Background/Purpose: African American (AA) people with Systemic Lupus Erythematosus (SLE) are at high risk for severe disease and depression, and often require complex medication regimes. Prior data suggest that AA patients with SLE have poor medication adherence; however little is known about the leading patient-centered factors. We sought to examine the effect of depression, medication satisfaction, and self-confidence to manage lupus on treatment adherence in an AA population with SLE.  

Methods: The Georgians Organized Against Lupus (GOAL) is a longitudinal cohort of patients with SLE living in Atlanta, predominantly derived from the population-based Georgia Lupus Registry. Since 2011, participants are surveyed annually on multiple exposures and outcomes. For this study, we selected all AA participants who completed the Morisky Medication Adherence Scale (MMAS-8) in 2015. MMAS-8 scores range from 0-8 and a cutpoint <6 has been validated as indicator of low adherence. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9) and categorized as minimal, mild/moderate, and moderately severe/severe depressive symptoms using clinically validated cutpoints. Self-confidence was assessed with the Stanford Self-efficacy 6-item Scale, and medication satisfaction with an ad-hoc 4-point Likert scale question (How satisfied are you with your current lupus medication options?). The association between patient centered-factors and low adherence (MMAS-8 <6) were examined with multiple logistic regression. Self-reported disease activity, organ damage, and demographic factors were tested as covariates.  

Results: We examined 632 AA participants (93% females; 44% living below the poverty level; 43% under- or uninsured). Mean age, disease duration and education at survey were 48, 15 and 14 years, respectively. Mild to severe depressive symptoms were endorsed by 392 (63%) and low adherence by 329 (54%) participants. Multivariate analysis revealed that the odds of low adherence were significantly higher in those with mild/moderate (OR= 2.3) and moderately severe/severe (OR= 2.4) depressive symptoms, compared to those with none/minimal symptoms.  While women and younger participants were more likely to be low-adherent, disease activity, organ damage and other patient-centered factors were not associated with treatment adherence.

Conclusion: Over half of AA patients with SLE are low adherent to their medications, and over 60% have depressive symptoms ranging from mild to severe. Women, those of younger age, and those with depressive symptoms are at high risk of low adherence. Notably, satisfaction with treatment and self-confidence were not associated with adherence. Our findings point to the need for wide-scale depression screening and effective depression management interventions as means to potentially improve treatment adherence in AA populations with SLE.