Background/Purpose:  Depression is commonly reported in systemic lupus erythematosus (SLE), yet information is lacking about long-term patterns of depression.  In particular, because depression is thought to arise at least partially from disease-specfiic sources, information regarding predictors of persistent depression is needed.  We examined a longitudinal SLE cohort to identify factors that predicted persistent depression vs. remission. 

Methods:   Data derive from the UCSF Lupus Outcomes Study (LOS), in which participants with confirmed SLE are interviewed by phone annually.  During each interview, the Center for Epidemiologic Studies Depression scale (CESD) is administered.  We defined depression using a lupus-specific cut-point of 20 (1).  Individuals who were depressed by this criterion at the initial interview were followed through subsequent interview waves.  Those whose CESD score remained ≥ 17 (within 0.5 SD of the cut-point) were classified as having persistent depression.  Those whose CESD score dropped below 17 were classified as remitting.  We then used bivariate and multivariate analyses to define baseline factors associated with persistent depression.  Variables examined were sociodemographics (age, sex, education, income), SLE duration, self-rated disease activity (on 0-10 scale), history of cardiovascular events (previous MI or stroke), history of other vascular events (e.g., DVT, PE, or other clot), obesity based on body mass index (BMI≥30), current smoking, and current reported use of antidepressants.  Analyses controlled for the number of interviews contributed by each individuals.  Individuals who were interviewed at least three times were included in the analysis.

Results:   Of 1008 individuals in the analysis sample, 340 were depressed at their initial interview.  Among these, 135 (40%) remained depressed through all remaining observations.  Factors significantly associated with persistent depression in bivariate analyses were:  low education, income below poverty, higher self-rated disease activity, current smoking, history of vascular events other than MI or stroke, obesity, and current use of depression medication (Table).  In multivariate analyses, low education, history of other vascular events, obesity, and current use of depression medication were independently associated with persistent depression.

Table. Factors associated with persistent depression in bivariate and multivariate analyses
	Bivariate analyses		Multivariate analysis†
	Remission (n = 205)	Persistent depression (n = 135)	OR (95% CI)
Sociodemographic      Age (mean±SD)	45 ± 13 yrs	47 ± 10 yrs	1.01 (0.98, 1.03)
Female	94%	94%	1.52 (0.44, 5.30)
Education ≤ high school	18%	36%*	2.16 (1.17, 3.99)
Income below poverty	17%	32%*	1.60 (0.84, 3.05)
Health characteristics      SLE duration (mean±SD)	12 ± 10 yrs	12 ± 10 yrs	0.98 (0.94, 1.02)
SLE disease activity (mean±SD)	5 ± 3	6 ± 3*	1.07 (0.97, 1.18)
Current smoking	8%	20%*	1.37 (0.60, 3.14)
History of MI or stroke	10%	14%	1.63 (0.73, 3.66)
History of other vascular event	15%	27%*	2.25 (1.14, 4.43)
Obese (BMI ≥ 30)	27%	42%*	1.87 (1.07, 3.26)
Taking antidepressants	42%	48%*	2.02 (1.12, 3.66)
* p<.01 † Multivariate model included all variables shown plus number of interviews contributed

Conclusion:   Forty percent of women who met the depression criterion initially were persistently depressed. Results suggest that obesity and vascular factors may play a role in persistent depression in SLE, and that such depression may be resistant to treatment.  Further study is needed to identify mechanisms for those associations.

(1) Julian L, et al. Using the CES-D to screen for depression in SLE.  Arthritis Care Res 2011; 63:884-890

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/obesity-and-vascular-factors-may-play-a-role-in-persistent-depression-among-individuals-with-systemic-lupus-erythematosus/