A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus

Jiafen Liao, Jin Kang, Fen Li, Qi Li, Jia Wang, Qi Tang, Ni Mao, Shu Li, Xi Xie, Jiafen Liao, Jin Kang, Fen Li, Qi Li, Jia Wang, Qi Tang, Ni Mao, Shu Li, Xi Xie

Abstract

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects multiple systems and increases the risk of mental disorders such as depression and anxiety. We conducted an observational, single-center, cross-sectional study to investigate the relationship between depression, anxiety, and SLE disease activity.

Methods: The Patient Health Questionnaire 9 (PHQ-9) was used to assess depression, and the 7-item Generalized Anxiety Disorders Scale was used to assess anxiety (GAD-7). Using the chi-square/exact Fisher's tests, socio-demographic data, clinical and other characteristics of SLE patients were compared between depression or anxiety and non-depression/non-anxiety groups. To identify optimal levels of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for predicting depression or anxiety, receiver-operator curves (ROC) were drawn.

Results: Among the 325 patients involved in this study, patients with depression or anxiety had significantly higher SLE activity (p < 0.001), and more frequent musculoskeletal (p < 0.05) and neuropsychiatric symptoms (p < 0.05). Depression and anxiety are more common in the moderate-severe active group than in the inactive-mild active group (depression: OR 3.350, 95%CI 2.015, 5.570, p < 0.001; anxiety: OR 4.085, 95%CI 2.493, 6.692, p < 0.001). The optimal SLEDAI cutoff value of 8.5 predicted depression with a sensitivity of 50.5% and a specificity of 78.4% (AUC 0.660, p < 0.001) and anxiety with a sensitivity of 54.2% and a specificity of 78.4% (AUC 0.684, p < 0.001).

Conclusion: SLE disease activity is positively associated with the severity of depression and anxiety. Those patients whose SLEDAI scores are greater than 8.5 are more likely to suffer from mental disorders which require additional attention to them.

Keywords: Anxiety; Depression; Disease activity; SLEDAI; Systemic lupus erythematosus.

Conflict of interest statement

The authors declare that there are no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The relationship between SLEDAI and depression or anxiety. 1A. The relationship between SLEDAI and depression; 1B. The relationship between SLEDAI and anxiety
Fig. 2
Fig. 2
Receiver-operating characteristic (ROC) curve for SLEDAI in the diagnosis of depression or anxiety. ROC curve for SLEDAI in the diagnosis of mild/moderate/severe depression is shown in Fig. 2A, 2B, and 2C, respectively. ROC curves for SLEDAI in the diagnosis of mild/moderate/severe anxiety are shown in Fig. 2D, 2E, and 2F, respectively

References

    1. Moustafa AT, Moazzami M, Engel L, Bangert E, Hassanein M, Marzouk S, et al. Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum. 2020;50(1):84–94. doi: 10.1016/j.semarthrit.2019.06.017.
    1. Du X, Chen H, Zhuang Y, Zhao Q, Shen B. Medication adherence in chinese patients with systemic lupus erythematosus. J Clin Rheumatol. 2020;26(3):94–98. doi: 10.1097/RHU.0000000000000952.
    1. Jordan J, Thompson NJ, Dunlop-Thomas C, Lim SS, Drenkard C. Relationships among organ damage, social support, and depression in African American women with systemic lupus erythematosus. Lupus. 2019;28(2):253–260. doi: 10.1177/0961203318815573.
    1. Yilmaz-Oner SOC, Dogukan FM, Moses TF, Demir K, Tekayev N, et al. Anxiety and depression predict quality of life in Turkish patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2015;33(3):360–365.
    1. Khedr EM, Gamal RM, Rashad SM, Yacoub M, Ahmed GK. Impact of depression on quality of life in systemic lupus erythematosus patients. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):88. doi: 10.1186/s41983-021-00343-y.
    1. Fernandez H, Cevallos A, Jimbo Sotomayor R, Naranjo-Saltos F, Mera Orces D, Basantes E. Mental disorders in systemic lupus erythematosus: a cohort study. Rheumatol Int. 2019;39(10):1689–1695. doi: 10.1007/s00296-019-04423-4.
    1. Dafna D Gladman DIaMBU. Systemic Lupus Erythematosus Disease Activity Index 2000. The Journal of Rheumatology. 2002;29(2):288–91.
    1. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266–274. doi: 10.1097/MLR.0b013e318160d093.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Mok CC, Chan KL, Ho LY. Association of depressive/anxiety symptoms with quality of life and work ability in patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2016;34(3):389–395.
    1. Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev. 2019;15(2):90–98. doi: 10.2174/1573397114666180926101513.
    1. Figueiredo-Braga M, Cornaby C, Cortez A, Bernardes M, Terroso G, Figueiredo M, et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Medicine (Baltimore) 2018;97(28):e11376. doi: 10.1097/MD.0000000000011376.
    1. Yin R, Li L, Xu L, Sui W, Niu M, Xu R, et al. Association between depression and sleep quality in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Sleep Breath. 2021.
    1. Parperis K, Psarelis S, Chatzittofis A, Michaelides M, Nikiforou D, Antoniade E, et al. Association of clinical characteristics, disease activity and health-related quality of life in SLE patients with major depressive disorder. Rheumatology (Oxford). 2021.
    1. Monahan RC, Beaart-van de Voorde LJ, Eikenboom J, Fronczek R, Kloppenburg M, Middelkoop HA, et al. Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity. Lupus. 2021;30(7):1124–32. doi: 10.1177/09612033211005014.
    1. Miyawaki Y, Shimizu S, Ogawa Y, Sada KE, Katayama Y, Asano Y, et al. Association of glucocorticoid doses and emotional health in lupus low disease activity state (LLDAS): a cross-sectional study. Arthritis Res Ther. 2021;23(1):79. doi: 10.1186/s13075-021-02466-2.
    1. Eldeiry D, Zandy M, Tayer-Shifman OE, Kwan A, Marzouk S, Su J, et al. Association between depression and anxiety with skin and musculoskeletal clinical phenotypes in systemic lupus erythematosus. Rheumatology (Oxford) 2020;59(11):3211–3220. doi: 10.1093/rheumatology/keaa098.
    1. Nery FG, Borba EF, Hatch JP, Soares JC, Bonfá E, Neto FL. Major depressive disorder and disease activity in systemic lupus erythematosus. Compr Psychiatry. 2007;48(1):14–19. doi: 10.1016/j.comppsych.2006.04.002.
    1. Tay SH, Cheung PP, Mak A. Active disease is independently associated with more severe anxiety rather than depressive symptoms in patients with systemic lupus erythematosus. Lupus. 2015;24(13):1392–1399. doi: 10.1177/0961203315591026.
    1. Mak A, Tang CS, Chan MF, Cheak AA, Ho RC. Damage accrual, cumulative glucocorticoid dose and depression predict anxiety in patients with systemic lupus erythematosus. Clin Rheumatol. 2011;30(6):795–803. doi: 10.1007/s10067-010-1651-8.
    1. Jarpa E, Babul M, Calderón J, González M, Martínez ME, Bravo-Zehnder M, et al. Common mental disorders and psychological distress in systemic lupus erythematosus are not associated with disease activity. Lupus. 2011;20(1):58–66. doi: 10.1177/0961203310381773.
    1. Tisseverasinghe A, Peschken C, Hitchon C. Anxiety and Mood Disorders in Systemic Lupus Erythematosus: Current Insights and Future Directions. Curr Rheumatol Rep. 2018;20(12):85. doi: 10.1007/s11926-018-0797-2.

Source: PubMed

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