Background/Purpose: The objectives of this study were to estimate prevalence of depression and medication non-adherence, describe demographic and disease characteristics associated with depression and medication non-adherence, and evaluate the association between depression and medication non-adherence among patients with childhood-onset systemic lupus erythematosus (cSLE).

Methods: Participants (n = 51) completed validated screening tools to identify depression and medication non-adherence, Patient Health Questionnaire-9 (PHQ-9) and Medication Adherence Self-report Inventory (MASRI), respectively. Eligibility criteria included a diagnosis of cSLE confirmed using the American College and Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria, presence of prescribed medication for management of SLE for at least 1 month, and ability to complete the consent form and study questionnaires in English. Demographic and disease characteristics for each enrolled participant were obtained via chart abstraction and compared between groups of depression and medication non-adherence. A multivariable linear regression model adjusting for propensity scores was conducted to evaluate the association between depression and medication non-adherence.

Results: The prevalence of a positive depression screen was 58.8% and four patients reported suicidal ideation (13.7%). The prevalence of self-reported medication non-adherence was 19.7%.  There were no statistically significant differences for measured demographic and disease characteristics between patients with a positive vs. negative depression screen. Patients reporting medication non-adherence were more likely to have longer disease duration (2.6 vs. 4.8 years, p = 0.035). As the severity of depression symptoms increased, the degree of medication non-adherence also increased (β = -1.89; p = 0.011). 

Conclusion: The prevalence of depression and medication non-adherence is high in cSLE, and these two factors are directly related.  Prospective, multi-center studies are needed to better characterize the relationship between depression and medication non-adherence to inform development of interventions that address these factors and improve outcomes in cSLE.