Background/Purpose:  Depression is commonly reported in systemic lupus erythematosus (SLE), yet information is lacking about long-term patterns of depression.  We examined a longitudinal SLE cohort to identify the proportions of individuals who were depressed at least once and who were persistently depressed over the 9-year observation period.

Methods:   Data derive from the UCSF Lupus Outcomes Study (LOS), in which participants are interviewed by phone annually.  Participants are recruited from medical and community settings, and all have confirmed SLE diagnoses. During each interview, the Center for Epidemiologic Studies Depression scale (CESD) is administered.  We defined depression using two lupus-specific cut-points – a score of 20 was used to approximate any mood disorder, and a score of 24 to define probable major depressive disorder (MDD) (1) – and conducted separate analyses for each.  Once individuals met a depression criterion, their CESD score was considered elevated until it dropped below the cut-point by 3 points (i.e., 0.5 standard deviation). Those whose CESD score remained within 0.5 SD of the cut-point (i.e., ≥ 17 for mood disorder, ≥21 for MDD) were classified as remaining depressed.  Those whose CESD score dropped below 17 (or 21) were classified as remitting.  In order to determine longitudinal patterns of depression, we included only individuals who had completed at least three annual interviews.

Results:  Of 1008 individuals who participated in at least 3 annual interviews, mean age was 46 (± 13) years, 92% were female, and mean SLE duration was 12 (±9) years.  340 (34%) met the criterion for mood disorder and 256 (25%) met the criterion for MDD at the first interview.  Among those who met the mood disorder criterion, 135 remained in this classification.  An additional 220 individuals met the mood disorder criterion in a later interview; 44 of them remained in this classification once they met the criterion.  In total, 560 (56%) were classified with a mood disorder in at least one interview, and179 (18%) were persistent in this classification once reaching it (Table).  For MDD, 47% met the criterion in at least one interview, and 13% were persistent.

Table.  Prevalence of mood disorder and major depressive disorder over time
	CESD ≥ 20: Any mood disorder % (n)	CESD ≥ 24: Major depressive disorder % (n)
Never depressed	44% (448)	53% (531)
Depressed at ≥1 interview	56% (560)	47% (477)
Remained depressed once meeting criterion	18% (179)	13% (128)
Depressed at all interviews	13% (135)	9%(89)

Conclusion:   In this large cohort of individuals with lupus, over half met the criterion for a mood disorder and just under half met the criterion for major depressive disorder in at least one interview.  Thirteen percent and 9% met these criteria in all interviews; 18% and 13% were persistently depressed once meeting the mood disorder or MDD criterion, respectively.  Results underscore the high prevalence of depressive disorders in lupus, the persistence of such disorders in a sizable group of individuals, and the need for effective prevention and treatments.

(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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