Session Information
Date: Sunday, November 8, 2015
Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster I: Lupus, Scleroderma, JDMS
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Neuropsychiatric syndromes are prevalent in childhood-onset systemic lupus erythematosus (cSLE), but the long-term risk of depression in adults with cSLE is unknown. We compared the prevalence of depression among adults with cSLE to those with adult-onset SLE (aSLE) using the UCSF Lupus Outcomes Study (LOS).
Methods:
Data derive from the 2002-2012 cycles of the LOS, an annual longitudinal telephone survey of diverse English-speaking individuals with confirmed SLE. Participants aged 18-45 years (N=520) were included. Respondents were classified as childhood-onset if age at diagnosis was <18 years (N=112). Mental health was assessed with the Center for Epidemiological Studies Depression Scale (CESD), the ACR Committee on Neuropsychiatric Lupus’ suggested measure of depression in SLE, using validated cutoff values. Outcome variables included CESD≥24 (indicative of major depression) and CESD≥20 (indicative of a mood disorder). We performed repeated measures analysis using generalized estimating equations to compare cSLE and aSLE with and without adjustment for other characteristics that could affect depression risk. Age, gender, non-white ethnicity, marital status, poverty, education attained, obesity, self-reported disease activity according to the Systemic Lupus Activity Questionnaire (SLAQ) score, and physical disability according to the SF-36 Scale of Physical Function (SF36-PF) were included as covariates.
Results:
Respondents with cSLE were younger at baseline (26±7 v. 35±6), more likely to be male (13% v. 5%), and more likely to be ethnic minorities (60% v. 46%), all p<0.01. Mean age at diagnosis was 14±3 for respondents with cSLE as compared to 27±6 for those with aSLE. Mean disease duration at baseline was 13±7 years in the cSLE group and 8±6 years in the aSLE group. Mean baseline SLAQ score was 12±8 for all respondents. Prevalence of depressed mood at baseline was slightly higher among respondents with aSLE, though not statistically significant (23% vs. 29% for major depression and 31% vs. 35% for all mood disorders). Respondents with aSLE were more likely to have ever taken medication to treat depression (59% vs. 43%, p=0.01). In multivariate analysis, the odds of major depression among participants with cSLE was increased as compared to those with aSLE (OR=1.7, 95% CI 1.1-2.6) after adjustment for covariates (Table 1).
Conclusion:
Onset of SLE in childhood may be an independent risk factor for the development of major depression in early adulthood, with other important predictors including older age, lower educational attainment, increased disease activity and decreased physical function. Appropriate screening and treatment for depression is important to maximize long-term quality of life and functional outcomes in patients with cSLE.
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Table 1. Adjusted and unadjusted odds ratios for the presence of major depression among individuals age 18-45 with SLE* |
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Variable |
Unadjusted OR for major depression (95% CI) |
Adjusted OR for major depression (95% CI)†
|
|
Childhood-onset SLE |
0.8 (0.5-1.1) |
1.7 (1.1-2.6) |
|
Age |
1.02 (1.00-1.03) |
1.04 (1.01-1.06) |
|
Female |
1.8 (0.9-3.8) |
1.1 (0.5-2.1) |
|
Non-white ethnicity |
1.2 (0.9-1.7) |
1.2 (0.9-1.7) |
|
Unmarried |
1.1 (1.0-1.4) |
1.2 (0.9-1.5) |
|
Poverty¶ |
1.8 (1.4-2.3) |
1.1 (0.8-1.6) |
|
Education# |
3.3 (2.5-4.2) |
2.1 (1.5-2.9) |
|
Obesity% |
1.3 (1.0-1.7) |
1.0 (0.7-1.3) |
|
Increasing disease activity (SLAQ) |
1.14 (1.12-1.16) |
1.11 (1.08-1.14) |
|
Decreasing physical function (SF36-PF) |
1.06 (1.05-1.07) |
1.02 (1.01-1.04) |
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*OR = odds ratio; 95% CI = 95% confidence interval; SLAQ = Systemic Lupus Activity Questionnaire (0-47); SF36-PF = SF-36 Scale of Physical Functioning (0-100) † OR adjusted for variables shown ¶ Income below 125% of the Federal poverty level # Less than a bachelor’s degree attained % BMI ≥ 30 |
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To cite this abstract in AMA style:
Lawson EF, Knight A, Trupin L, Katz PP, Yelin EH. Depression Risk Among Adults with Childhood- and Adult-Onset Systemic Lupus Erythematosus: 11 Years of Follow-up [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/depression-risk-among-adults-with-childhood-and-adult-onset-systemic-lupus-erythematosus-11-years-of-follow-up/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-risk-among-adults-with-childhood-and-adult-onset-systemic-lupus-erythematosus-11-years-of-follow-up/