Background/Purpose: While mood disorder, most commonly manifesting as depression and anxiety symptoms, is often reported in pediatric lupus patients, prevalence rates vary widely. Many published studies did not use validated tools to systematically screen cohorts. Furthermore, although mood disorders occur more frequently in urban, minority, low-income individuals, little is known about the prevalence of mood disorder in pediatric SLE patients from these populations.

Methods: We screened patients for mood disorder who were between the ages of 10-21 and enrolled in the Einstein Lupus Cohort. Patients met the ACR 1997 revised SLE criteria or SLICC 2012 SLE criteria, and were recruited from pediatric rheumatology clinics in Bronx, NY. To screen for mood disorder we used the Patient Health Qustionaire-9 (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7), validated screening tools for depressive symptoms and anxiety symptoms, respectively, in patients ≥10 years of age.

Results: Forty-two patients were screened over a 9 month period with follow up screens on 24 patients (57%) at subsequent visits. The cohort was 83% female, 52% Hispanic, and 40% black. The median age of patients at their baseline screens was 18.4 (IQR 15.3, 19.7). Medicaid-covered patients comprised 79% of the cohort. The median SLEDAI score at baseline was 4 (IQR 2, 8) and 17% of patients had a previous history of neuropsychiatric SLE (NPSLE). The median baseline PHQ-9 score was 5 (IQR 3, 8) and the median baseline GAD-7 score was 3 (IQR 1, 7). Twenty-one percent of patients screened positive for depression at baseline, including 7% who had suicidal ideation or thoughts of self-harm, while 19% screened positive for anxiety. The most commonly endorsed depressive symptoms on baseline and follow-up screens were fatigue (79% of screens), difficulty sleeping (69%), anhedonia (63%), and changes in appetite (55%). The most commonly endorsed anxiety symptoms were irritability (70%) and excessive worrying (67%). Neither PHQ-9 nor GAD-7 scores correlated with SLEDAI or age of patient. From baseline to first follow-up visit, 54% of patients had worsening PHQ-9 scores; whereas 65% of patients had improved or stable GAD-7 scores from baseline to the next screens (Table 1). No significant differences were seen between scores based on sex, race/ethnicity, or history of NPSLE. 

Conclusion: Depressive and anxiety symptoms are prevalent in a pediatric SLE cohort with high disease activity from an urban, primarily minority, and low-income cohort. Suicidal ideation and thoughts of self-harm were also not uncommon. Mood disorder symptoms did not correlate with disease activity, and were not associated with a NPSLE history. The high prevalence of mood disorder in this pediatric SLE cohort, if corroborated in other cohorts, may indicate that systematic screening for mood disorder in pediatric lupus patients should become standard of care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mood-disorder-is-highly-prevalent-in-a-multi-ethnic-urban-pediatric-lupus-cohort/