18 and 0.23, independent of SLE severity measures such as SLEDAI and organ damage. This is in agreement with other studies that have identified socioeconomic factors, in particular unemployment, financial strain, or low-social support, as significant correlates of depression in SLE [ 5 , 14 , 19 , 23 , 61 ]. Indeed, mediation modeling has suggested that low-socioeconomic status may impact negatively on the psychosocial resilience [ 61 ] and perceived stress [ 13 ] of lupus patients, thus contributing to higher anxiety, depression, and subsequent disability.…”

“…In our sample comprising of active SLE patients with an average age and disease duration of 50.5 and 10.3 years, respectively, significant anxiety (HADS-A ≥ 11) and depression (HADS-D ≥ 8) was each noted in 52.5%. This is in line with the results from previous cross-sectional observational studies [ 7 , 11 , 18 , 23 , 50 , 51 , 52 , 53 ] and meta-analyses of published data [ 3 , 4 ], although reported rates may vary according to the study design, population characteristics, and diagnostic instruments used. In the same context, a large Danish cohort study found that compared with the general population, the adjusted hazard ratio of depression was 2.22 (95% CI 1.77–2.77) for SLE patients [ 54 ].…”

“…Although it is plausible to consider inflammation as a determining factor for mental disorders in SLE [ 56 ], there are conflicting reports regarding the relationship of disease activity with anxiety and depression [ 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. To overcome the cross-sectional design limitations of most aforementioned studies, we enrolled active SLE individuals according to predetermined criteria and monitored them at two consecutive time points, i.e., at inclusion and six months post-treatment modification.…”

“…In this regard, controversy exists over the relationship between anxiety and depression and SLE disease activity. Thus, active lupus (quantified for example, with the SLE Disease Activity Index [SLEDAI]), especially from the mucocutaneous and musculoskeletal domains, has been correlated with increased depression and anxiety symptoms in some [ 14 , 17 , 18 , 19 ]—but not all [ 15 , 20 , 21 , 22 , 23 ]—studies. Likewise, a connection between inflammatory mediators such as lupus autoantibodies and mood disorders has not been consistently shown (reviewed in [ 24 ]).…”

Differential impact of disease activity and damage on health-related quality of life in patients with systemic lupus erythematosus

“…1,2 Particularly, pain, fatigue, dissatisfaction with body image and poor social support are strongly associated with depressive symptoms in patients with SLE. 3 Unfortunately, not all disease-related factors that impair HRQoL can be directly addressed with better SLE treatment, since pharmacotherapy cannot reverse disease-related organ damage nor directly improve fatigue or body image. Therefore, there is a need to comprehensively study HRQoL in SLE in order to improve patient care via strategic and possibly non-pharmacologic interventions.…”